Survey on first-line therapeutic management of relapsing–remitting multiple sclerosis in clinical practice in Spain

Introduction

Current therapies for relapsing–remitting multiple sclerosis (RRMS) help reduce morbidity and delay disease progression. However, the available information on factors influencing decision-making regarding first-line treatment remain poorly understood.

Methods

Based on a review of the literature and the experience of a scientific committee made up by 2 neurologists, an ad hoc survey was developed and distributed to Spanish neurologists. It included 22 questions related to the first-line therapeutic management of RRMS.

Results

Sixty neurologists (mean age: 45.6 years, 60% women, mean of 16.0 years of experience, mean of 93.8 patients with RRMS attended/month) participated in the study. Neurologists considered that the 3 most important treatment characteristics (1–8 points, with higher scores denoting greater relevance) in treatment decision-making were efficacy in disease control (7.8 ± 0.5), safety/tolerability (6.7 ± 0.9), and improvements in patient quality of life (5.0 ± 1.5); regarding patient characteristics, the 3 most important (1–7 points) were disease activity (6.9 ± 0.5), intention to become pregnant (5.0 ± 1.0), and level of disability (4.3 ± 1.8). Dimethyl fumarate (32.6%) was the most frequently prescribed treatment, followed by teriflunomide (24.8%) and glatiramer acetate (17.6%). According to over 87% of the specialists, the latter drug was considered the most appropriate treatment for patients with liver disorders, who intended to become pregnant, and who presented low disease activity.

Conclusions

Our study provides evidence on the first-line therapeutic management of non-aggressive forms of RRMS and the factors influencing decision-making in routine clinical practice.