Adherence to First-Line Disease-Modifying Therapy for Multiple Sclerosis in Kuwait

Abstract

The aim of this retrospective study was to determine the rate of nonadherence to disease-modifying therapies (DMTs) among multiple sclerosis (MS) patients in Kuwait and to identify reasons for patient discontinuation of long-term therapy. Using a newly established MS registry at our institution, we collected data on MS patients' demographics, clinical characteristics, disability measures, and continuation or discontinuation of first-line DMTs. Reasons for nonadherence were divided into four categories: adverse events, inconvenience, perceived lack of efficacy, and physician-documented disease progression. Of 212 eligible patients, 40.1% were found to be nonadherent to first-line DMTs. In the nonadherent group, the female-to-male ratio was 1.75:1 and the mean age at disease onset was 26.8 years. Of this group, 69.4% of patients had a relapsing-remitting course, 18.8% had a secondary progressive course, and 11.8% had clinically isolated syndrome. Compared with the adherent group, the nonadherent group had a shorter mean disease duration (P = .014) and a greater likelihood of having Expanded Disability Status Scale (EDSS) scores of 3 or lower (67.1% vs. 48.0%; P = .007). Inconvenience was the most common reason for nonadherence (32.9%), followed by perceived lack of efficacy (25.9%), adverse events (23.5%), and physician-documented disease progression (17.7%). In summary, the rate of nonadherence to first-line DMTs in MS patients at our institution is considered high. Most nonadherent patients had a short disease duration and low EDSS scores. Inconvenience and perceived lack of efficacy were the most common reasons for nonadherence. The results demonstrate a need to improve treatment adherence among MS patients in Kuwait through providing better patient education, improving communication between patients and health-care providers, defining therapy expectations, and instituting new therapeutic techniques. Int J MS Care. 2012;14:17-24.

Risk Factors for Poor Adherence to Betaferon® Treatment in Patients with Relapsing-Remitting Multiple Sclerosis or Clinically Isolated Syndrome

“…Our results are only partly in line with the study by Alroughani et al, who found that in a Kuwait population those who did not adhere to therapy had a shorter mean disease duration and a greater likelihood of having EDSS scores of 3 or lower compared with those who did adhere to therapy [ 24 ]. Inconvenience was the most common reason for non-adherence (32.9%), followed by perceived lack of efficacy (25.9%), adverse events (23.5%), and physician-documented disease progression (17.7%) [ 24 ]. Devonshire et al reported that adherent patients had shorter disease duration, and a shorter duration of therapy, than non-adherent patients [ 25 ].…”

“…Our study shows that constant patient support during MS treatment is important. Support offered by healthcare personnel, such as nurses, physician assistants or neurologists, may alleviate some of the problems that occur during MS therapy [ 24 ]. Support from the caregivers may also influence treatment adherence; however, we could not confirm this from the results of our study.…”