Risk Acceptance in Multiple Sclerosis Patients on Natalizumab Treatment |
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Authors: | Carmen Tur Mar Tintoré ángela Vidal-Jordana Denis Bichuetti Pablo Nieto González María Jesús Arévalo Georgina Arrambide Elisenda Anglada Ingrid Galán Joaquín Castilló Carlos Nos Jordi Río María Isabel Martín Manuel Comabella Jaume Sastre-Garriga Xavier Montalban |
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Affiliation: | 1. Multiple Sclerosis Centre of Catalonia (Cemcat), Department of Neurology-Neuroimmunology, Vall d’Hebron University Hospital, Barcelona, Spain.; 2. Department of Neurology and Neurosurgery, Federal University of São Paulo, São Paulo, Brazil.; 3. Department of Neurology, University Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain.; Friedrich-Alexander University Erlangen, Germany, |
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Abstract: | ObjectiveWe aimed to investigate the ability of natalizumab (NTZ)-treated patients to assume treatment-associated risks and the factors involved in such risk acceptance. MethodsFrom a total of 185 patients, 114 patients on NTZ as of July 2011 carried out a comprehensive survey. We obtained disease severity perception scores, personality traits’ scores, and risk-acceptance scores (RAS) so that higher RAS indicated higher risk acceptance. We recorded JC virus status (JCV+/-), prior immunosuppression, NTZ treatment duration, and clinical characteristics. NTZ patients were split into subgroups (A-E), depending on their individual PML risk. Some 22 MS patients on first-line drugs (DMD) acted as controls. ResultsNo differences between treatment groups were observed in disease severity perception and personality traits. RAS were higher in NTZ than in DMD patients (p<0.01). Perception of the own disease as a more severe condition tended to predict higher RAS (p=0.07). Higher neuroticism scores predicted higher RAS in the NTZ group as a whole (p=0.04), and in high PML-risk subgroups (A-B) (p=0.02). In low PML-risk subgroups (C-E), higher RAS were associated with a JCV+ status (p=0.01). Neither disability scores nor pre-treatment relapse rate predicted RAS in either group.ConclusionsRisk acceptance is a multifactorial phenomenon, which might be partly explained by an adaptive process, in light of the higher risk acceptance amongst NTZ-treated patients and, especially, amongst those who are JCV seropositive but still have low PML risk, but which seems also intimately related to personality traits. |
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