Factors Affecting the Adherence to Disease-Modifying Therapy in Patients With Multiple Sclerosis

Erbay, Öznur; Yeşilbalkan, Öznur Usta; Yüceyar, Nur

doi:10.1097/jnn.0000000000000395

Cited by 25 publications

(31 citation statements)

References 4 publications

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“…MS specialists are aware of discontinuation in more than one in every 14 patients. Since physicians tend to over-estimate adherence in patients, and MS DMT adherence ranges from 46 to 97% in non-pandemic times [15][16][17], the number of people living with MS taking their DMTs on schedule is likely even lower than estimated here.…”

Section: Summary Of Qualitative Responsesmentioning

confidence: 78%

Impact of COVID-19 on U.S. and Canadian neurologists’ therapeutic approach to multiple sclerosis: a survey of knowledge, attitudes, and practices

et al. 2020

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Objective To report the understanding and decision-making of neuroimmunologists and their treatment of patients with multiple sclerosis (MS) during the early stages of the SARS-CoV-2 (COVID-19) outbreak. Methods A survey instrument was designed and distributed online to neurologists in April 2020. Results There were 250 respondents (response rate 21.8%). 243 saw > = 10 MS patients in the prior 6 months (average 197 patients) and were analyzed further (92% USA, 8% Canada; average practice duration 16 years; 5% rural, 17% small city, 38% large city, 40% highly urbanized). Patient volume dropped an average of 79% (53-11 per month). 23% were aware of patients self-discontinuing a DMT due to fear of COVID-19 with 43% estimated to be doing so against medical advice. 65% of respondents reported deferring > = 1 doses of a DMT (49%), changing the dosing interval (34%), changing to home infusions (20%), switching a DMT (9%), and discontinuing DMTs altogether (8%) as a result of COVID-19. Changes in DMTs were most common with the high-efficacy therapies alemtuzumab, cladribine, ocrelizumab, rituximab, and natalizumab. 35% made no changes to DMT prescribing. 98% expressed worry about their patients contracting COVID-19 and 78% expressed the same degree of worry about themselves. > 50% believed high-efficacy DMTs prolong viral shedding of SARS-CoV-2 and that B-cell therapies might prevent protective vaccine effects. Accelerated pace of telemedicine and practice model changes were identified as major shifts in practice. Conclusions Reported prescribing changes and practice disruptions due to COVID-19 may be temporary but could have a lasting influence on MS care.

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Section: Summary Of Qualitative Responsesmentioning

confidence: 78%

Impact of COVID-19 on U.S. and Canadian neurologists’ therapeutic approach to multiple sclerosis: a survey of knowledge, attitudes, and practices

et al. 2020

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“…Adherence to disease modifying agent (DMA) treatment is vital among patients with multiple sclerosis (MS) and is associated with positive clinical outcomes such as a reduction in relapses, progression of disability, and hospitalization. [1][2][3] Unfortunately, adherence to DMAs among patients with MS is often less than ideal ranging from 41%-88%. [4][5][6] In addition, early discontinuation of DMA is very common in MS; 9%-20% of patients discontinue DMA within six months from the date of initiation.…”

Section: Introductionmentioning

confidence: 99%

“…7 Non-adherence to DMA leads to serious negative consequences such as increased relapses, progression of disability, and higher healthcare resource utilization, and significantly impacts the quality of life. 2,3,5,[7][8][9] Previous studies have found that adherence to DMAs is associated with factors related to the treatment route of administration, insurance coverage, patient and clinician. 8,9 The route of administration is one of the important factors associated with treatment adherence.…”

Section: Introductionmentioning

confidence: 99%

<p>Comparative Adherence Trajectories of Oral Fingolimod and Injectable Disease Modifying Agents in Multiple Sclerosis</p>

Earla¹,

Hutton²,

Thornton³

et al. 2020

PPA

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Background Oral fingolimod is convenient to use than injectable disease modifying agents (DMAs) in patients with multiple sclerosis (MS). However, the existing literature regarding the comparative adherence trajectories between oral fingolimod and injectable DMAs is limited. Objective To compare the adherence trajectories between oral DMA, fingolimod, and injectable DMAs in patients with MS. Methods A retrospective longitudinal study was conducted using adults (≥18 years) with MS (ICD-9-CM: 340 and a DMA prescription) from the IBM MarketScan Commercial Claims and Encounters Database between 2010 and 2012. Patients were grouped into oral fingolimod or injectable DMA users based on the index DMA among patients with MS. The annual DMA adherence trajectories, based on the proportion of days covered (PDC), were examined using group-based trajectory modeling (GBTM) during the one-year follow-up period after treatment initiation. Multivariable multinomial logistic regression using stabilized inverse probability treatment weights (IPTW) was performed to assess the association between the DMA route of administration (Oral vs Injectable) and the adherence trajectory groups. The balance of covariates between oral and injectable DMAs before and after IPTW was checked against a standardized difference threshold of 0.25. Results The study cohort consisted of 1,700 MS patients who were initiated with oral (15.8%) or injectable (84.2%) DMAs between 2010 and 2012. The adherence rates (PDC≥0.8) in oral fingolimod and injectable DMA users were found to be 64.7% and 50.8%, respectively. The GBTM grouped individuals in the study cohort into three adherence trajectories – rapid discontinuers (23.5%), complete adherers (49.9%), and slow decliners (26.6%). The multinomial logistic regression model with stabilized IPTW revealed that oral fingolimod users had higher odds to be a complete adherer (adjusted odds ratio [AOR]: 2.78, 95% CI: 1.85–4.16) or a slow discontinuer (AOR: 2.62, 95% CI: 1.70–4.05) than injectable DMA users. Conclusions Oral DMA fingolimod was associated with better adherence than injectable DMAs across group-based trajectories. Further research is warranted to evaluate the adherence trajectories with newer oral DMAs introduced in the last decade for MS.

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“…Patients with MS are expected to take DMAs for at least 3 months to show a therapeutic response 46 . Therefore, adherence to DMAs in the initial period can play a significant role in treatment outcomes such as reducing relapses and in delaying the progression of MS 22,47–51 . Therefore, composite outcome evaluation was additionally done on a sub‐cohort who were adherent to DMAs during the first 3 months after DMA initiation (proportion of days covered [PDC] ≥0.8).…”

Section: Methodsmentioning

confidence: 99%

Comparative treatment effectiveness of oral fingolimod and conventional injectable disease‐modifying agents in multiple sclerosis

et al. 2021

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Study Objective To compare the effectiveness of oral fingolimod and conventional injectable disease‐modifying agents (DMAs) using the composite endpoint of relapse or DMA treatment switch in patients with multiple sclerosis (MS). Design A retrospective longitudinal cohort study. Data Source IBM MarketScan Commercial Claims and Encounters Database from 2010–2012. Patients Adults (≥18 years) with MS diagnosis (ICD‐9‐CM:340) who newly initiated DMAs. Intervention Oral fingolimod and conventional injectable DMAs (interferon beta and glatiramer acetate). Measurements Composite endpoint of time to relapse or DMA treatment switch. Main Results The incident study cohort consisted of 1997 MS patients who initiated oral fingolimod (15.6%) or injectable (84.4%) DMAs. The proportion of patients who had a composite endpoint (relapse/DMA treatment switch) in oral fingolimod and injectable DMA users was found to be 16.72% and 27.16%, respectively. The Cox PH regression model with stabilized IPTW revealed that fingolimod is equally effective as conventional injectable DMAs in reducing the risk of experiencing the composite endpoint of relapse or DMA switch (adjusted hazard ratio [aHR]: 0.67, 95% CI: 0.43–1.03). Additional analysis among patients who were adherent also found no significant difference in the composite endpoint (aHR: 0.70, 95% CI 0.49–1.15) between oral fingolimod and injectable DMA users. Conclusions Oral fingolimod has similar effectiveness as conventional injectable DMAs in reducing the risk of experiencing the composite endpoint (relapse or DMA treatment switch). In addition, when assessed independently, oral fingolimod showed no difference in reducing the time to relapse or DMA treatment switch compared to injectable DMAs.

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Factors Affecting the Adherence to Disease-Modifying Therapy in Patients With Multiple Sclerosis

Abstract: Patients' adherence to medication treatment was low and may be associated with social, physical, and cognitive measures.

Cited by 25 publications

References 4 publications

Impact of COVID-19 on U.S. and Canadian neurologists’ therapeutic approach to multiple sclerosis: a survey of knowledge, attitudes, and practices

Impact of COVID-19 on U.S. and Canadian neurologists’ therapeutic approach to multiple sclerosis: a survey of knowledge, attitudes, and practices

<p>Comparative Adherence Trajectories of Oral Fingolimod and Injectable Disease Modifying Agents in Multiple Sclerosis</p>

Comparative treatment effectiveness of oral fingolimod and conventional injectable disease‐modifying agents in multiple sclerosis

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