Modified Delphi study of decision-making around treatment sequencing in relapsing-remitting multiple sclerosis

Area of Science:

• Neurology
• Pharmacology
• Health Economics

Background:

• Current models for disease-modifying drugs (DMDs) in relapsing-remitting multiple sclerosis (RRMS) focus on single treatments.
• Patients with RRMS frequently transition between multiple DMDs throughout their lifetime.
• Understanding treatment switching decisions is crucial for developing realistic RRMS management models.

Purpose of the Study:

• To achieve consensus on modeling assumptions for DMD treatment sequencing in RRMS.
• To inform the development of clinically relevant models for DMD treatment strategies.
• To address the need for evaluating sequential DMD use in RRMS.

Main Methods:

• A modified Delphi technique involving three rounds of expert discussion.
• An international panel of 10 physicians specializing in RRMS management participated.
• Consensus-building on assumptions for modeling DMD treatment sequences.

Main Results:

• Agreement was reached that time to Expanded Disability Status Scale 6.0 is a suitable proxy for disease severity.
• Key factors for modeling DMD switching decisions include time between relapses, MRI outcomes, and adverse event risk.
• Adverse event risk tolerance for DMDs is disease severity-dependent.
• Consensus on some aspects of DMD effectiveness in sequences was achieved, but significant knowledge gaps and uncertainty remain.

Conclusions:

• Valuable insights into clinical decision-making for RRMS treatment sequencing were gained.
• The study's findings validate core modeling concepts for DMD treatment strategies.
• The acquired knowledge facilitates the generation of clinically meaningful results for RRMS management.