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Therapeutic status quo in patients with relapsing-remitting multiple sclerosis: a sign of poor self-perception of their clinical status?


Saposnik, Gustavo; Sotoca, Javier; Sempere, Ángel P; Candeliere-Merlicco, Antonio; Díaz-Abós, Paola; Tobler, Philippe N; Terzaghi, Maria; Maurino, Jorge (2020). Therapeutic status quo in patients with relapsing-remitting multiple sclerosis: a sign of poor self-perception of their clinical status? Multiple Sclerosis and Related Disorders, 45(102354):online.

Abstract

Background
Status quo (SQ) bias is defined as patient´s tendency to continue taking a previously selected but inferior therapeutic option.
Objective
To assess the presence of SQ bias and its associated factors in patients with relapsing-remitting multiple sclerosis (RRMS).
Methods
A multicenter, non-interventional study involving 211 patients with RRMS was conducted. Participants answered questions regarding risk preferences and management of simulated MS case-scenarios. The SymptoMScreen (SMSS) questionnaire was used to assess the perception of severity from the patients´ perspective. SQ bias was defined as patients’ preference to maintain the current treatment despite evidence of disease activity. Mixed linear models adjusting for clustering assessed the association of candidate predictors with the outcome of interest.
Results
The mean age (SD) was 39.1 (9.5) years and 70.6% were women. SQ bias was observed in 74.4% (n=161) participants. Univariate analysis showed that SMSS score was associated with SQ bias (OR 1.04; 95% CI 1.01-1.07). Mixed linear regression models suggest that for every point increase in SMSS, there was a 4% increase in the likelihood of SQ bias (β 0.04; 95%CI 0.015-0.06; p<0.002). Among the different symptomatic dimensions included in the SMSS, only vision impairment (β 0.32; 95%CI 0.05-0.50) and depression (β 0.29; 95%CI 0.006-0.58) remained associated with SQ bias in the multivariate analysis. There was no association between participants’ risk preferences and SQ bias.
Conclusions
Unwillingness to pursue treatments that are more effective is a common phenomenon affecting over 7 out of 10 patients with RRMS. This phenomenon appears to be driven by patients’ negative self-perception of their clinical status.

Abstract

Background
Status quo (SQ) bias is defined as patient´s tendency to continue taking a previously selected but inferior therapeutic option.
Objective
To assess the presence of SQ bias and its associated factors in patients with relapsing-remitting multiple sclerosis (RRMS).
Methods
A multicenter, non-interventional study involving 211 patients with RRMS was conducted. Participants answered questions regarding risk preferences and management of simulated MS case-scenarios. The SymptoMScreen (SMSS) questionnaire was used to assess the perception of severity from the patients´ perspective. SQ bias was defined as patients’ preference to maintain the current treatment despite evidence of disease activity. Mixed linear models adjusting for clustering assessed the association of candidate predictors with the outcome of interest.
Results
The mean age (SD) was 39.1 (9.5) years and 70.6% were women. SQ bias was observed in 74.4% (n=161) participants. Univariate analysis showed that SMSS score was associated with SQ bias (OR 1.04; 95% CI 1.01-1.07). Mixed linear regression models suggest that for every point increase in SMSS, there was a 4% increase in the likelihood of SQ bias (β 0.04; 95%CI 0.015-0.06; p<0.002). Among the different symptomatic dimensions included in the SMSS, only vision impairment (β 0.32; 95%CI 0.05-0.50) and depression (β 0.29; 95%CI 0.006-0.58) remained associated with SQ bias in the multivariate analysis. There was no association between participants’ risk preferences and SQ bias.
Conclusions
Unwillingness to pursue treatments that are more effective is a common phenomenon affecting over 7 out of 10 patients with RRMS. This phenomenon appears to be driven by patients’ negative self-perception of their clinical status.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:03 Faculty of Economics > Department of Economics
Dewey Decimal Classification:330 Economics
Scopus Subject Areas:Life Sciences > Neurology
Health Sciences > Neurology (clinical)
Uncontrolled Keywords:Neurology, clinical neurology, general medicine, multiple sclerosis, status quo bias, therapeutic inertia, decision-making, disease-modifying therapy
Language:English
Date:October 2020
Deposited On:08 Jan 2021 13:39
Last Modified:02 Feb 2021 21:53
Publisher:Elsevier
ISSN:2211-0348
OA Status:Hybrid
Publisher DOI:https://doi.org/10.1016/j.msard.2020.102354

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