Exploring therapeutic inertia in multiple sclerosis

 

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Comment by Dr. Daniel Selchen – St. Michael’s Hospital, Toronto, Ontario

An estimated 70% of clinicians managing multiple sclerosis experience therapeutic inertia when faced with the decision to escalate therapy, according to a series of studies conducted by Saposnik and colleagues. This delay in the use of more effective therapies may result in worse clinical outcomes.

Therapeutic inertia is a term coined a decade ago and refers to the tendency for clinicians not to start a treatment when one is needed, or to maintain status quo despite evidence of treatment ineffectiveness or worsening disease (Okonofua et al. Hypertension 2006;47:345-351).

This issue was examined in the prospective DIScUTIR MS study, which used case vignettes to investigate clinical decision-making in MS (Saposnik et al. Front Neurol 2017;8:65; free full text at www.ncbi.nlm.nih.gov/pmc/articles/PMC5331032/pdf/fneur-08-00065.pdf). Participants also completed surveys about their aversion to ambiguity in financial and clinical areas and risk preferences in different domains.

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