Patients' Preferences for Sphingosine-1-Phosphate Receptor Modulators in Multiple Sclerosis Based on Clinical...

Area of Science:

• Neurology
• Pharmacology
• Health Economics

Background:

• Multiple treatments for relapsing forms of multiple sclerosis (RMS) exist, primarily sphingosine-1-phosphate receptor (S1PR) modulators.
• These S1PR modulators demonstrate comparable efficacy and safety, shifting patient decision-making towards clinical management characteristics.
• Comorbidities, such as heart conditions (HC), can influence the clinical management of certain S1PR modulators.

Purpose of the Study:

• To determine patient preference for S1PR modulators in relapsing-remitting multiple sclerosis (RRMS) based on clinical management.
• To quantify the impact of specific clinical management attributes on patient preferences.
• To analyze preferences separately for patients with and without comorbid heart conditions (HC).

Main Methods:

• A multicriteria decision analysis (MCDA) using a discrete choice experiment (DCE) was performed on four S1PR modulators: fingolimod, ozanimod, siponimod, and ponesimod.
• Patient preferences for RRMS were elicited by repeatedly choosing between hypothetical S1PR modulator profiles based on attributes like first-dose observations, genotyping, and immune system recovery time.
• Marginal utilities were calculated using a mixed logit model, and partial value scores were summed to determine overall clinical management value scores for each S1PR modulator.

Main Results:

• Four hundred RRMS patients completed the DCE. Ponesimod achieved the highest overall value score for both patients without HC (5.1) and with HC (4.0).
• Immune system recovery time (up to 1.9 points) and drug-drug interactions (up to 1.7 points) were the most significant contributors to value scores.
• Siponimod, fingolimod, and ozanimod followed ponesimod in overall value scores, with significant differences observed between patient groups with and without HC.

Conclusions:

• Patients with RRMS prioritize shorter immune system recovery times and fewer drug interactions when selecting S1PR modulators.
• Ponesimod's clinical management profile is preferred by the average RRMS patient, including those with heart conditions, over other evaluated S1PR modulators.
• These findings can guide treatment recommendations and shared decision-making for managing RRMS.