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Abstract Details

Patient and Physician Perspectives on the Wearing-off Effect in Multiple Sclerosis: Results from Structured Interviews
Multiple Sclerosis
P1 - Poster Session 1 (8:00 AM-9:00 AM)
6-015
The WOE refers to symptoms such as fatigue, cognitive dysfunction, sensory symptoms, and pain that occur toward the end of treatment cycles. There is limited information available on patients' and clinicians' perspectives regarding the wearing-off phenomenon of DMTs.
To identify key symptoms reported by patients and observed by clinicians due to the wearing-off effect (WOE) associated with multiple sclerosis (MS) disease-modifying therapies (DMTs), and to better understand patient and physician perspectives on the WOE.
Thirty adults with MS and 9 clinicians underwent structured interviews, focusing on disease experience, relapse and remission, and WOE symptoms. Patients were also asked about their experience with their neurologists, while clinicians were asked about their perspective on the WOE. 
All patients recognized ≥1 WOE-associated symptoms, irrespective of the type, route of administration, and frequency of DMT received, whereas 7/9 clinicians reported observing WOE in their practice. Most patients (n=22/30) were able to differentiate WOE from relapse-related symptoms. Fatigue was the most common WOE symptom reported by patients (n=29/30) and clinicians (n=7/7) and was also indicated as the most bothersome symptom. Other common symptoms reported by patients were cognitive difficulties (28/30) and sensory dysfunction or numbness (20/30). In comparison, clinicians most often identified weakness, cognitive difficulties, or pain (n=5/7 each) as related to WOE. All patients reported WOE symptoms negatively impacted their daily activities. 25/30 patients discussed WOE symptoms with their neurologists; 15/25 patients perceived that the attention received was appropriate. The primary coping mechanisms recommended to patients included stress management and prescription of medications. Clinician perspectives on WOE varied describing it as psychosomatic manifestations, lack of efficacy, or placebo effect.
Perception and comprehension of the WOE differs between MS patients and clinicians indicating the need for effective health communication, and further work to elucidate the mechanisms of the WOE. 
Authors/Disclosures
Enrique Alvarez, MD, PhD (University of Colorado)
PRESENTER
Dr. Alvarez has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Alvarez has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TG Therapeutics. Dr. Alvarez has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Alvarez has received personal compensation in the range of $50,000-$99,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD Serono. Dr. Alvarez has received personal compensation in the range of $50,000-$99,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Alvarez has received personal compensation in the range of $50,000-$99,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Alvarez has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Alvarez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi. Dr. Alvarez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Celgene/BMS. The institution of an immediate family member of Dr. Alvarez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB. The institution of Dr. Alvarez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon. The institution of Dr. Alvarez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Motric Bio.
Joanne Fielding No disclosure on file
Ivan John Clement (Novartis) Mr. Clement has received personal compensation for serving as an employee of Novartis. Mr. Clement has stock in Roche.
Dorsa Khazaei (Evidera) No disclosure on file
Aura Cecilia Jimenez-Moreno (Evidera) No disclosure on file
Donald Bushnell No disclosure on file
Diogo Pata No disclosure on file
John Parratt No disclosure on file