The Impact of Reproductive Issues on Preferences of Women with Relapsing Multiple Sclerosis for Disease-Modifying Treatments

Background Relapsing–remitting multiple sclerosis (RRMS) is an incurable disease characterised by relapses (periods of function loss) followed by full or partial recovery, and potential permanent disability over time. Many disease-modifying treatments (DMTs) exist that help reduce relapses and slow disease progression. Most are contraindicated during conception/pregnancy and some require a discontinuation period before trying to conceive. Although around three-quarters of people with RRMS are women, there is limited knowledge about how reproductive issues impact DMT preference. Objective The aim of this study was to measure the preferences for DMTs of women with RRMS who are considering pregnancy. Design An online discrete choice experiment (DCE). Methods Participants chose between two hypothetical DMTs characterised by a set of attributes, then indicated if they preferred their choice to no treatment. Attributes were identified from interviews and focus groups with people with RRMS and MS professionals, as well as literature reviews, and included the probability of problems with pregnancy, discontinuation of DMTs, and breastfeeding safety. In each DCE task, participants were asked to imagine making decisions in three scenarios: now; when trying to conceive; and when pregnant. Analysis Two mixed logit models were estimated, one to assess the statistical significance between scenarios and one in maximum acceptable risk space to allow comparison of the magnitudes of parameters between scenarios. Sample Women with RRMS who were considering having a child in the future, recruited from a UK MS patient register. Results Sixty respondents completed the survey. Participants preferred no treatment in 12.6% of choices in the ‘now’ scenario, rising significantly to 37.6% in the ‘trying to conceive’ scenario and 60.3% in the ‘pregnant’ scenario (Kruskal–Wallis p