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Six factors that drive a multiple sclerosis patient's choice of disease-modifying therapy

MS advocate Trishna Bharadia explains the numerous factors that lead patients to choose a disease-modifying therapy, including the important considerations healthcare professionals and pharma often forget.

MS advocate Trishna Bharadia explains the numerous factors that lead patients to choose a disease-modifying therapy, including the important considerations healthcare professionals and pharma often forget​.

When I was diagnosed with relapsing multiple sclerosis (RMS) in 2008, the landscape for disease-modifying therapies (DMTs) looked very different from now. There were five DMTs available on the NHS for RMS and nothing for people with progressive MS. At the start of 2019, options are very different. There are 14 DMTs available for people with RMS and some for people with progressive MS who still experience relapses. There is also optimism that soon DMTs will become widely available for people with progressive MS, evidenced by the current pipeline and the funding and attention being given to this area.

A misconception I often encounter from pharma is that choosing a DMT is black and white with the only considerations being efficacy and side effects. This isn’t true. With the landscape changing so rapidly, patients with MS face more choices and increasingly complex decisions about treatment. As a result, it’s important for clinicians, pharma and regulators to understand some of the factors that can influence decisions about whether to take a DMT (or not) and why one may be chosen over another.

With the landscape changing so rapidly, patients with MS face more choices and increasingly complex decisions about treatment. As a result, it's important for clinicians, pharma and regulators to understand some of the factors that can influence decisions about whether to take a DMT (or not) and why one may be chosen over another.

1. ELIGIBILITY AND AVAILABILITY

There are stricter criteria for some DMTs and some are more easily available in certain geographic areas, either due to funding or resources. For example, some hospitals have longer waiting lists for infusion drugs because they don’t have sufficient nurses or physical capacity to administer them. However, if a patient is willing and able, they might decide to travel further to get the DMT they want.

2. EFFICACY

Efficacy is an obvious influencing factor. However, the way that patients’ view this can sometimes differ from the way clinicians’, pharma and regulators’ view it. The 2017 ‘Missing Pieces report’ by Sanofi showed 65% of people with MS valued maintaining independence and described it as their main treatment goal, with reducing relapses coming second to that. In addition, 54% said they were worried and 45% said they were scared of possibly becoming disabled, indicating that quality of life is a key outcome measure for patients. Despite this, the report also showed that just half of those surveyed said disability was discussed with their HCP at diagnosis.

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22nd March 2019

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