Adherence and persistence to drug therapies for multiple sclerosis: A population-based study

Evans, Charity; Marrie, Ruth Ann; Zhu, Feng; Leung, Stella; Lu, Xinya; Melesse, Dessalegn Y.; Kingwell, Elaine; Zhao, Yinshan; Tremlett, Helen

doi:10.1016/j.msard.2016.05.006

Cited by 60 publications

(62 citation statements)

References 36 publications

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“…In addition, the outcomes could have been affected by variability in the clinical management of patients, a reflection of the existing lack of consensus on criteria for progression to treatment, a factor that we have not analysed. Our estimations for persistence at 6 months and 1 year are higher than those obtained in studies conducted with large healthcare system databases such as the cohort studies by Evans et al 15 and Reynolds et al 16 Sample size is probably a decisive factor for these differences.…”

Section: Discussioncontrasting

confidence: 86%

Persistence and adherence to interferon and glatiramer acetate in patients with multiple sclerosis

et al. 2017

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ObjectivesTo analyse persistence and adherence in patients with multiple sclerosis receiving first-line treatment with subcutaneous glatiramer acetate 20 mg (GA), subcutaneous interferon β1a (IFNβ1a-sc), intramuscular interferon β1a (IFNβ1a-im) and subcutaneous interferon β1b (IFNβ1b-sc) and to identify associated factors and reasons for discontinuation.MethodsAn observational retrospective study was performed between January 1999 and November 2014. Persistence was defined as the time from treatment initiation until discontinuation, and adherence as the number of units dispensed since treatment initiation until its interruption divided by the theoretical number of units needed to cover said period as a percentage. A patient was considered adherent if ≥95%. Persistence was measured using the Kaplan–Meier method and univariate Cox regression; adherence was measured using a univariate binary logistical regression model.ResultsThe study included 224 patients. The median persistence was 1349 days (95% CI 1017.4 to 1680.6). Patients receiving IFNβ1a-im continued treatment for a longer time (1720 days; 95% CI 1196.8 to 2243.2), while patients treated with IFNβ1a-sc had the lowest persistence (771 days; 95% CI 377.4 to 1164.6) (HR=1.7; 95% CI 1.02 to 2.72). Patients with Expanded Disability Status Scale (EDSS) 1.5–6 discontinued treatment earlier than those with EDSS 0–1 (HR 1.5; 95% CI 1.01 to 2.25); 94.4% of patients discontinued treatment due to medical decision, primarily due to lack of efficacy (24.6%) and adverse effects (17.4%), while 80.8% of patients had good adherence. GA had the highest adherence, with no major difference from IFNβ1a-im, while IFNβ1b-sc showed the highest non-adherence (OR 3.5; 95% CI 1.29 to 9.28).ConclusionsThe persistence levels obtained were lower than in similar studies. EDSS was identified as an independent predictor of treatment interruption. Acceptable adherence was achieved among the population, comparable to other studies and influenced by the drug.

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Section: Discussioncontrasting

confidence: 86%

Persistence and adherence to interferon and glatiramer acetate in patients with multiple sclerosis

et al. 2017

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“…Second, the different time periods explored in self-report and pharmacy records (30 days vs. 1 year) likely contributed to the fair to moderate agreement between the 2 sources. Rates of nonadherence in MS increase with longer follow-up time [14]. Last, we assessed adherence using a fixed MPR, which takes into account not only compliance but also persistence (continuing treatment for the prescribed duration).…”

Section: Discussionmentioning

confidence: 99%

“…Despite the regularity with which self-report and pharmacy records are employed in research [6,7,12,14], little is known about the agreement between the 2 methods. We aimed to compare self-reported DMT use and adherence against pharmacy records.…”

Section: Introductionmentioning

confidence: 99%

Disease-Modifying Therapies and Adherence in Multiple Sclerosis: Comparing Patient Self-Report with Pharmacy Records

et al. 2017

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Background: Self-report and pharmacy records are often used to measure adherence rates to disease-modifying therapies (DMTs) in multiple sclerosis (MS), but little is known about how the sources compare. Objective: Compare self-report and pharmacy records for assessing DMT use and adherence rates. Methods: Demographic information, self-reported DMT use, and missed DMT doses in the previous 30 days were obtained from consecutive MS patients attending an MS clinic and linked to pharmacy records. A medication possession ratio (MPR) was calculated using pharmacy records for the year before and after the visit; MPR <80% defined nonadherence. Agreement between self-report and pharmacy records was assessed using Cohen's kappa (κ). Results: Of 326 participants, 135 reported using an injectable DMT. There was near-perfect and perfect agreement between self-report and pharmacy records for DMT use (κ = 0.95; 95% CI 0.91-0.98) and DMT agent (κ = 1.00). Nonadherence was estimated at 13% (17/128) from the 30-days self-report compared to 30% (34/113) and 43% (53/123) in the year pre- and post-clinic visit from pharmacy records, indicating moderate to fair agreement (year prior: κ = 0.41; 95% CI 0.22-0.59; year post: κ = 0.22; 95% CI 0.09-0.36). Conclusions: Patients self-reports closely reflected pharmacy records when assessing DMT use and product. Moderate to fair agreement was found when comparing adherence rates between sources.

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“…This is considered sub-therapeutic. From a study of three western Canadian provinces, Evans et al report the proportion of days covered by DMTs ≥ 0.8 for only 76.4% (95%CI: 69.1 -82.4%) of subjects at one year 35 . Over the period of the study (1996-2012) the combined proportion of subjects with optimal adherence was 42.4% (95% CI: 32.5% -52.9%).…”

Section: Adherence and Persistencementioning

confidence: 99%

Multiple Sclerosis and the Comparative Value Disease Modifying Therapy Report of the Institute for Clinical and Economic Review (ICER)

Langley

2017

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Adherence and persistence to drug therapies for multiple sclerosis: A population-based study

Cited by 60 publications

References 36 publications

Persistence and adherence to interferon and glatiramer acetate in patients with multiple sclerosis

Persistence and adherence to interferon and glatiramer acetate in patients with multiple sclerosis

Disease-Modifying Therapies and Adherence in Multiple Sclerosis: Comparing Patient Self-Report with Pharmacy Records

Multiple Sclerosis and the Comparative Value Disease Modifying Therapy Report of the Institute for Clinical and Economic Review (ICER)

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