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Utility of the Canadian Treatment Optimization Recommendations (TOR) in MS care
François Grand'Maison1, Virender Bhan, Mark S Freedman
1Department of Medicine (Neurology), University of Sherbrooke, Hôpital Charles LeMoyne, Greenfield Park, Quebec, Canada. fgrandm@videotron.ca
Objectives:
Criteria for Treatment Optimization Recommendations (TOR) for patients with multiple sclerosis (MS) identify suboptimal response to disease-modifying treatment (DMT). The Canadian TOR (CanTOR) were used to indicate recommendations for treatment switches or treatment maintenance based on relapse, disease progression and magnetic resonance imaging (MRI) criteria in patients. We assessed concordance between the TOR and clinicians' decisions regarding treatment response and identified prevalence of patients with MS receiving DMT meeting medium/high levels of concern according to TOR.
Methods:
Prospective baseline and end-of-study assessments of patients with relapsing-remitting MS (RRMS) or clinically isolated syndrome were conducted in this open-label, 12-month, Phase IV, observational Canadian study.
Results:
Data were reported for 184 patients (female 72%, mean age 39 years) of which 96% had RRMS. The TOR criteria identified 19 (10.3%) patients with suboptimal response to treatment. Twelve patients had ≥1 high level of concern. Two patients had ≥2 medium levels of concern. Concordance between TOR and clinician decision in maintaining treatment was 95.3%. Where treatment change was recommended by the TOR, concordance was 29.4%. Clinicians identified the TOR as the principal reason for changing treatment in 50.0% of cases where the TOR identified suboptimal response. The TOR were considered useful by 70.6% of clinicians when treatment optimization was recommended and by 55.3% when maintaining treatment was recommended.
Conclusions:
The TOR criteria can identify suboptimal response in this patient cohort. Concordance between TOR and clinician decision was high when maintaining treatment was recommended. Usefulness of the TOR was most apparent when treatment optimization was recommended.
Insights
The Canadian Treatment Optimization Recommendations (TOR) effectively identify multiple sclerosis (MS) patients needing treatment changes. While concordance was high for maintaining treatment, the TOR proved most useful for guiding treatment optimization decisions.
Area of Science:
- Neurology
- Clinical Research
- Pharmacology
Background:
- Multiple sclerosis (MS) management requires optimizing disease-modifying treatments (DMTs) to improve patient outcomes.
- Established criteria are needed to objectively assess treatment response and guide decisions on switching or maintaining DMTs in MS patients.
Purpose of the Study:
- To evaluate the concordance between the Canadian Treatment Optimization Recommendations (CanTOR) and clinicians' decisions regarding DMT response in MS patients.
- To determine the prevalence of MS patients on DMTs who meet medium/high levels of concern according to CanTOR criteria.
- To assess the perceived usefulness of CanTOR by clinicians in guiding treatment optimization.
Main Methods:
- An open-label, 12-month, Phase IV observational study in Canada involving patients with relapsing-remitting MS (RRMS) or clinically isolated syndrome.
- Prospective assessments included baseline and end-of-study evaluations.
- Analysis focused on comparing CanTOR criteria-based recommendations with actual clinician decisions on DMT adjustments.
Main Results:
- The CanTOR criteria identified 10.3% of 184 patients as having a suboptimal response to their current DMT.
- Clinician concordance with CanTOR recommendations was high (95.3%) for treatment maintenance but lower (29.4%) for treatment changes.
- Clinicians found CanTOR useful, particularly when treatment optimization was recommended (70.6%).
Conclusions:
- The CanTOR criteria effectively identify suboptimal DMT response in patients with multiple sclerosis.
- High concordance exists between CanTOR and clinician decisions for maintaining treatment.
- The CanTOR criteria demonstrate significant utility in guiding treatment optimization decisions for MS patients.
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