AUTHOR=Saposnik Gustavo , Montalban Xavier , Selchen Daniel , Terzaghi Maria A. , Bakdache Fabien , Montoya Alonso , Fruns Manuel , Caceres Fernando , Oh Jiwon 

TITLE=Therapeutic Inertia in Multiple Sclerosis Care: A Study of Canadian Neurologists

JOURNAL=Frontiers in Neurology

VOLUME=Volume 9 - 2018

YEAR=2018

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2018.00781

DOI=10.3389/fneur.2018.00781

ISSN=1664-2295

ABSTRACT=Introduction: Limited information is available on the prevalence of therapeutic inertia (TI) and its associated factors in Canada. 

Objectives: i) To evaluate factors associated with TI amongst neurologists caring for MS patients across Canada; ii) to compare TI between Canadian neurologists with historical controls from prior studies.
 
Design: 108 neurologists with expertise in MS were invited to participate in an online study in Canada. Participants answered questions regarding their clinical practice, risk preferences, management of 10 simulated case-scenarios. TI was defined as lack of treatment initiation or escalation when there was clear evidence of clinical and radiological disease activity (8 case-scenarios, 440 individual responses). TI scores observed in the Canadian study were compared with those observed in Argentina and Chile, as both studies followed the same design, case-scenarios and methodologies. 

Results: 55 Canadian neurologists completed the study (completion rate: 50.9%). Overall, 54 of 440 (12.3%) individual responses were classified as TI. 60% of participants displayed TI in at least one case-scenario. The mean TI score across Canada [0.98 (SD=1.15)] was significantly lower than the TI score observed in the Argentinean-Chilean [1.82 (SD=1.47); p<0.001] study.  

Conclusions: TI in Canada was observed in 6 out of 10 neurologists, affecting on average 1 in 8 therapeutic decisions in MS care. TI in Canada is significantly lower than in the other studied countries. Factors associated with TI include older age, lower years of experience and willingness to risk disease progression by avoiding treatment initiation or treatment change.