Background

Therapeutic inertia is defined as a failure to initiate or intensify treatments despite clinical and paraclinical evidence of disease activity. Its prevalence and determining factors in Relapsing-Remitting Multiple Sclerosis (RRMS) patients in Portugal are not known.

Objectives

Our primary goal was to determine the frequency of therapeutic inertia in our RRMS patients; our secondary goal was to describe therapeutic inertia predisposing factors.

Methods

A multicentre retrospective observational study was performed. We studied patients with RRMS followed in MS Clinics of six Portuguese hospitals with at least one medical appointment during the study period (January 1^st to December 31^st 2018).

Results

We included 427 patients with RRMS, 69.6% females, with a mean age of 41.66 years-old and a mean age at diagnosis of 33.17 years-old. The average number of years since diagnosis was 8.72. MS relapses were reported on 54 patients. Median EDSS score was 1.5 (IQR=1.5). Among the 365 patients who underwent MRI during the study period, 23.8% had new T2 lesions and 7.4% had lesions with contrast enhancement. Therapeutic inertia was present in 80 patients, representing 18.7% of the total sample and 54.8% of the patients with potential to inertia (indication for treatment escalation). Patients with no more than one new T2 lesion, no gadolinium-enhancing lesions, already on a DMT, without adverse events from their current DMT and who were followed in higher care level centres were more likely to have therapeutic inertia (p<0.05). In a binary logistic regression model, the current treatment with DMT (p=0.050), the absence of adverse events (p<0.001), the higher care level (p=0.015) as defined in the Hospital Referral Network in Neurology, and the absence of relapses (p=0.021) or the presence of mild relapses (p=0.027) had an independent effect in therapeutic inertia.

Conclusions

Therapeutic inertia was present in about 1 in 5 patients, exceeding half of the population when considering all the patients with potential to inertia. The subgroup of patients with indication for therapeutic escalation and which also have less active radiological disease was associated with more therapeutic inertia, although these results were not confirmed in a multivariate analysis. Attending a higher care level center, being under DMT, absence of adverse events, and having none or mild relapses, were determining factors for therapeutic inertia.

We believe this study raises awareness to therapeutic inertia as an important problem, providing further knowledge on predisposing factors that may be adressed in MS care.

Background

Little research has studied the relationship between self-concept and depressive and anxiety symptoms and quality of life (QoL) on Multiple Sclerosis (MS). Previous studies suggested that perceived health status and self-perception seems to be affected by disease duration.

Objectives

In this study, we evaluate the impact of receiving a MS diagnosis on disease perception (expectation and knowledge), depression, anxiety, fatigue, and QoL; and how these measures interact.

Methods

Observational, cross-sectional, multicentre study, with two matched groups.

Patients up to 3 months from diagnosis date were included in Group 1 and patients with diagnosis established for 12 to 36 months were included in Group 2. A 19-item true/false questionnaire developed by the investigators was used to assess disease knowledge and expectations. The remaining outcomes were assessed though: Hospital Anxiety and Depression Scale (HADS); Fatigue Severity Scale (FSS); and EuroQoL five-dimensional instrument (EQ-5D), 3-level version.

Results

We included 90 patients from six centres (38 in the Group 1), of which 80% had a good disease knowledge whereas only 48% reported positive expectations. No differences were found between groups in demographic and clinical data. There were also no differences in disease knowledge, disease expectations, HADS, FSS, and EQ-5D. We found an inverse correlation between disease knowledge and problems in self-care (p=0.018) and fatigue (p=0.032). Patients with worse expectations about the disease were more anxious (p=0.012 on HADS and p<0.001 on EQ-5D). They also reported more problems in mobility (p=0.002), self-care (p=0.005), usual activities (p=0.009), and pain (p=0.001), having a worse health status comparing the last 12 months to the best imaginable status (p<0.001).

Conclusions

Our study showed no association between disease duration and disease knowledge, disease expectations, depression levels, anxiety, fatigue, and perceived QoL. Patients with less disease knowledge reported more problems in self-care and higher fatigue scores. Patients with worse disease expectations were more anxious and reported a worse health status. Our findings suggest that more attention should be driven to perceived health status and to depressive and anxious symptoms in MS patients.