Treatment decisions: is there a need for additional support?

People with MS are faced with complicated decisions when choosing between disease-modifying therapies (DMTs). The choices people with MS tend to make, and the types of information available to help them to make those choices, have recently been discussed in two articles by Professor Dawn Langdon and colleagues, which systematically reviewed the literature in this area.1,2

Different DMTs act on the body in different ways, and each is associated with a particular set of benefits and possible side effects. Therefore, people with MS are faced with making difficult decisions when choosing between DMTs. Effective shared decision-making should facilitate understanding of the benefits and risks of each treatment, and allow people with MS to make decisions in accordance with their disease stage, personal values, needs, limitations and lifestyle.3

When given a choice between hypothetical treatments with different characteristics, Professor Langdon and colleagues noted a tendency for people with MS to favour treatments with robust benefits and seemingly high risks, over treatments with less robust benefits and lower risks. This finding suggested that it may be worth exploring how the benefits and risks of treatments are communicated to people with MS. The authors investigated the methods used to provide treatment information in a second review. They found a considerable array of educational tools to be available, with materials ranging from comprehensive educational programmes to booklets of a few pages. The authors highlighted the need for a standardized information-based tool, and called for additional support with treatment-related decision making to be made available for people with MS.



1. Reen GK, Silber E, Langdon DW. Multiple sclerosis patients' understanding and preferences for risks and benefits of disease-modifying drugs: A systematic review. J Neurol Sci. 2017;375:107–22.

2. Reen GK, Silber E, Langdon DW. Interventions to support risk and benefit understanding of disease-modifying drugs in Multiple Sclerosis patients: A systematic review. Patient Educ Couns. 2017;100:1031–48.

3. Giovannoni G, Butzkueven H, Dhib-Jalbut S et al. Brain health: time matters in multiple sclerosis. Mult Scler Relat Disord. 2016;9 Suppl 1:S5–S48.

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