Original article| Volume 39, 101887, April 2020

Factors associated with therapeutic inertia among pharmacists caring for people with multiple sclerosis

Published:December 09, 2019DOI:


      • Therapeutic inertia is a well-known phenomenon in multiple sclerosis that may lead to poorer clinical outcomes, including greater disability and lower quality of life.
      • Pharmacists are increasingly playing a critical role in the multidisciplinary management of multiple sclerosis. In this study using a behavioral economics approach, all pharmacists failed to recommend treatment escalation despite clinical and radiological evidence of a suboptimal disease activity control.
      • Specialization in MS, more years of experience in dispensing disease-modifying therapies, and being a co-author of a peer-reviewed publication were associated with a lower likelihood of therapeutic inertia among pharmacists. Tolerance to uncertainty and willingness to take risks in different domains were not associated with TI.



      Pharmacists play a critical role on therapeutic decisions in multiple sclerosis (MS) care. Therapeutic inertia (TI) is defined as the lack of treatment initiation or escalation when there was evidence of clinical and radiological disease activity. The aim of this study was to assess factors associated with TI among pharmacists involved in MS care.


      A multicenter, non-interventional, cross-sectional study involving hospital pharmacists in Spain was conducted. Participants answered questions regarding their standard practice, risk preferences, and management of nine simulated MS case-scenarios. We created a score defined as the number of case-scenarios that fit the TI criteria over the total number of presented cases (score range from 0–6). Similarly, an optimal treatment score (OTS) was created to determine the degree of appropriate pharmacological decisions (ranging from 0-lowest to 9-highest). Candidate predictors of TI included demographic data, practice setting, years of practice, MS expertise, number of MS patients managed at hospital/year, participation in MS clinical trials, and participants’ risk preferences.


      Overall, 65 pharmacists initiated and completed the study (response rate: 45.5%). The mean age was 43.5 ± 7.8 years and 67.1% were female. Forty-two (64.6%) participants had specialization in MS management. Overall, the mean TI score was 3.4 ± 1.1. Of 390 individual responses, 224 (57.4%) met the TI criteria. All participants failed to recommend treatment escalation in at least one of the six case-scenarios. The mean OTS was 4.1 ± 1.4. Of 585 individual responses, 264 (45.1%) met the optimal choice criteria. Only 40% of participants (23/65) made five or more optimal treatment choices. Lower experience in dispensing MS drugs and lack of specialization in MS were the most common factors associated with TI and optimal management. The multivariable analysis revealed that more years of experience (p = 0.03), being a co-author of a peer-reviewed publication (p = 0.03), and specialization in MS (p = 0.017) were associated with lower TI scores (adjusted R2 = 0.23).


      Therapeutic inertia was observed in all pharmacist participants, affecting over fifty percent of MS treatment choices. Continuing education and specialization in MS may facilitate therapeutic decisions in MS care.


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