To evaluate patient and neurologist preferences for relapsing-remitting multiple sclerosis (RRMS) medications by considering benefits and risks associated with novel and common disease-modifying therapies (DMTs).

As the RRMS treatment landscape evolves, patients and physicians must consider trade-offs between the benefits and risks of DMTs when selecting treatment. Many studies have shown that brain volume loss (BVL) is associated with long-term physical and cognitive disability in RRMS. However, while preferences for traditional measures of efficacy (eg, relapse) have been studied, the level of importance of BVL is unknown.

Patients diagnosed with RRMS who had never used a DMT that is typically prescribed in advanced RRMS and neurologists in the US completed an online survey using a discrete choice experiment to evaluate preferences; neurologists considered non-highly active RRMS in their responses. In a series of choice tasks, all respondents chose between 2 treatment profiles that varied on 7 attributes identified in previous qualitative research: 2-year disability progression, 1-year relapse rate, rate of BVL, and risks of gastrointestinal (GI) symptoms, flu-like symptoms, infection, and a life-threatening side effect. Hierarchical Bayesian modeling was used to estimate attribute-level preference weights.

Analysis included 150 patients with RRMS (mean age: 54 years; 84% female) and 150 neurologists (65% private practice). While patients were most concerned with reducing the rate of BVL, followed by the risks of infection and flu-like symptoms, neurologists were most concerned with reducing the risk of a life-threatening side effect, followed by slowing the 2-year disability progression and risk of infection. Reducing the 1-year relapse rate and risk of GI symptoms were least important to both groups.

Patients and neurologists differed in the attributes that were most important in selecting treatment. Patients’ perspectives and BVL should be considered and discussed when determining treatment selection.