A collaborative approach between physicians and patients
In Prof. Pozo-Rosich’s opinion, defining the ‘right’ treatment and the ‘right’ patient are matters of perspective. Indeed, physicians need to be aware that there is no single ‘right’ answer and that their patient’s perspective needs to be considered in the treatment decision-making process. While the overall goal of treatment for both physicians and patients is to improve life and minimise burden, it is crucial to enquire about which specific treatment outcomes are the most important for a particular patient. It is only when physicians and patients collaborate that the principles of precision medicine can be applied and the ‘right’ treatment is chosen for the ‘right’ patient.
Incorporating patient preferences and patient-reported outcomes into clinical practice
Patient preferences can be used to inform physicians on desired treatment outcomes. According to the results obtained from a patient questionnaire, most patients agreed that efficacy is the most important treatment outcome in headache disorders, for both symptomatic and preventative treatment.1 Patient preferences and global treatment satisfaction are essential components when deciding on a treatment course. Prof. Pozo-Rosich proceeded to highlight that patient-reported outcomes (PROs) allow for a more precise quantification of patient preferences compared with global satisfaction. She further stressed that learnings from PROs monitored in clinical trials should also be incorporated into clinical practice.
“The right patient needs the right treatment when migraine has a disabling impact on their life.”
– Patricia Pozo-Rosich (Vall d’Hebron University Hospital of Barcelona, Spain)
As outlined in a recent review, several different PRO tools were used in clinical trials of CGRP antibodies.2 However, questions remain about the validity of the selected tools and outcomes. In particular, Prof. Pozo-Rosich pointed out that current tools capture baseline and final outcomes, and that new evaluations are needed to better represent the progressive changes experienced by patients during treatment. Furthermore, based on unpublished data from Dr Gil-Gouveia and colleagues, 41% of physicians disagreed with patients when evaluating treatment outcomes. These results suggest a disconnect between physicians and patients with respect to the selection of desired treatment outcomes.
Finding middle ground
For both patients and physicians, treatment should result in fast and significant improvements when migraine has a profoundly disruptive impact on the patient, their family, their work and society as a whole. Physicians should consider different aspects of the patient’s life, use appropriate PROs and leverage their own clinical experience when deciding on a treatment course. Physicians should also look out for patient cues to help guide them towards the ‘right’ treatment for that person. Prof. Pozo-Rosich ended her presentation by encouraging the audience to incorporate patient preferences and PROs into their daily clinical practice.
Mitsikostas DD, et al. Patients’ preferences for headache acute and preventive treatment. J Headache Pain. 2017;18:102.
Torres-Férrus M, et al. How much do calcitonin gene-related peptide monoclonal antibodies improve the quality of life in migraine? A patient’s perspective. Curr Opin Neurol. 2019;32:395–404.