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Table 4 Timing for initiation of DMD treatment and follow-up MRI for the case scenarios

From: Insights on diagnosis and therapeutic decision-making patterns for multiple sclerosis treatment: cross-sectional opinion survey results from Japanese neurologists

Case scenario, questions and answers Overall (n = 205) Sub-group by the number of MS patients under care P value
Group 1: 1–3 patients (n = 69) Group 2: 4–9 patients (n = 58) Group 3: ≥10 patients (n = 78) Group comparison*,† Trend test
Case 1: A 25-year-old man with RRMS and 2 clinical relapses in the last 4 years is treatment naïve and presents with a normal neurologic exam. A recent MRI reveals 5 non-enhancing T2 lesions in the brain.
Question 1: Would you initiate DMD# treatment?
Yes, n (%) 187 (91.2) 63 (91.3) 53 (91.4) 71 (91.0) 0.988a 0.953b 0.943c 0.951
Question 2: If you answered yes in Question 1, when would you perform the follow-up MRI?
 Follow-up timing, n/187 (%) §
   ≤ 3 months 62 (33.2) 22 (34.9) 17 (32.7) 23 (32.4) 0.480a 0.331b 0.197c 0.657
   > 3– ≤6 months 98 (52.4) 31 (49.2) 25 (48.1) 42 (59.2)
   > 6– ≤12 months 24 (12.8) 10 (15.9) 8 (15.1) 6 (8.5)
   > 12 months 2 (1.1) 0 (0.0) 2 (3.8) 0 (0.0)
Case 2: Assume that you are presented with the Case 1 patient with RRMS who remains as treatment naïve and has had 2 clinical relapses in close proximity (last 6 months) that have left him with a residual disability. MRI reveals multiple, extensive, non-enhancing T2 lesions in the brain, brainstem, and spinal cord.
Question 3: Would you initiate DMD# treatment?
Yes, n (%) 198 (96.6) 65 (94.2) 57 (98.3) 76 (97.4) 0.240a 0.323b 0.742c 0.294
Case 3: Assume that you are presented with the Case 1 patient with RRMS who remains as treatment naïve and has had 2 clinical relapses in close proximity (last 6 months) that have left him with residual disability. MRI shows multiple, extensive, non-enhancing T2 lesions in the brain, brainstem, and spinal cord; multiple T1 hypointense lesions; and brain atrophy.
Question 4: Following initiation of therapy, when would you perform a follow-up MRI?
 Follow-up timing, n/205 (%)
   ≤ 3 months 95 (46.3) 36 (52.2) 24 (41.4) 35 (44.9) 0.200a 0.626b 0.411c 0.400
   > 3– ≤6 months 86 (42.0) 28 (40.6) 23 (39.7) 35 (44.9)
   > 6– ≤12 months 23 (11.2) 5 (7.2) 10 (17.2) 8 (10.3)
   > 12 months 1 (0.5) 0 (0.0) 1 (1.7) 0 (0.0)
  1. DMD disease-modifying drug, DMT disease-modifying therapy, MRI magnetic resonance imaging, MS multiple sclerosis, RRMS relapsing-remitting multiple sclerosis, SC IFNβ-1b subcutaneous interferon beta-1b, IM IFNβ-1a intramuscular interferon beta-1a, JCV John Cunningham virus
  2. *Percentages were compared in groups of two using the chi-square test, and the corresponding p-values are indicated for the following comparisons: a: Group 1 vs. Group 2, b: Group 1 vs. Group 3, c: Group 2 vs. Group 3
  3. The distributions of selected DMDs were compared among the three groups using the chi-square test
  4. The trend across the three groups was tested using the Cochran-Armitage test for a binominal response or Cochrane-Mantel-Haenszel test for a multiple response
  5. #In the actual question, the term DMT was used instead of DMD added supplementary explanation which means DMD
  6. §Responses of only those who reported that they would initiate DMD for each case were calculated