Choosing Drugs

Lynd LD, Traboulsee A, Marra CA, Mittmann N, Evans C, Li KH, Carter M, Hategekimana C.Quantitative analysis of multiple sclerosis patients' preferences for drug treatment: a best-worst scaling study. Ther Adv Neurol Disord. 2016;9(4):287-96.

OBJECTIVES:The objective of this study was to elicit patients' preferences for different attributes of MS drug therapy.
METHODS: A representative sample of patients with MS across Canada (n=189) participated in a best-worst scaling study to quantify preferences for different attributes of MS drug therapy, including delaying progression, improving symptoms, preventing relapse, minor side effects, rare but serious adverse events (SAEs), and route of administration.
RESULTS: Analysis revealed heterogeneity of preferences across respondents, with preferences differing across five classes. The most important attributes of drug therapy were the avoidance of SAEs for three classes and the improvement of symptoms for two other classes. Only a smaller group of patients demonstrated a specific preference for avoiding SAEs, and route of administration.
CONCLUSION: This study shows that preferences for drug therapy among patients with MS are different, some of which can be explained by experiences with their disease and treatment. These findings can help to inform the focus of interactions that healthcare practitioners have with patients with MS, as well as further drug development.

This study looks at peoples preferences and then they divided people into different groups


What this study says is depending on the drug will influence why you choose it. It appears that one selects the more effective drugs based on their efficacy and the less efficacious drugs based on their side effect. Should this define how we develop drugs?

I don't think we should developing drugs that don't work very well we have enough of them already, we should aim for agents that work. 

However, risk aversion appears to play an important part and so it is understandable that people want drugs that work but drugs that have as low a side effect as possible. However when you are using a sledge hammer to crack a nut as we are now doing, these two desires are poles apart. If the immune system is the problem and you smash it , it means you can't fight infections etc.

The only way to get the high efficacy with the low side effect profile if MS is an autoimmune system, is to develop antigen-specific therapy. Should you hold your breath for this?

No it is not coming soon.  There are only phase II studies in progress and in my opinion some of these are not going to make it. 

I was at a meeting recently and a load of people said to me that, they think the only way it will work if the mechanism is by bystander suppression. The idea is that the regulatory cell produces an inhibitory cytokine response to suppress other immune cells in the local environment.

Yes I buy the idea, but the reality so far has been universal failure.

Also if you suppress other unrelated immune responses in an environment then why would this not suppress your responsiveness to an immune response against an infection in the brain? 

However, I really wonder if these antigen-specific therapies actually work in the CNS or do they actually work by suppressing the immune response in the peripheral circulation?

If this is the case directing the suppressing cells to myelin basic protein to supress and immune response against myelin oligodendrocyte glycoprotein or proteolipid protein as you may do in  bystander suppression, may be irrelevant if the target for suppression is say within the lymph glands, what will secreting IL-10 there do?

Labels: