Highlights
- •Patients’ preferences should be considered in RRMS treatment decisions.
- •We aimed to understand factors driving status quo bias in early-stage RRMS patients.
- •Over forty percent of patients suffer cognitive delays in the early stages of RRMS.
- •Despite evidence of disease progression, patients tend to maintain their treatment.
- •Disease severity perception and cognitive delays affect patients’ treatment choices.
Abstract
Background
The evolving therapeutic landscape requires more participation of patients with relapsing
remitting multiple sclerosis (RRMS) in treatment decisions. The aim of this study
was to assess the association between patient's self-perception, cognitive impairment
and behavioral factors in treatment choices in a cohort of patients at an early stage
of RRMS.
Methods
We conducted a multicenter, non-interventional study including adult patients with
a diagnosis of RRMS, a disease duration ≤18 months and receiving care at one of the
21 participating MS centers from across Spain. We used patient-reported measures to
gather information on fatigue, mood, quality of life, and perception of severity of
their MS. Functional metrics (Expanded Disability Status Scale [EDSS], cognitive function
by the Symbol Digit Modalities Test [SDMT], 25-foot walk test) and clinical and radiological
data were provided by the treating neurologist. The primary outcome of the study was
status quo (SQ) bias, defined as participant's tendency to continue taking a previously
selected but inferior treatment when intensification was warranted. SQ bias was assessed
based on participants treatment preference in six simulated RRMS case scenarios with
evidence of clinical relapses and radiological disease progression.
Results
Of 189 participants who met the inclusion criteria, 188 (99.5%) fully completed the
study. The mean age was 36.6 ± 9.5 years, 70.7% female, mean disease duration: 1.2 ± 0.8
years, median EDSS score: 1.0 [IQR=0.0–2.0]). Overall, 43.1% patients (n = 81/188) had an abnormal SDMT (≤49 correct answers). SQ bias was observed in at
least one case scenario in 72.3% (137/188). Participant's perception of their MS severity
was associated with higher SQ bias (β coeff 0.042; 95% CI 0.0074–0.076) among those
with delayed cognitive processing. Higher baseline EDSS and number of T2 lesions were
predictors of delayed processing speed (OR EDSS=1.57, 95% CI: 1.11–2.21, p = 0.011; OR T2 lesions=1.50, 95% CI: 1.11–2.03, p<0.01). Bayesian multilevel model accounting for clustering showed that delayed cognitive
processing (exp coeff 1.06; 95% CI 1.04–1.09) and MS symptoms severity (exp coeff
1.28; 95% CI 1.22–1.33) were associated with SQ bias.
Conclusion
Over 40% of patients in earlier stages of RRMS experience delays in cognitive processing
that might affect their decision-making ability. Our findings suggest that patients'
self-perception of disease severity combined with a delay in cognitive processing
would affect treatment choices leading to status quo bias early in the course of their
disease.
Keywords
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Article info
Publication history
Published online: August 20, 2022
Accepted:
August 19,
2022
Received in revised form:
July 27,
2022
Received:
April 8,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
