Tallantyre, Emma  ORCID: https://orcid.org/0000-0002-3760-6634, Planchon, Sarah M., Howard, Harriet, Mays, John and Frowd, Nadia
2026.
Disease-modifying treatment preferences and decision-making in a multiple sclerosis randomized and observational clinical trial (DELIVER-MS).
Multiple Sclerosis Journal
32
(7)
, pp. 722-736.
10.1177/13524585261449988
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Abstract
There is growing support for high-efficacy disease-modifying therapy (DMT) in multiple sclerosis (MS), but escalation (ESC) approaches remain common. To describe decision-making in a pragmatic trial of early high-efficacy treatment (EHT) versus ESC. DELIVER-MS is a multi-center, pragmatic, randomized controlled trial (RCT) with a parallel observational study (OBS), which enrolled treatment-naïve people with RRMS in 31 UK/US sites. Primary outcome was as follows: 36-month brain volume loss according to initial treatment approach (EHT vs. ESC). Stepwise multivariable logistic regression was used to predict participation in RCT versus OBS and choice of EHT versus ESC within the OBS cohort. In total, 816 people with MS were enrolled. Participants declined randomization due to preference for a particular DMT (85%), efficacy concerns (20%), and safety concerns (9%). RCT versus OBS participation was associated with lower relapse rate ( = 0.043) and greater brain parenchymal fraction ( = 0.002). Among 374 in the OBS cohort, 125 (33%) chose ESC and 249 (67%) chose EHT. People commencing EHT had higher education attainment ( < 0.001) and relapse rate ( = 0.025). Baseline DELIVER-MS data demonstrate that participants with milder disease are more likely to participate in RCT. The choice of EHT versus ESC was associated with demographic factors and disease activity. NCT03535298.
| Item Type: | Article |
|---|---|
| Date Type: | Publication |
| Status: | Published |
| Schools: | Schools > Medicine |
| Additional Information: | RRS policy applied. For full list of authors please see article webpage https://doi.org/10.1177/13524585261449988 |
| Publisher: | SAGE Publications |
| ISSN: | 1352-4585 |
| Date of First Compliant Deposit: | 30 June 2026 |
| Last Modified: | 30 Jun 2026 13:00 |
| URI: | https://orca.cardiff.ac.uk/id/eprint/187599 |
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