Patients With MS Prefer S1P Modulator With Fast Immune Recovery, Few Interactions

Patients with multiple sclerosis (MS) who are candidates for sphingosine-1-phosphate (S1P) receptor modulators likely prefer those that offer the most rapid immune system recovery and the fewest food and drug interactions. These are the findings of a study presented at the 2023 Consortium of Multiple Sclerosis Centers (CMSC) Annual Meeting, held from May 31 to June 3 in Aurora, Colorado.

The burden of treatment may vary across the S1P modulator class, for patients with relapsing-remitting MS (RRMS). Important drug-specific characteristics include immune system recovery time, interactions with other drugs or foods, and need for genetic or organ function testing. However, identifying which variables matter most to patients is uncertain.

For the study, researchers conducted a discrete-choice experiment in which 400 US-based participants with RRMS chose among hypothetical (anonymous) drugs, reporting their preferences across a spectrum of S1P-modulating drug attributes. The researchers then created a multicriteria decision analytical model, using the patients’ selections to calculate model weights for each drug criterion. The weighted criteria were matched to the known attributes of the real-world S1P modulators ponesimod, siponimod, fingolimod, and ozanimod. This allowed the researchers to estimate the probability that patients would choose each drug.

Among all drug attributes, patients most heavily prioritized immune system recovery time (relative attribute importance [RAI] = 34.6%) and drug-drug interactions (RAI = 24.2%). Interactions with foods and antidepressants were rated 3^rd and 4^th most important considerations.

Corresponding to these ratings, of the 4 considered drugs, ponesimod met the patients’ criteria most closely (predicted choice probability [PCP] = 47.7%), followed by siponimod (PCP = 39.9%). Fingolimod and ozanimod were considerably less likely to be chosen. The overall value score, under the decision analysis model, followed the same ordering.

The researchers concluded, “When clinical management considerations are considered, the average US patient is expected to choose a treatment with short immune system recovery time and few interactions with other drugs or foods.”

Authors concluded that patients may opt first for S1P modulators that minimize immune cell recovery times and food or drug interactions; and that when incorporating patient preference, clinicians should discuss these drugs‘ attributes with patients.

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.