OBJECTIVES : Many disease-modifying therapies are available for relapsing-remitting multiple sclerosis (RRMS), including injectables, infusions, and oral therapies, which vary with respect to their attributes. This study sought to better understand the impact of RRMS and consideration of treatment choice among neurologists and patients.

METHODS : Neurologists (n=20) and patients with RRMS (n=20) in the United Kingdom and United States participated in in-depth telephone interviews. Trained interviewers used a semi-structured interview guide focusing on factors affecting treatment decision-making. Interview transcripts were coded to identify key themes emerging from the data.

RESULTS : The most bothersome effects of RRMS on patients were fatigue, cognitive problems, and difficulty walking/balance issues. All neurologists said they prescribe injectables or orals about equally as first-line treatment for low to moderate disease activity; treatment choice was primarily driven by patients. As MS progresses, neurologists indicated they prescribe orals with perceived greater efficacy or infusions. Preventing progression and reducing relapses and brain lesions were key treatment goals for both groups. Most neurologists indicated that reducing brain volume loss (BVL) is important. Many neurologists noted the importance of reducing cognitive decline, which they correlated with BVL; however, they indicated a lack of adequate measures for assessing cognitive function in routine practice (n=8 [40%]). Risk of serious infections and life-threatening adverse events were important to neurologists (50%) and patients (75%). Flu-like symptoms and gastrointestinal problems were also important to both groups. Required monitoring may dissuade neurologists (n=14 [70%]), while patients do not see this as particularly burdensome. Patients prefer orals over injectables (n=12 [60%]); preferences for orals vs infusions were similar, with treatment frequency as an important factor. Results were largely consistent across countries.

CONCLUSIONS : This study highlights distinctions between neurologists and patients in treatment attribute perceptions. While cognitive functioning is a concern, it may not be adequately captured in clinical practice.