Contributions
Abstract: P795
Type: Poster
Abstract Category: Therapy - disease modifying - 32 Others
Introduction: Therapeutic inertia (TI) is a common phenomenon in multiple sclerosis (MS) care defined as the lack of treatment escalation despite evidence of disease progression. The consequences of TI include poorer patient's outcomes and diminished quality of life.
Objective: To evaluate the feasibility of an educational intervention (traffic light system - TLS) designed to overcome TI among neurologists managing MS patients.
Design: A pilot, double-blind, randomized study. Neurologists were assigned to receive the educational intervention (n=11) or standard of care (n=14). Participants answered questions regarding the management of 20 simulated case-scenarios commonly encountered in clinical practice. The intervention consisted of introducing the TLS to help participants identify patients at high-risk of progression. TI was defined according to best practice guidelines based on clinical/radiological activity to escalate therapy. Primary outcome (feasibility): completion rate and the proportion of participants who correctly identified the traffic light (red for high-risk, yellow for moderate-risk) according to the simulated case-scenarios.
Results: TI was present in 72.0% of participants in at least one case scenario. There were no significant differences between groups at baseline (responses with TI in the interventional group 23.9% vs. 26.8% in the control group; p=0.74) (Figure). The completion rate of the study was 100% (25/25 participants). Overall, 77.4% of participants correctly identified the 'red traffic light' for clinical-scenarios with high-risk of disease progression. Similarly, 86.4% of participants correctly identified the 'yellow traffic light' for cases that would require a reassessment within 6-to-12 months. We found a 43% trend of reduction in odds of TI in the interventional group compared to controls (22.6% vs. 33.9%; OR 0.57; 95%CI 0.26-1.22).
Conclusions: TI is a common phenomenon in MS care affecting 7 out of 10 neurologists. TLS is a feasible educational intervention that when applied to neurologists may help overcome TI and improve MS outcomes.
Disclosure: The study was sponsored by the Sociedad Española de Neurologia (SEN) and funded by Roche Farma Spain.
Peter Tobler and Christian Ruff were funded by the Swiss National Science Foundation (PNT: PP00P1_150739 and 00014_165884, CCR: 105314_152891, CRSII3_141965, and 320030_143443).
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, Genzyme, Novartis, Roche, Sanofi-Aventis, and Teva Pharmaceutical Industries Ltd.
Jorge Maurino is an employee of Roche Farma Spain. Angel Perez Sempere, Maria Terzaghi, and M Mamdani: nothing to disclose.
Abstract: P795
Type: Poster
Abstract Category: Therapy - disease modifying - 32 Others
Introduction: Therapeutic inertia (TI) is a common phenomenon in multiple sclerosis (MS) care defined as the lack of treatment escalation despite evidence of disease progression. The consequences of TI include poorer patient's outcomes and diminished quality of life.
Objective: To evaluate the feasibility of an educational intervention (traffic light system - TLS) designed to overcome TI among neurologists managing MS patients.
Design: A pilot, double-blind, randomized study. Neurologists were assigned to receive the educational intervention (n=11) or standard of care (n=14). Participants answered questions regarding the management of 20 simulated case-scenarios commonly encountered in clinical practice. The intervention consisted of introducing the TLS to help participants identify patients at high-risk of progression. TI was defined according to best practice guidelines based on clinical/radiological activity to escalate therapy. Primary outcome (feasibility): completion rate and the proportion of participants who correctly identified the traffic light (red for high-risk, yellow for moderate-risk) according to the simulated case-scenarios.
Results: TI was present in 72.0% of participants in at least one case scenario. There were no significant differences between groups at baseline (responses with TI in the interventional group 23.9% vs. 26.8% in the control group; p=0.74) (Figure). The completion rate of the study was 100% (25/25 participants). Overall, 77.4% of participants correctly identified the 'red traffic light' for clinical-scenarios with high-risk of disease progression. Similarly, 86.4% of participants correctly identified the 'yellow traffic light' for cases that would require a reassessment within 6-to-12 months. We found a 43% trend of reduction in odds of TI in the interventional group compared to controls (22.6% vs. 33.9%; OR 0.57; 95%CI 0.26-1.22).
Conclusions: TI is a common phenomenon in MS care affecting 7 out of 10 neurologists. TLS is a feasible educational intervention that when applied to neurologists may help overcome TI and improve MS outcomes.
Disclosure: The study was sponsored by the Sociedad Española de Neurologia (SEN) and funded by Roche Farma Spain.
Peter Tobler and Christian Ruff were funded by the Swiss National Science Foundation (PNT: PP00P1_150739 and 00014_165884, CCR: 105314_152891, CRSII3_141965, and 320030_143443).
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, Genzyme, Novartis, Roche, Sanofi-Aventis, and Teva Pharmaceutical Industries Ltd.
Jorge Maurino is an employee of Roche Farma Spain. Angel Perez Sempere, Maria Terzaghi, and M Mamdani: nothing to disclose.