title: Patient perspectives on switching disease-modifying therapies in the NARCOMS registry.
abstract: BACKGROUND
  The evolving landscape of disease-modifying therapies (DMTs) for multiple sclerosis raises important questions about why patients change DMTs. Physicians and patients could benefit from a better understanding of the reasons for switching therapy.
  
  
  OBJECTIVE
  To investigate the reasons patients switch DMTs and identify characteristics associated with the decision to switch.
  
  
  METHODS
  The North American Research Committee on Multiple Sclerosis (NARCOMS) Registry conducted a supplemental survey among registry participants responding to the 2011 update survey. The supplemental survey investigated reasons for switching DMT, origin of the discussion of DMT change, and which factors influenced the decision. Chi-square tests, Fisher's exact tests, and logistic regression were used for the analyses.
  
  
  RESULTS
  Of the 691 eligible candidates, 308 responded and met the inclusion criteria (relapsing disease course, switched DMT after September 2010). The responders were 83.4% female, on average 52 years old, with a median (interquartile range) Patient-Determined Disease Steps score of 4 (2-5). The most recent prior therapy included first-line injectables (74.5%), infusions (18.1%), an oral DMT (3.4%), and other DMTs (4.0%). The discussion to switch DMT was initiated almost equally by physicians and participants. The primary reason for choosing the new DMT was based most frequently on physician's recommendation (24.5%) and patient perception of efficacy (13.7%).
  
  
  CONCLUSIONS
  Participants frequently initiated the discussion regarding changing DMT, although physician recommendations regarding the specific therapy were still weighed highly. Long-term follow-up of these participants will provide valuable information on their disease trajectory, satisfaction with, and effectiveness of their new medication.
authors.affiliation: Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Amber R
authors.initials: AR
authors.lastname: Salter
authors.affiliation: Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada ; Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
authors.forename: Ruth Ann
authors.initials: RA
authors.lastname: Marrie
authors.affiliation: Novartis Pharmaceutical Corporation, East Hanover, NJ, USA.
authors.forename: Neetu
authors.initials: N
authors.lastname: Agashivala
authors.affiliation: Novartis Pharmaceutical Corporation, East Hanover, NJ, USA.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Belletti
authors.affiliation: Novartis Pharmaceutical Corporation, East Hanover, NJ, USA.
authors.forename: Edward
authors.initials: E
authors.lastname: Kim
authors.affiliation: Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Gary R
authors.initials: GR
authors.lastname: Cutter
authors.affiliation: Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Stacey S
authors.initials: SS
authors.lastname: Cofield
authors.affiliation: Division of Neurology, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
authors.forename: Tuula
authors.initials: T
authors.lastname: Tyry
keywords: health communication; multiple sclerosis