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Therapeutic inertia in the management of neuromyelitis optica spectrum disorder.
Cobo-Calvo, Álvaro; Gómez-Ballesteros, Rocío; Orviz, Aida; Díaz Sánchez, María; Boyero, Sabas; Aguado-Valcarcel, Marta; Sepúlveda, María; Rebollo, Pablo; López-Laiz, Paloma; Maurino, Jorge; Téllez Lara, Nieves.
Affiliation
  • Cobo-Calvo Á; Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.
  • Gómez-Ballesteros R; Medical Department, Roche Farma, Madrid, Spain.
  • Orviz A; Department of Neurology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.
  • Díaz Sánchez M; Department of Neurology, Hospital Universitario Virgen del Rocío, Seville, Spain.
  • Boyero S; Department of Neurology, Hospital Universitario Cruces, Bilbao, Spain.
  • Aguado-Valcarcel M; Department of Neurology, Hospital Álvaro Cunqueiro, Vigo, Spain.
  • Sepúlveda M; Department of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain.
  • Rebollo P; IQVIA, Madrid, Spain.
  • López-Laiz P; Medical Department, Roche Farma, Madrid, Spain.
  • Maurino J; Medical Department, Roche Farma, Madrid, Spain.
  • Téllez Lara N; Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
Front Neurol ; 15: 1341473, 2024.
Article in En | MEDLINE | ID: mdl-38450077
ABSTRACT
Introduction and

objective:

Limited 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.

Methods:

An 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.

Results:

A 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.

Conclusion:

TI 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.
Key words

Full text: 1 Collection: 01-internacional Database: MEDLINE Language: En Journal: Front Neurol Year: 2024 Type: Article Affiliation country: Spain

Full text: 1 Collection: 01-internacional Database: MEDLINE Language: En Journal: Front Neurol Year: 2024 Type: Article Affiliation country: Spain