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Utility of the Canadian Treatment Optimization Recommendations (TOR) in MS Care

Published online by Cambridge University Press:  23 September 2014

François Grand'Maison ,
Virender Bhan ,
Mark S. Freedman ,
Mary L. Myles ,
David G. Patry ,
Daniel H. Selchen ,
Patrick Moriarty  and
Anthony L. Traboulsee
François Grand'Maison*
Affiliation:
Department of Medicine (Neurology), University of Sherbrooke, Hôpital Charles LeMoyne, Greenfield Park, Quebec
Virender Bhan
Affiliation:
Department of Medicine (Neurology), Dalhousie University, Halifax, Nova Scotia
Mark S. Freedman
Affiliation:
Department of Medicine (Neurology), The Ottawa Hospital Research Institute, University of Ottawa, Ottawa
Mary L. Myles
Affiliation:
Department of Medicine (Neurology), University of Alberta, Edmonton
David G. Patry
Affiliation:
Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta
Daniel H. Selchen
Affiliation:
Division of Neurology, St. Michael's Hospital, University of Toronto, Toronto
Patrick Moriarty
Affiliation:
Division of Neurology, EMD Serono Canada Inc., Mississauga, Ontario
Anthony L. Traboulsee
Affiliation:
Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada
*
Division of Neurology, University of Sherbrooke, Hôpital Charles LeMoyne, Greenfield Park, Quebec, J1H 5N4, Canada Email: fgrandm@videotron.ca
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Abstract

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Objectives:

Criteria for Treatment Optimization Recommendations (TOR) for patients with multiple sclerosis (MS) identify suboptimal response to disease-modifying treatment (DMT). The Canadian TOR (CanTOR) were used to indicate recommendations for treatment switches or treatment maintenance based on relapse, disease progression and magnetic resonance imaging (MRI) criteria in patients. We assessed concordance between the TOR and clinicians' decisions regarding treatment response and identified prevalence of patients with MS receiving DMT meeting medium/high levels of concern according to TOR.

Methods:

Prospective baseline and end-of-study assessments of patients with relapsing-remitting MS (RRMS) or clinically isolated syndrome were conducted in this open-label, 12-month, Phase IV, observational Canadian study.

Results:

Data were reported for 184 patients (female 72%, mean age 39 years) of which 96% had RRMS. The TOR criteria identified 19 (10.3%) patients with suboptimal response to treatment. Twelve patients had ≥1 high level of concern. Two patients had ≥2 medium levels of concern. Concordance between TOR and clinician decision in maintaining treatment was 95.3%. Where treatment change was recommended by the TOR, concordance was 29.4%. Clinicians identified the TOR as the principal reason for changing treatment in 50.0% of cases where the TOR identified suboptimal response. The TOR were considered useful by 70.6% of clinicians when treatment optimization was recommended and by 55.3% when maintaining treatment was recommended.

Conclusions:

The TOR criteria can identify suboptimal response in this patient cohort. Concordance between TOR and clinician decision was high when maintaining treatment was recommended. Usefulness of the TOR was most apparent when treatment optimization was recommended.

Résumé:

Résumé:

Utilité des recommandations canadiennes pour l'optimisation du traitement dans les soins prodigués aux patients atteints de SP.

Objectifs:

Les critères des recommandations pour l'optimisation du traitement (TOR) chez les patients atteints de sclérose en plaques (SP) aident à identifier une réponse sous-optimale aux traitements modifiant l'évolution de la maladie (TMM). Les TOR canadiennes ont été utilisées pour indiquer que le traitement doit être modifié ou maintenu, en tenant compte des poussées, de la progression de la maladie et de critères identifiés à l'IRM chez les patients. Nous avons évalué la concordance entre les TOR et les décisions des cliniciens selon la réponse au traitement et nous avons déterminé la prévalence de patients atteints de SP qui reçoivent un TMM qui suscite un niveau moyen/élevé de préoccupation selon les TOR. Méthode : Il s'agit d'une étude canadienne d'observation prospective et ouverte, de phase IV, d'une durée de 12 mois, comportant une évaluation initiale et une évaluation de fin d'étude de patients atteints de SP rémittente (SPR) ou d'un syndrome clinique isolé.

Résultats:

Les données de 184 patients atteints pour la plupart de SPR (96%), dont 72% étaient des femmes et dont l'âge moyen était de 39 ans, ont été recueillies. Dix-neuf patients (10,3%) présentaient une réponse sous-optimale au traitement selon les critères TOR. Chez 12 patients le niveau de préoccupation était ≥ 1 soit élevé. Chez 2 patients il était ≥ 2 ou moyen. La concordance entre les TOR et la décision clinique de maintenir le traitement en cours était de 95,3%. Quand un changement de traitement était recommandé par les TOR, la concordance était de 29,4%. Les cliniciens ont identifié les TOR comme étant la raison principale pour changer le traitement dans 50,0% des cas où les TOR identifiaient une réponse sous-optimale. Les TOR étaient considérées comme étant utiles par 70,6% des cliniciens quand une optimisation du traitement était recommandée et par 55,3% quand la recommandation était de maintenir le traitement.

Conclusions:

Les critères TOR peuvent identifier une réponse sous-optimale chez cette cohorte de patients. La concordance entre les TOR et la décision du clinicien était élevée quand la recommandation était de maintenir le traitement. La situation dans laquelle l'utilité des TOR était la plus évidente était quand la recommandation était d'optimiser le traitement.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 40 , Issue 4 , July 2013 , pp. 527 - 535
Copyright
Copyright © The Canadian Journal of Neurological 2013

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