The impact of patients' pre-treatment expectations on immunosuppressive treatment outcomes in myasthenia gravis: A pilot correlational study. in Muscle & nerve / Muscle Nerve. 2024 Sep;70(3):413-419. doi: 10.1002/mus.28189. Epub 2024 Jun 28.
2024
AOU Città della Salute di Torino
ASL Città di Torino
Tipo pubblicazione
Journal Article
Autori/Collaboratori (12)Vedi tutti...
Shaibani A
Department of Psychology, University of Milan-Bicocca, Milan, Italy.
Benedetti F
Rita Levi Montalcini Department of Neuroscience, University of Turin Medical School, Turin, Italy.
Lopiano L
Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Savona, Italy.
et alii...
Abstract
INTRODUCTION/AIMS: The impact of treatment expectations on active treatment outcomes has not been specifically investigated in neuromuscular disorders. We thus explored in myasthenia gravis (MG) the contribution of patients' pre-treatment expectations combined with an immunosuppressant drug on treatment outcomes. METHODS: This pilot correlational study involved 17 patients with generalized MG, scheduled to start immunosuppressant azathioprine. At baseline, a healthcare professional administered: (i) the Stanford Expectations of Treatment Scale; (ii) a structured checklist paper form asking patients which side-effects they expected to develop after starting azathioprine, coupled with a standardized framing of statements. Quantitative Myasthenia Gravis (QMG) score and daily dose of concomitant drugs were assessed by neurologists as clinical outcomes. Clinical outcomes and side-effects were re-assessed at 3 and 6?months, and clinical outcomes were monitored at 18?months. RESULTS: Clinically significant improvement in the QMG scores was achieved at 3 or 6?months. The level of state anxiety appeared to act as moderator of pre-treatment negative expectations (strong, positive, indicative correlation, rs?=?.733, p?=?.001). The latter were, in turn, associated with the fulfillment of side-effects that patients expected to develop with the new treatment (moderate, positive, indicative correlation, rs?=?.699, p?=?.002). No significant correlation emerged between positive and negative expectations. DISCUSSION: Our findings show a very quick clinical response and also suggest that patients' expectations and anxiety contributed to treatment outcomes, highlighting the importance of promoting safety messages and education strategies around newly introduced treatments. Future goals include evaluating a larger cohort that includes a matched control group.
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PMID : 38940302
DOI : 10.1002/mus.28189
Keywords
Female; side?effects; treatment expectations; placebo?related effects; quantitative myasthenia gravis score; myasthenia gravis; Anxiety/etiology/psychology; Aged; Azathioprine/therapeutic use; Adult; Treatment Outcome; Immunosuppressive Agents/therapeutic use/adverse effects; Pilot Projects; Middle Aged; Male; Myasthenia Gravis/drug therapy/psychology; Humans;