117 neurologists with MS expertise answered questions regarding the management of simulated clinical case-scenarios and a figure representing the safety and efficacy profiles of DMTs. Participants rated their agreement with the figure using an analog visual scale ranging from 0-10 (no-full agreement). TI was classified as a categorical (yes/no) and as a continuous variable by creating a score  ranging from 0 to 8. TI was defined as lack of treatment escalation when there was clear evidence of clinical and radiological activity (8 case-scenarios).

90 neurologists (76.9%) completed the study. TI was present in 74.4% of participants in at least one case scenario. The mean TI score (SD) was 1.7 (1.4). The mean level of agreement with the landscape figure was 8.1 (SD 1.9). Participants with lower agreement rate (≤6 out of 10) had a higher mean TI score compared to their counterparts (2.33 vs 1.60; p=0.10).

After adjusting for age, being an MS specialist, years of practice, and volume of patients seen per week, the agreement with the MS treatment figure was associated with lower incident risk of TI (OR 0.88; 95%CI 0.79-0.97).  

A higher level of agreement with a figure depicting the safety and efficacy of existing MS DMTs was independently associated with a lower incident risk of TI. These results suggest that a single question may be useful to identify neurologists prone to exhibiting TI.