title: Risk acceptance in multiple sclerosis patients on natalizumab treatment.
abstract: OBJECTIVE
  We aimed to investigate the ability of natalizumab (NTZ)-treated patients to assume treatment-associated risks and the factors involved in such risk acceptance.
  
  
  METHODS
  From a total of 185 patients, 114 patients on NTZ as of July 2011 carried out a comprehensive survey. We obtained disease severity perception scores, personality traits' scores, and risk-acceptance scores (RAS) so that higher RAS indicated higher risk acceptance. We recorded JC virus status (JCV+/-), prior immunosuppression, NTZ treatment duration, and clinical characteristics. NTZ patients were split into subgroups (A-E), depending on their individual PML risk. Some 22 MS patients on first-line drugs (DMD) acted as controls.
  
  
  RESULTS
  No differences between treatment groups were observed in disease severity perception and personality traits. RAS were higher in NTZ than in DMD patients (p<0.01). Perception of the own disease as a more severe condition tended to predict higher RAS (p=0.07). Higher neuroticism scores predicted higher RAS in the NTZ group as a whole (p=0.04), and in high PML-risk subgroups (A-B) (p=0.02). In low PML-risk subgroups (C-E), higher RAS were associated with a JCV+ status (p=0.01). Neither disability scores nor pre-treatment relapse rate predicted RAS in either group.
  
  
  CONCLUSIONS
  Risk acceptance is a multifactorial phenomenon, which might be partly explained by an adaptive process, in light of the higher risk acceptance amongst NTZ-treated patients and, especially, amongst those who are JCV seropositive but still have low PML risk, but which seems also intimately related to personality traits.
authors: Multiple Sclerosis Centre of Catalonia (Cemcat), Department of Neurology-Neuroimmunology, Vall d'Hebron University Hospital, Barcelona, Spain.
authors: Carmen
authors: C
authors: Tur
authors: Mar
authors: M
authors: Tintoré
authors: Ángela
authors: Á
authors: Vidal-Jordana
authors: Denis
authors: D
authors: Bichuetti
authors: Pablo
authors: P
authors: Nieto González
authors: María Jesús
authors: MJ
authors: Arévalo
authors: Georgina
authors: G
authors: Arrambide
authors: Elisenda
authors: E
authors: Anglada
authors: Ingrid
authors: I
authors: Galán
authors: Joaquín
authors: J
authors: Castilló
authors: Carlos
authors: C
authors: Nos
authors: Jordi
authors: J
authors: Río
authors: María Isabel
authors: MI
authors: Martín
authors: Manuel
authors: M
authors: Comabella
authors: Jaume
authors: J
authors: Sastre-Garriga
authors: Xavier
authors: X
authors: Montalban
mesh_terms: D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D009103:Multiple Sclerosis / Q000188:drug therapy / Q000523:psychology; D000069442:Natalizumab; D010349:Patient Compliance / Q000523:psychology*; D010465:Perception / Q000187:drug effects*; D012307:Risk Factors
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000069442:Natalizumab