O Fernández1, M Delvecchio2, G Edan3, S Fredrikson4, G Gionvannoni5, H-P Hartung6, E Havrdova7, L Kappos8, C Pozzilli9, P S Soerensen10, B Tackenberg11, P Vermersch12, G Comi13. 1. Department of Neurology, Instituto de Investigación Biomédica de Malaga, Hospital Regional Universitario, Malaga University, Malaga, Spain. 2. Public Management and Policy, SDA Bocconi Scuola di Direzione Aziendale, Milano, Italy. 3. Neurology, Institut des Neurosciences Cliniques de Rennes, Rennes, France. 4. Division of Neurology, Karolinska Institute, Stockholm, Sweden. 5. Centre for Neuroscience and Trauma, Department of Neurology, Blizard Institute of Cell and Molecular Science, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK. 6. Neurology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany. 7. Department of Neurology, Charles University, Prague, Czech Republic. 8. Neurology and Department of Biomedicine, Universitatsspital Basel, Basel, Switzerland. 9. Neurological Sciences, MS Centre, Rome, Italy. 10. Department of Neurology, Danish Multiple Sclerosis Research Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark. 11. Klinik für Neurologie, Phillipps-Universitat Marburg Fachgebiet Indologie und Tibetologie, Marburg, Germany. 12. Neurology D, CHU Lille, Lille, France. 13. Neuroimaging Research Unit, Osepdale San Raffaele, Milan, Italy.
Abstract
BACKGROUND AND PURPOSE: Up-to-date information is needed on the extent to which neurologists treating multiple sclerosis (MS) in Europe are integrating rapidly evolving diagnostic criteria, disease-modifying therapies and recommendations for monitoring disease activity into their clinical practice. METHODS: A steering committee of MS neurologists used a modified Delphi process to develop case- and practice-based questions for two sequential surveys distributed to MS neurologists throughout Europe. Case-based questions were developed for radiologically isolated syndrome (RIS), clinically isolated syndrome (CIS), relapsing-remitting MS (RRMS) and RRMS with breakthrough disease. RESULTS: Multiple sclerosis neurologists from 11 European countries responded to survey 1 (n = 233) and survey 2 (n = 171). Respondents agreed that they would not treat the patients in the RIS or CIS cases but would treat a patient with a relatively mild form of RRMS. Choice of treatment was evenly distributed among first-line injectables and oral treatments for mild RRMS, and moved to second-line treatment as the RRMS case increased in severity. Additional results on RRMS with breakthrough disease are presented. CONCLUSIONS: Although there was general agreement on some aspects of treatment, responses to other management and clinical practice questions varied considerably. These results, which reflect current clinical practice patterns, highlight the need for additional MS treatment education and awareness and may help inform the development of MS practice guidelines in Europe.
BACKGROUND AND PURPOSE: Up-to-date information is needed on the extent to which neurologists treating multiple sclerosis (MS) in Europe are integrating rapidly evolving diagnostic criteria, disease-modifying therapies and recommendations for monitoring disease activity into their clinical practice. METHODS: A steering committee of MS neurologists used a modified Delphi process to develop case- and practice-based questions for two sequential surveys distributed to MS neurologists throughout Europe. Case-based questions were developed for radiologically isolated syndrome (RIS), clinically isolated syndrome (CIS), relapsing-remitting MS (RRMS) and RRMS with breakthrough disease. RESULTS:Multiple sclerosis neurologists from 11 European countries responded to survey 1 (n = 233) and survey 2 (n = 171). Respondents agreed that they would not treat the patients in the RIS or CIS cases but would treat a patient with a relatively mild form of RRMS. Choice of treatment was evenly distributed among first-line injectables and oral treatments for mild RRMS, and moved to second-line treatment as the RRMS case increased in severity. Additional results on RRMS with breakthrough disease are presented. CONCLUSIONS: Although there was general agreement on some aspects of treatment, responses to other management and clinical practice questions varied considerably. These results, which reflect current clinical practice patterns, highlight the need for additional MS treatment education and awareness and may help inform the development of MS practice guidelines in Europe.