Long-Term Management and Therapeutic Sequencing for Patients with Relapsing Multiple Sclerosis in France: A Vignette...

We have analysed prescribing decisions for relapsing multiple sclerosis (RMS) of 111 neurologists ("participating physicians") in France using hypothetical case vignettes.

Six case vignettes were presented to participating physicians, each based on realistic, hypothetical clinical interactions between a neurologist and people with active or highly active RMS, with or without prior treatment with a disease-modifying therapy (DMT). "Disruptive events" are where the appearance of new MS disease activity, side-effects or other issues prompted the return of the hypothetical patients for a review of their care.

A population of 111 participating physicians reviewed the cases and recommended treatments. Our data suggested a willingness among participating physicians to treat with higher-efficacy DMTs early in the course of RMS, with platform agents given to only one-quarter of DMT-naïve cases. MS disease activity was the main driver of switches to higher-efficacy DMTs, although an escalation approach was common in response to either moderate MS disease activity or side-effects on platform agents. A desire for pregnancy drove high usage of cladribine tablets and natalizumab (especially for cases negative for John Cunningham virus).

These findings suggest that the management of RMS in France has shifted in recent years towards a desire to achieve earlier and more effective control of disease activity for people with RMS. Better guidance on the sequencing of DMTs for different scenarios within the overall management of RMS may be warranted. This study offers valuable insights into the current practices of French neurologists in managing RMS, emphasizing the complexity of therapeutic decisions, the diversity of strategies, and the significance of an individualized approach in treatment management.