@misc{10481/93845,
year = {2022},
month = {12},
url = {https://hdl.handle.net/10481/93845},
abstract = {Background: The evolving therapeutic landscape requires more participation of patients with relapsing remitting
multiple sclerosis (RRMS) in treatment decisions. The aim of this study was to assess the association between
patient’s self-perception, cognitive impairment and behavioral factors in treatment choices in a cohort of patients
at an early stage of RRMS.
Methods: We conducted a multicenter, non-interventional study including adult patients with a diagnosis of
RRMS, a disease duration ≤18 months and receiving care at one of the 21 participating MS centers from across
Spain. We used patient-reported measures to gather information on fatigue, mood, quality of life, and perception
of severity of their MS. Functional metrics (Expanded Disability Status Scale [EDSS], cognitive function by the
Symbol Digit Modalities Test [SDMT], 25-foot walk test) and clinical and radiological data were provided by the
treating neurologist. The primary outcome of the study was status quo (SQ) bias, defined as participant’s tendency to continue taking a previously selected but inferior treatment when intensification was warranted. SQ
bias was assessed based on participants treatment preference in six simulated RRMS case scenarios with evidence
of clinical relapses and radiological disease progression.
Results: Of 189 participants who met the inclusion criteria, 188 (99.5%) fully completed the study. The mean age
was 36.6 ± 9.5 years, 70.7% female, mean disease duration: 1.2 ± 0.8 years, median EDSS score: 1.0
[IQR=0.0–2.0]). Overall, 43.1% patients (n = 81/188) had an abnormal SDMT (≤49 correct answers). SQ bias
was observed in at least one case scenario in 72.3% (137/188). Participant’s perception of their MS severity was
associated with higher SQ bias (β coeff 0.042; 95% CI 0.0074–0.076) among those with delayed cognitive
processing. Higher baseline EDSS and number of T2 lesions were predictors of delayed processing speed (OR
EDSS=1.57, 95% CI: 1.11–2.21, p = 0.011; OR T2 lesions=1.50, 95% CI: 1.11–2.03, p<0.01). Bayesian multilevel model accounting for clustering showed that delayed cognitive processing (exp coeff 1.06; 95% CI
1.04–1.09) and MS symptoms severity (exp coeff 1.28; 95% CI 1.22–1.33) were associated with SQ bias.
Conclusion: Over 40% of patients in earlier stages of RRMS experience delays in cognitive processing that might
affect their decision-making ability. Our findings suggest that patients’ self-perception of disease severity combined with a delay in cognitive processing would affect treatment choices leading to status quo bias early in the
course of their disease.},
organization = {Roche Medical Department, Spain (ML42064)},
publisher = {Elsevier},
keywords = {Multiple sclerosis},
keywords = {Status quo bias},
keywords = {Therapeutic inertia},
keywords = {Shared decision making},
keywords = {Disease-modifying therapy},
keywords = {Patient perspective},
title = {Delayed cognitive processing and treatment status quo bias in early-stage multiple sclerosis},
doi = {10.1016/j.msard.2022.104138},
author = {Saposnik, Gustavo and Andhavarapu,  Sanketh and Sainz de la Maza, Susana and Castillo-Triviño, Tamara and Borges, Mónica and Pardiñas Barón, Beatriz and Sotoca, Javier and Alonso, Ana and Caminero, Ana B. and Borrega, Laura and Sánchez-Menoyo, José Luis and Barrero Hernández, Francisco Javier and Calles, Carmen and Brieva, Luis and Blasco, María R. and Dotor García-Soto, Julio and Del Campo Amigo, María and Navarro-Cantó, Laura and Agüera, Eduardo and Garcés, Moisés and Carmona, Olga and Gabaldón-Torres, Laura and Forero, Lucía and Hervás, Mariona and García-Arcelay, Elena and Terzaghi, María and Gómez Ballesteros, Rocío and Mauriño, Jorge},
}