Adherence to Therapy in Patients with Multiple Sclerosis—Review

Background: A poor patient adherence often limits the real-world effectiveness of an oral disease-modifying therapy (DMT) for multiple sclerosis (MS). In the present study, we aimed to map patient preferences, attitudes toward treatment, and quality of life to identify the predictors of non-adherence to teriflunomide. Methods: This was a single-arm, non-interventional, multicenter study (Czech Act 378/2007 Coll.) consisting of three visits: the first at treatment initiation (teriflunomide 14 mg), and then after 3 and 9 months of therapy. We enrolled both DMT-naïve and patients who had undergone a DMT diagnosed with a clinically isolated syndrome (CIS) or relapsing-remitting multiple sclerosis (RRMS). The functional status and MS activity were estimated using the Expanded Disability Status Scale (EDSS) and annualized relapse rate (ARR); the quality of life via the Multiple Sclerosis Impact Scale (MSIS-29); the medication adherence with the Morisky Medication Adherence Scale (MMAS-8); the confidence in the ability to take medications by the Self-Efficacy for Appropriate Medication Score (SEAMS); and the attitude to the therapy via the Beliefs about Medicines Questionnaire (BMQ). After nine months of therapy, we predicted the adherence to teriflunomide (MMAS-8) by fitting a multivariate ordinal logistic model with EDSS changes, gender, previous DMT, MSIS-29, BMQ, and SEAMS as the explanatory variables. Results: Between 2018 and 2019, 114 patients were enrolled at 10 sites in the Czech Republic. The mean age was 41.2 years, 64.8% were diagnosed with a CIS, 52.4% were DMT-naïve, and 98.1% of patients preferred an oral administration at the baseline. The mean EDSS baseline was 1.97 and remained constant during the 9 months of therapy. The ARR baseline was 0.72 and dropped to 0.19 and 0.15 after 3 and 9 months, respectively. Despite a more than 4-fold higher ARR baseline, the treatment-naïve patients achieved an ARR at 9 months comparable with those previously treated. There were ten non-serious adverse reactions. After nine months of teriflunomide therapy, 63.3%, 21.2%, and 15.4% of patients had a high, medium, and low adherence, respectively, as per the MMAS-8; 100% of patients preferred an oral administration. The SEAMS score (odds ratio (OR) = 0.91; p = 0.013) and previous DMT (OR = 4.28; p = 0.005) were the only significant predictors of non-adherence. The disability, the quality of life, and beliefs about medicines had no measurable effect on adherence. Conclusion: After nine months of teriflunomide therapy, both the disability and quality of life remained stable; the relapse rate significantly decreased, 63.3% of patients had a high adherence, and 100% of patients preferred an oral administration. A low adherence was associated with previous DMT experiences and a low self-efficacy for the appropriate medication (i.e., the confidence in one’s ability to take medication correctly).

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“…Regular distant and on-site monitoring visits were conducted. We reported in line with the STROBE statement [ 26 ].…”

Section: Methodssupporting

confidence: 78%

Relationship between Patient Preferences, Attitudes to Treatment, Adherence, and Quality of Life in New Users of Teriflunomide

Štrosová¹,

Tužil

Turková³

et al. 2022

Pharmaceuticals

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“…The SPMS subtype requires disability progression following the initial diagnosis of RRMS [ 3 ]. Several disease modifying treatments (DMTs) are currently in use in order to manage the ongoing disease activity in an attempt to control relapses and disability progression [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

The Role of Diet and Interventions on Multiple Sclerosis: A Review

et al. 2022

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Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system (CNS) characterized by inflammation and neurodegeneration. The most prominent clinical features include visual loss and sensorimotor symptoms and mainly affects those of young age. Some of the factors affecting its pathogenesis are genetic and/or environmental including viruses, smoking, obesity, and nutrition. Current research provides evidence that diet may influence MS onset, course, and quality of life of the patients. In this review, we address the role of nutrition on MS pathogenesis as well as dietary interventions that show promising beneficial results with respect to MS activity and progression. Investigation with large prospective clinical studies is required in order to thoroughly evaluate the role of diet in MS.

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“…Interestingly, forgetfulness is the most common cause of poor adherence in our study and is also indicated in many studies. 5,13,23 To our knowledge, there are no studies in our country which address the five dimensions in the WHO model of medication adherence. In other regions, some studies identified several key factors associated with adherence, such as age, gender, disability, depression, cognition or treatment satisfaction.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, the variables "satisfaction with the neurologist", "presence of comorbidities" and "time since MS diagnosis (chronicity)" were initially considered for the multivariate analysis based on previous evidence. 8,13,23 Third, we applied the best subsets regression method with the goodness of fit (R 2 ) metric to identify the variables that best predict the adherence to MS treatment. One of the advantages of this method, compared to other common strategies such as stepwise regression, is the capacity to identify combinations of variables without eliminating any of them in the process.…”

Section: Methodsmentioning

confidence: 99%

“…12 In MS, a variety of factors were associated with adherent patients, including age, cognition, depression, treatment satisfaction, duration of the disease, severity of disease, comorbidities, route of administration, perceived lack of efficacy and adverse effects of the drugs. 5,13 The reasons for non-adherence in MS are complex but can be addressed through appropriate interventions by health professionals, 14 especially those factors that can be modified, such as beliefs about medication. Only a few studies have jointly assessed these psychological predictors of non-adherence in the MS population.…”

Section: Introductionmentioning

confidence: 99%

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Factors Associated with Therapeutic Adherence in Multiple Sclerosis in Spain

Soria¹,

Prieto²,

Lázaro³

et al. 2023

PPA

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Adherence to disease-modifying therapies (DMTs) in multiple sclerosis (MS) is a complex and multidimensional phenomenon. Identifying the predictors of therapeutic adherence in MS will guide the design of interventions to improve health outcomes. Our aim was to assess the degree of adherence to pharmacological treatments, assess the relationship between patientrelated factors and pharmacological adherence and to identify predictors of adherence to pharmacological treatments in patients with MS in Spain. Patients and Methods:A cross-sectional nationwide study was carried out in Spain between December 2020 and September 2021. The web-based evaluation protocol consisted of a self-questionnaire survey designed ad hoc and the application of validated questionnaires to assess adherence, as well as beliefs about medication and quality of life. Predictor variables of adherence to MS treatment were assessed using multivariate analysis. Results: A total of 152 patients with MS participated (mean age: 44 years; 64% were female; and 78% had relapsing-remitting MS). Seventy-three percent of the patients reported being adherent to their pharmacological treatment for MS. Forgetfulness was the most common cause of non-adherence. Necessity beliefs and concerns beliefs were not statistically associated with adherence. The adherent group shows statistically significant better levels of quality of life in the cognitive function subscale than the non-adherent participants (p=0.040). Role limitations-emotional, emotional well-being and overall quality of life were not significantly associated with adherence. Predictors with a statistical association with adherence to treatment were years of education (OR=0.79; 95% CI: 0.65-0.96; p=0.020) and intravenous treatment (OR=3.17; 95% CI: 1.07-9.45; p=0.038). Conclusion:We found an adequate adherence to pharmacological treatment. Low education and intravenous treatment were significant predictors of adherence to DMTs.

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Adherence to Therapy in Patients with Multiple Sclerosis—Review

Cited by 31 publications

References 74 publications

Relationship between Patient Preferences, Attitudes to Treatment, Adherence, and Quality of Life in New Users of Teriflunomide

Relationship between Patient Preferences, Attitudes to Treatment, Adherence, and Quality of Life in New Users of Teriflunomide

The Role of Diet and Interventions on Multiple Sclerosis: A Review

Factors Associated with Therapeutic Adherence in Multiple Sclerosis in Spain

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