Therapeutic inertia in the management of neuromyelitis optica spectrum disorder
Introduction and objectiveLimited information is available on how neurologists make therapeutic decisions in neuromyelitis optica spectrum disorder (NMOSD), especially when new treatments with different mechanisms of action, administration, and safety profile are being approved. Decision-making can...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2024-02-01
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| Series: | Frontiers in Neurology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2024.1341473/full |
| _version_ | 1827345959122632704 |
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| author | Álvaro Cobo-Calvo Rocío Gómez-Ballesteros Aida Orviz María Díaz Sánchez Sabas Boyero Marta Aguado-Valcarcel María Sepúlveda Pablo Rebollo Paloma López-Laiz Jorge Maurino Nieves Téllez Lara |
| author_facet | Álvaro Cobo-Calvo Rocío Gómez-Ballesteros Aida Orviz María Díaz Sánchez Sabas Boyero Marta Aguado-Valcarcel María Sepúlveda Pablo Rebollo Paloma López-Laiz Jorge Maurino Nieves Téllez Lara |
| author_sort | Álvaro Cobo-Calvo |
| collection | DOAJ |
| description | Introduction and objectiveLimited information is available on how neurologists make therapeutic decisions in neuromyelitis optica spectrum disorder (NMOSD), especially when new treatments with different mechanisms of action, administration, and safety profile are being approved. Decision-making can be complex under this uncertainty and may lead to therapeutic inertia (TI), which refers to lack of treatment initiation or intensification when therapeutic goals are not met. The study aim was to assess neurologists’ TI in NMOSD.MethodsAn online, cross-sectional study was conducted in collaboration with the Spanish Society of Neurology. Neurologists answered a survey composed of demographic characteristics, professional background, and behavioral traits. TI was defined as the lack of initiation or intensification with high-efficacy treatments when there is evidence of disease activity and was assessed through five NMOSD aquaporin-4 positive (AQP4+) simulated case scenarios. A multivariate logistic regression analysis was used to determine the association between neurologists’ characteristics and TI.ResultsA total of 78 neurologists were included (median interquartile range [IQR] age: 36.0 [29.0–46.0] years, 55.1% male, median [IQR] experience managing demyelinating conditions was 5.2 [3.0–11.1] years). The majority of participants were general neurologists (59.0%) attending a median (IQR) of 5.0 NMOSD patients (3.0–12.0) annually. Thirty participants (38.5%) were classified as having TI. Working in a low complexity hospital and giving high importance to patient’s tolerability/safety when choosing a treatment were predictors of TI.ConclusionTI is a common phenomenon among neurologists managing NMOSD AQP4+. Identifying TI and implementing specific intervention strategies may be critical to improving therapeutic decisions and patient care. |
| first_indexed | 2024-03-07T23:21:14Z |
| format | Article |
| id | doaj.art-af3c8ced9be44b378c63407c24bf2982 |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-03-07T23:21:14Z |
| publishDate | 2024-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-af3c8ced9be44b378c63407c24bf29822024-02-21T05:51:39ZengFrontiers Media S.A.Frontiers in Neurology1664-22952024-02-011510.3389/fneur.2024.13414731341473Therapeutic inertia in the management of neuromyelitis optica spectrum disorderÁlvaro Cobo-Calvo0Rocío Gómez-Ballesteros1Aida Orviz2María Díaz Sánchez3Sabas Boyero4Marta Aguado-Valcarcel5María Sepúlveda6Pablo Rebollo7Paloma López-Laiz8Jorge Maurino9Nieves Téllez Lara10Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autonoma de Barcelona, Barcelona, SpainMedical Department, Roche Farma, Madrid, SpainDepartment of Neurology, Hospital Universitario Fundación Jiménez Díaz, Madrid, SpainDepartment of Neurology, Hospital Universitario Virgen del Rocío, Seville, SpainDepartment of Neurology, Hospital Universitario Cruces, Bilbao, SpainDepartment of Neurology, Hospital Álvaro Cunqueiro, Vigo, SpainDepartment of Neurology, Hospital Clínic de Barcelona, Barcelona, SpainIQVIA, Madrid, SpainMedical Department, Roche Farma, Madrid, SpainMedical Department, Roche Farma, Madrid, SpainDepartment of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, SpainIntroduction and objectiveLimited information is available on how neurologists make therapeutic decisions in neuromyelitis optica spectrum disorder (NMOSD), especially when new treatments with different mechanisms of action, administration, and safety profile are being approved. Decision-making can be complex under this uncertainty and may lead to therapeutic inertia (TI), which refers to lack of treatment initiation or intensification when therapeutic goals are not met. The study aim was to assess neurologists’ TI in NMOSD.MethodsAn online, cross-sectional study was conducted in collaboration with the Spanish Society of Neurology. Neurologists answered a survey composed of demographic characteristics, professional background, and behavioral traits. TI was defined as the lack of initiation or intensification with high-efficacy treatments when there is evidence of disease activity and was assessed through five NMOSD aquaporin-4 positive (AQP4+) simulated case scenarios. A multivariate logistic regression analysis was used to determine the association between neurologists’ characteristics and TI.ResultsA total of 78 neurologists were included (median interquartile range [IQR] age: 36.0 [29.0–46.0] years, 55.1% male, median [IQR] experience managing demyelinating conditions was 5.2 [3.0–11.1] years). The majority of participants were general neurologists (59.0%) attending a median (IQR) of 5.0 NMOSD patients (3.0–12.0) annually. Thirty participants (38.5%) were classified as having TI. Working in a low complexity hospital and giving high importance to patient’s tolerability/safety when choosing a treatment were predictors of TI.ConclusionTI is a common phenomenon among neurologists managing NMOSD AQP4+. Identifying TI and implementing specific intervention strategies may be critical to improving therapeutic decisions and patient care.https://www.frontiersin.org/articles/10.3389/fneur.2024.1341473/fullneuromyelitis opticatherapeutic inertiasevere diseaseshared decision-makinghigh-efficacy treatments |
| spellingShingle | Álvaro Cobo-Calvo Rocío Gómez-Ballesteros Aida Orviz María Díaz Sánchez Sabas Boyero Marta Aguado-Valcarcel María Sepúlveda Pablo Rebollo Paloma López-Laiz Jorge Maurino Nieves Téllez Lara Therapeutic inertia in the management of neuromyelitis optica spectrum disorder Frontiers in Neurology neuromyelitis optica therapeutic inertia severe disease shared decision-making high-efficacy treatments |
| title | Therapeutic inertia in the management of neuromyelitis optica spectrum disorder |
| title_full | Therapeutic inertia in the management of neuromyelitis optica spectrum disorder |
| title_fullStr | Therapeutic inertia in the management of neuromyelitis optica spectrum disorder |
| title_full_unstemmed | Therapeutic inertia in the management of neuromyelitis optica spectrum disorder |
| title_short | Therapeutic inertia in the management of neuromyelitis optica spectrum disorder |
| title_sort | therapeutic inertia in the management of neuromyelitis optica spectrum disorder |
| topic | neuromyelitis optica therapeutic inertia severe disease shared decision-making high-efficacy treatments |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2024.1341473/full |
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