Abstract Details

Title Outsmarting Therapeutic Inertia: Can ChatGPT-4o Beat Neurologists in Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorder Care?

Topic Multiple Sclerosis

Presentation(s) P6 - Poster Session 6 (5:00 PM-6:00 PM)

Poster/Presentation
Number 18-001

Objective

This study's aim was to compare therapeutic decisions made by neurologists vs. ChatGPT based on best practice guidelines.

Background Artificial intelligence (AI) tools can help doctors in clinical decision-making by processing complex information into coherent, evidence-based recommendations. A major challenge in managing neurological disorders is therapeutic inertia (TI), defined as the lack of treatment initiation or intensification when therapeutic goals are unmet.

Design/Methods Three cross-sectional online studies were conducted with the Spanish Society of Neurology. Participating neurologists completed 20 simulated case-scenarios on multiple sclerosis (MS) [DiscutirMS], use of neurofilament light chain (sNfL) levels [NewFeeLs-MS study], and neuromyelitis optica spectrum disorder (NMOSD) [PREFERENCES-NMOSD study]. Each vignette was also presented to ChatGPT-4o under two conditions: with and without an explicit guideline prompt (context). The primary outcome was a guideline-concordant recommendation response. Multivariate logistic regression analyses were used to evaluate neurologists' performance vs ChatGPT.

Results

A total of 290 neurologists participated (n=96 in Discutir MS, n=116 in NewFeeLs-MS, and n=78 in PREFERENCES-NMOSD). Participants’ characteristics were similar across studies [mean age: 40.2±9.9 years, 150 (51.7%) male, mean years of experience: 14.1±9.6, 174 (60%) had an MS-specific consultation, median MS patients attended/week (IQR): 15 (8-25)].

Overall, ChatGPT demonstrated superior accuracy: 80.5% ± 40.1 with context; 72.9% ± 42.8 without context, compared to neurologists (66.5% ± 35.0, p=0.001).

When introducing into the model the common patient characteristics in the simulated case-scenarios, ChatGPT had greater odds of following the latest guidelines (lower TI) vs neurologists, either with context (OR=3.59, 95%CI:2.24-5.57, p<0.0001) or without context (OR=1.68, 95%CI:1.06-2.66, p=0.03) compared to neurologist’s decisions.

Conclusions ChatGPT outperformed neurologists in simulated MS and NMOSD scenarios, showing higher adherence to guidelines and reduced TI. It is consistent with or without explicit guideline prompts, highlighting AI’s potential to support timely treatment decisions. Incorporating such tools into practice and training may accelerate best-practice adoption and improve patient outcomes.

Authors/Disclosures
Elena Garcia-Arcelay PRESENTER	Mrs. Arcelay has received personal compensation for serving as an employee of Roche.
Rocío Gómez, Other (Roche Farma S.A.)	Ms. Gómez has received personal compensation for serving as an employee of Roche Farma Spain, Medical Department.
Aleix Solanes	Dr. Solanes has nothing to disclose.
Enric Monreal Laguillo	Enric Monreal Laguillo has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Enric Monreal Laguillo has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Enric Monreal Laguillo has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi. Enric Monreal Laguillo has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck. Enric Monreal Laguillo has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Bristol-Myers Squibb. Enric Monreal Laguillo has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Biogen. Enric Monreal Laguillo has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Sanofi. Enric Monreal Laguillo has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. Enric Monreal Laguillo has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Merck. Enric Monreal Laguillo has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Janssen. Enric Monreal Laguillo has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Bristol-Myers Squibb.
Maria Sepúlveda	No disclosure on file
Angel P. Sempere, MD	Dr. Sempere has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Sempere has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Sempere has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Roche. Dr. Sempere has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Biogen. Dr. Sempere has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Merck.
Miguel Angel Hernandez Perez (Hospital Nuestra Senora de Candelaria)	Miguel Angel Hernandez Perez has nothing to disclose.
Juan Pablo Cuello (Hospital General Universitario Gregorio Maran)	Juan Pablo Cuello has nothing to disclose.
Gary Alvarez-Bravo, MD	Prof. Alvarez-Bravo has nothing to disclose.
Eduardo Aguera Morales, MD, PhD (As. ENINDE V14776132)	Dr. Aguera Morales has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck. Dr. Aguera Morales has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis .
Javier Riancho, MD, PhD	Dr. Riancho has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Riancho has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck. Dr. Riancho has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for BMS. Dr. Riancho has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Angelini. Dr. Riancho has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Roche. Dr. Riancho has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. Dr. Riancho has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Merck. Dr. Riancho has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for BMS. Dr. Riancho has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Neuraxpharm. Dr. Riancho has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Biogen. The institution of Dr. Riancho has received research support from Roche.
Jorge Maurino	Jorge Maurino has received personal compensation for serving as an employee of Roche Pharma Spain, Medical Department.
Gustavo Saposnik, MD (Director, Clinical Outcomes & Decision Neuroscience Research Centre)	Dr. Saposnik has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Roche. Dr. Saposnik has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for NIHSS. The institution of Dr. Saposnik has received research support from Roche. The institution of Dr. Saposnik has received research support from Heart and Stroke Foundation of Canada.

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