Therapeutic inertia in the management of neuromyelitis optica spectrum disorder

Álvaro Cobo-Calvo; Rocío Gómez-Ballesteros; Aida Orviz; María Díaz Sánchez; Sabas Boyero; Marta Aguado-Valcarcel; María Sepúlveda; Pablo Rebollo; Paloma López-Laiz; Jorge Maurino; Nieves Téllez Lara

doi:10.3389/fneur.2024.1341473

Therapeutic inertia in the management of neuromyelitis optica spectrum disorder

Front Neurol. 2024 Feb 21:15:1341473. doi: 10.3389/fneur.2024.1341473. eCollection 2024.

Affiliations

¹ Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.
² Medical Department, Roche Farma, Madrid, Spain.
³ Department of Neurology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.
⁴ Department of Neurology, Hospital Universitario Virgen del Rocío, Seville, Spain.
⁵ Department of Neurology, Hospital Universitario Cruces, Bilbao, Spain.
⁶ Department of Neurology, Hospital Álvaro Cunqueiro, Vigo, Spain.
⁷ Department of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain.
⁸ IQVIA, Madrid, Spain.
⁹ Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.

Abstract

Introduction and objective: Limited information is available on how neurologists make therapeutic decisions in neuromyelitis optica spectrum disorder (NMOSD), especially when new treatments with different mechanisms of action, administration, and safety profile are being approved. Decision-making can be complex under this uncertainty and may lead to therapeutic inertia (TI), which refers to lack of treatment initiation or intensification when therapeutic goals are not met. The study aim was to assess neurologists' TI in NMOSD.

Methods: An online, cross-sectional study was conducted in collaboration with the Spanish Society of Neurology. Neurologists answered a survey composed of demographic characteristics, professional background, and behavioral traits. TI was defined as the lack of initiation or intensification with high-efficacy treatments when there is evidence of disease activity and was assessed through five NMOSD aquaporin-4 positive (AQP4+) simulated case scenarios. A multivariate logistic regression analysis was used to determine the association between neurologists' characteristics and TI.

Results: A total of 78 neurologists were included (median interquartile range [IQR] age: 36.0 [29.0-46.0] years, 55.1% male, median [IQR] experience managing demyelinating conditions was 5.2 [3.0-11.1] years). The majority of participants were general neurologists (59.0%) attending a median (IQR) of 5.0 NMOSD patients (3.0-12.0) annually. Thirty participants (38.5%) were classified as having TI. Working in a low complexity hospital and giving high importance to patient's tolerability/safety when choosing a treatment were predictors of TI.

Conclusion: TI is a common phenomenon among neurologists managing NMOSD AQP4+. Identifying TI and implementing specific intervention strategies may be critical to improving therapeutic decisions and patient care.

Keywords: high-efficacy treatments; neuromyelitis optica; severe disease; shared decision-making; therapeutic inertia.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. The study was funded by the Medical Department of Roche Farma Spain (SL43671). The funding source had no role in the design of this study, data analysis and interpretation, review and approval of the manuscript or the decision to submit for publication.