Contributions
Abstract: EP1750
Type: ePoster
Abstract Category: Therapy - disease modifying - 29 Risk management for disease modifying treatments
Introduction: The current treatment landscape in multiple sclerosis (MS) includes the acceptance of potential risks of lymphopenia and elevated liver transaminases with some disease-modifying therapies. Physicians' tolerance to risk is a new paradigm that may influence therapeutic decisions under uncertainty in MS care.
Objectives: To assess physicians' tolerance to three specific therapeutic decisions under uncertainty: i) risk of lymphopenia, 2) risk of elevated liver transaminases, 3) willingness to discontinue treatment for patients who remained stable (neither clinical nor radiological activity) over 10 years.
Design: Overall, 25 neurologists completed a survey regarding the optimal management of 20 simulated case-scenarios, their willingness to accept risks of lymphopenia and elevated transaminases for effective MS therapies, and treatment discontinuation for longstanding stable patients. We used the 'physicians reaction to uncertainty', a validated scale to assess neurologists' tolerance to uncertainty.
Results: Overall, 60% of participants had low tolerance to uncertainty (mean score 22.5+/-7.9). Participants were more likely to accept a 10% risk of lymphopenia (mean score 86.4+/-11.1%) compared to the risk of elevated transaminases (mean 28.8 +/-19) (p< 0.0001). Most of participants were not willing to stop MS treatment even when simulated-cases were stable for over 10 years (mean score 21.2+/-23.1). Multivariable analysis revealed that women neurologists were less likely to accept the risks associated with elevated transaminases (p=0.024) and treatment discontinuation (p=0.005) despite having similar tolerance to uncertainty score compared to men.
Conclusions: Neurologists caring for MS patients have low tolerance to the risks of transaminitis and are not willing to accept treatment discontinuation for longstanding stable patients.
Disclosure: The study was sponsored by the Sociedad Española de Neurologia (SEN) and funded by Roche Farma Spain.
Gustavo Saposnik is supported by the Distinguished Clinicians Scientist Award from HSFC. Xavier Montalban has received honoraria for speaking and travel expenses to scientific meetings; was a steering member or participated in advisory boards in corporate-sponsored clinical trials or has had consulting agreements with Bayer Schering Pharma, Biogen, EMD Merck Serono, Roche, Genzyme, Novartis, Sanofi-Aventis, and Teva Pharmaceutical Industries Ltd.
Jorge Maurino is an employee of Roche Farma Spain.
Angel Perez Sempere and Maria Terzaghi: nothing to disclose.
Abstract: EP1750
Type: ePoster
Abstract Category: Therapy - disease modifying - 29 Risk management for disease modifying treatments
Introduction: The current treatment landscape in multiple sclerosis (MS) includes the acceptance of potential risks of lymphopenia and elevated liver transaminases with some disease-modifying therapies. Physicians' tolerance to risk is a new paradigm that may influence therapeutic decisions under uncertainty in MS care.
Objectives: To assess physicians' tolerance to three specific therapeutic decisions under uncertainty: i) risk of lymphopenia, 2) risk of elevated liver transaminases, 3) willingness to discontinue treatment for patients who remained stable (neither clinical nor radiological activity) over 10 years.
Design: Overall, 25 neurologists completed a survey regarding the optimal management of 20 simulated case-scenarios, their willingness to accept risks of lymphopenia and elevated transaminases for effective MS therapies, and treatment discontinuation for longstanding stable patients. We used the 'physicians reaction to uncertainty', a validated scale to assess neurologists' tolerance to uncertainty.
Results: Overall, 60% of participants had low tolerance to uncertainty (mean score 22.5+/-7.9). Participants were more likely to accept a 10% risk of lymphopenia (mean score 86.4+/-11.1%) compared to the risk of elevated transaminases (mean 28.8 +/-19) (p< 0.0001). Most of participants were not willing to stop MS treatment even when simulated-cases were stable for over 10 years (mean score 21.2+/-23.1). Multivariable analysis revealed that women neurologists were less likely to accept the risks associated with elevated transaminases (p=0.024) and treatment discontinuation (p=0.005) despite having similar tolerance to uncertainty score compared to men.
Conclusions: Neurologists caring for MS patients have low tolerance to the risks of transaminitis and are not willing to accept treatment discontinuation for longstanding stable patients.
Disclosure: The study was sponsored by the Sociedad Española de Neurologia (SEN) and funded by Roche Farma Spain.
Gustavo Saposnik is supported by the Distinguished Clinicians Scientist Award from HSFC. Xavier Montalban has received honoraria for speaking and travel expenses to scientific meetings; was a steering member or participated in advisory boards in corporate-sponsored clinical trials or has had consulting agreements with Bayer Schering Pharma, Biogen, EMD Merck Serono, Roche, Genzyme, Novartis, Sanofi-Aventis, and Teva Pharmaceutical Industries Ltd.
Jorge Maurino is an employee of Roche Farma Spain.
Angel Perez Sempere and Maria Terzaghi: nothing to disclose.