PND120 - TREATMENT DECISIONS ABOUT FIRST-LINE DISEASE-MODIFYING TREATMENTS (DMTS) IN RELAPSING REMITTING MULTIPLE SCLEROSIS: A SYSTEMATIC REVIEW OF PATIENT NEEDS AND PREFERENCES

Abstract

Multiple first-line disease modifying treatments (DMTs) are currently available for patients with relapsing-remitting multiple sclerosis (RRMS). However, many patients have difficulty choosing amongst them and adhering to their regimen. This systematic review examined what has been published about the needs and preferences of RRMS patients when making treatment decisions. A systematic search was done using Embase, Medline, PsychINFO, Web of Science and Google Scholar. Eligibility criteria included whether the article described a study of adult patients with RRMS (or clinically isolated syndrome, CIS) and reported patient needs or preferences regarding decisions about first-line DMTs. Eligible publications were categorized by treatment decision: initiation of first DMT (D1), DMT adherence/discontinuation (D2a/D2b), and switch to a second DMT (D3). A separate category was created for studies like discrete choice experiments (DCEs) that examine the relative importance of different treatment attributes. Publications in each category were compared to identify patterns and inconsistencies. The search yielded 2310 articles after removal of duplicates and 318 full-text publications were reviewed for eligibility. Fifteen articles fulfilled all criteria: n=3 (D1), n=9 (D2a), n=8 (D2b), and n=2 (D3); five articles studied more than one treatment decision. Of the three D1 studies, the only recent one was a qualitative study of 10 patients. In the D2a/D2b studies, the most common reasons for adherence/discontinuation included forgetfulness, side-effects, and injection-related reasons. Eight articles described DCEs; the most important attributes in these DCEs were DMT efficacy, mode and frequency of administration, and side-effect profile. Given the different DMT treatments now available, it is important to have a better understanding about the preferences of RRMS patients, since this would help to improve decision-making and could improve adherence and health outcomes. However, there are no recent studies of preferences relating to treatment initiation; most studies have focused on treatment discontinuation/adherence.