Insights on diagnosis and therapeutic decision-making patterns for multiple sclerosis treatment: cross-sectional opinion survey results from Japanese neurologists

Abstract

Background: There are few reports about the actual state of diagnosis for multiple sclerosis (MS) in Japan. In addition, in late years multiple disease-modifying drugs (DMDs) were released in Japan, but there are few reports of the actual treatment situation including the choice of DMD as well. Therefore, we conducted a questionnaire survey involving neurologists across Japan to investigate the current practices of diagnosing and determining the treatment strategy for MS. Method(s): A case-based survey was conducted among Japanese neurologists currently treating MS patients with DMD to understand the current situation of MS diagnosis and treatment policy determination in Japan. Respondents were divided into tertiles, group 1 (one to three), group 2 (four to nine) and group 3 (>= ten) by the number of MS patients under management. Results were evaluated as the whole and in each group. Consensus opinion was defined a priori as at least 75% agreement. Result(s): Effective responses were obtained from 205 neurologists by web-based survey. 86.3% of the respondents answered that they are able to diagnose MS in accordance with the 2010 revised McDonald criteria for MS. This proportion increased in accordance with the abundance of experience gained treating MS patients (trend test: p < 0.014). All the respondents answered that magnetic resonance imaging (MRI) was to be used for all suspected clinical relapse regardless of the presence or absence of new signs on any neurological examinations, and even when no neurological exams were performed, suggesting that they value MRI testing as a key criterion for diagnosing MS regardless of treatment experience. While no consensus was achieved on DMD selection to treat naive patients with different disease activities, most of the respondents answered to choose either IFNbeta products or fingolimod. The neurologists with abundant treatment experience (group 3) would change DMD as the disease activity increased, whereas the less experienced groups (group 1 and 2) replied that they would choose the same DMDs regardless of disease activity level. Conclusion(s): The present study shed light on diagnosis and treatment decision-making patterns for MS in Japan.Copyright © 2018 The Author(s).