AI Article Synopsis
- Natalizumab (NAT) poses a risk of progressive multifocal leukoencephalopathy (PML), but despite the development of risk stratification algorithms, the incidence of PML remains unchanged.
- A study involving 801 MS patients and 99 neurologists revealed that over 90% preferred shared decision-making and both groups overestimated the benefits of NAT, with men finding MS more severe than women.
- While neurologists displayed strong knowledge of risk stratification, patients had a lower understanding; however, patients were more willing to accept the risk of PML than their neurologists, influenced by their perception of MS's severity and treatment benefits.
Article Abstract
Background: Natalizumab (NAT) is associated with the risk of progressive multifocal leukoencephalopathy (PML). Risk stratification algorithms have been developed, however, without detectable reduction of PML incidence.
Objective: To evaluate to which extent patients and physicians understand and accept risks associated with NAT treatment.
Methods: Prospective observational cohort study in German MS centers (n=73) among NAT-treated MS patients (n=801) and their neurologists (n=99). Patients included in this study had mean disease duration of 10.2years and a mean NAT treatment duration of 24months.
Results: More than 90% of patients and physicians voted for shared decision making or an informed choice decision making approach. Patients and physicians perceived a similar threat from MS as serious disease and both overestimated treatment benefits from NAT based on trial data. Men perceived MS more severe than women and perception of seriousness increased with age in both groups and in patients as well with increasing disability. Although patients evaluated their PML risk higher, their risk acceptance was significantly higher than of their neurologists. Risk stratification knowledge was good among neurologists and significantly lower among patients.
Conclusion: While patients and physicians seem to have realistic risk perception of PML and knowledge of risk stratification concepts, the threat of MS and the perception of treatment benefits may explain the ongoing high acceptance of PML risk.
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| http://dx.doi.org/10.1016/j.jns.2017.03.001 | DOI Listing |
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