Factors associated with adherence to disease modifying therapy in multiple sclerosis: An observational survey from a referral center in Lithuania

Duchovskiene, Neringa; Mickevičienė, Dalia; Jurkevičienė, Giedrė; Diržiuvienė, Birutė; Balnytė, Renata

doi:10.1016/j.msard.2017.02.016

Cited by 12 publications

(10 citation statements)

References 21 publications

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“…These results may due to in fact that patients in Henry's study [16] were characterized by different type of disease and not all were treated by immunomodulation-drug. In this study no statistically significant difference in average score in the anxiety and depression subscale was observed between the ADH and non ADH group (p > 0.005), which coincides with the results of Duchovskiene et al [35] and McKay et al [36]. Table 5.…”

Section: Discussionsupporting

confidence: 91%

The Levels of Depression, Anxiety, Acceptance of Illness, and Medication Adherence in Patients with Multiple Sclerosis - Descriptive and Correlational Study

Kołtuniuk¹,

Rosińczuk²

2021

Int. J. Med. Sci.

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Emotional functioning is one of the factors affecting medication adherence in patients with multiple sclerosis (MS). Adherence to treatment is a very important element in the therapy of patients with MS and requires from them cooperation, positive emotional status and acceptance of illness. This study evaluated the role of depression, anxiety, and the acceptance of illness on adherence to disease-modifying therapies (DMT) in MS. A group of 226 MS patients was included. The Beck Depression Inventory (BDI), the Hospital Anxiety and Depression Scale-Modified Version (HADS-M), the Acceptance of Illness Scale (AIS) and the Multiple Sclerosis Treatment Adherence Questionnaire (MS-TAQ) were used. It was shown that 41% of patients reported the symptoms of anxiety, 28% reported the symptoms of depression, and 63% were irritated and aggressive (HADS-M). Over 80% of patients accept their disease to varying degrees. There was a correlation between the results of HADS-M, BDI, and AIS and the domains of MS-TAQ. Analysis of the multiple-regression model showed that only being very satisfied with treatment positively affects adherence to DMT in MS patients. It has to be concluded that anxiety and depression have a significant negative impact on medication adherence in MS patients. However, MS patients with an increased acceptance of their illness have a higher rate of adherence to DMT. The emotional state of a patient is an important factor that can both positively and negatively affect their adherence and their resulting prognosis.

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Section: Discussionsupporting

confidence: 91%

The Levels of Depression, Anxiety, Acceptance of Illness, and Medication Adherence in Patients with Multiple Sclerosis - Descriptive and Correlational Study

Kołtuniuk¹,

Rosińczuk²

2021

Int. J. Med. Sci.

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“…Our finding that educational levels did not differ between optimally and suboptimally adherent patients is in line with several studies in the MS population, 37 – 40 whereas in two MS studies patients with university degrees were less likely to be adherent. 41 , 42 While Phillips et al reported higher odds of adherence in patients with full insurance coverage, the high implementation rates in our study were found in spite the fact that patients paid the equivalent of at least US$990 per year out-of-pocket. 43 …”

Section: Discussioncontrasting

confidence: 64%

Adherence to fingolimod in multiple sclerosis: an investigator-initiated, prospective, observational, single-center cohort study

Zimmer¹,

Coslovsky²,

Abraham³

et al. 2017

PPA

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ObjectivesAdherence to multiple sclerosis (MS) treatment is essential to optimize the likelihood of full treatment effect. This prospective, observational, single-center cohort study investigated adherence to fingolimod over the 2 years following treatment initiation. Two facets of adherence – implementation and persistence – were examined and compared between new and experienced users of disease-modifying treatments (DMTs).Materials and methodsImplementation rates were based on the proportion of days covered and calculated as percentages per half-yearly visits and over 2 years, captured through refill data, pill count, and self-report. Nonadherence was defined as taking less than 85.8% of prescribed pills. Implementation rates were classified as nonadherent (<85.8%), suboptimally adherent (≥85.8% but <96.2%), and optimally adherent (≥96.2%), including perfectly adherent (100%). Persistence, ie, time until discontinuation, was analyzed by Kaplan–Meier analysis. Reasons for discontinuation were recorded.ResultsThe cohort included 98 patients with relapsing MS, all of whom received a dedicated education session about their medication. Of these 80% were women, 31.6% had fingolimod as first DMT, and 68.4% had switched from other DMTs. The mean implementation rate over 2 years was 98.6% (IQR1–3 98.51%–98.7%) and did not change significantly over time; 89% of measurements were in the optimally adherent category, 45.6% in the perfectly adherent category. There was one single occurrence of nonadherence. New users of DMTs were 1.29 times more likely to be adherent than experienced users (OR 1.29, 95% CI 1.11–1.51; P<0.001), but not more persistent. Nineteen of 98 patients discontinued fingolimod.ConclusionThe very high implementation rates displayed in this sample of MS patients suggest that facilitation by health care professionals in preserving adherence behavior may be sufficient for the majority of patients. Targeted interventions should focus on patients who are nonadherent or who stop treatment without intention to reinitiate.

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“…However, this relationship is not well established; some studies have found an association between depression and nonadherence in people with MS, 26 while others reported no association. 30,31 Third, pathogenic similarities may exist between CNS inflammation and depression that led to enhanced CNS vulnerability among these patients. While behavior and mood disorders have long been considered to result from biochemical alterations in neuronal networks, glia malfunctioning is now achieving greater attention.…”

Section: Discussionmentioning

confidence: 99%

Disability worsening among persons with multiple sclerosis and depression

et al. 2019

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ObjectiveDepression is common in multiple sclerosis (MS), but its impact on disability worsening has not yet been determined. We explored the risk of disability worsening associated with depression in a nationwide longitudinal cohort.MethodsThis retrospective cohort study used linked data from 3 Swedish nationwide registries: the MS Register, National Patient Register, and Prescribed Drug Register. Two incident cohorts were developed: cohort 1 included all registered cases of MS in the MS Registry (2001–2014) with depression defined as ≥1 ICD-10 code for depression; and cohort 2 comprised all cases of MS in the MS Registry (2005–2014) with depression defined as ≥1 prescription filled for an antidepressant. Cox regression models were used to compare the risk of reaching sustained disability milestone scores of 3.0, 4.0, and 6.0 on the Expanded Disability Status Scale (EDSS) between persons with MS with and without depression.ResultsCohort 1 included 5,875 cases; 502 (8.5%) had depression. Cohort 2 had 3,817 cases; 1,289 (33.8%) were prescribed an antidepressant. Persons with depression were at a significantly higher risk of reaching sustained EDSS scores of 3.0, 4.0, and 6.0, with hazard ratios of 1.50 (95% confidence interval [CI] 1.20–1.87), 1.79 (95% CI 1.40–2.29), and 1.89 (95% CI 1.38–2.57), respectively. A similar increased risk among persons exposed to antidepressants was observed, with hazard ratios of 1.37 (95% CI 1.18–1.60), 1.93 (95% CI 1.61–2.31), and 1.86 (95% CI 1.45–2.40) for sustained EDSS scores of 3.0, 4.0, and 6.0, respectively.ConclusionPersons with MS and comorbid depression had a significantly increased risk of disability worsening. This finding highlights the need for early recognition and appropriate treatment of depression in persons with MS.

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Factors associated with adherence to disease modifying therapy in multiple sclerosis: An observational survey from a referral center in Lithuania

Cited by 12 publications

References 21 publications

The Levels of Depression, Anxiety, Acceptance of Illness, and Medication Adherence in Patients with Multiple Sclerosis - Descriptive and Correlational Study

The Levels of Depression, Anxiety, Acceptance of Illness, and Medication Adherence in Patients with Multiple Sclerosis - Descriptive and Correlational Study

Adherence to fingolimod in multiple sclerosis: an investigator-initiated, prospective, observational, single-center cohort study

Disability worsening among persons with multiple sclerosis and depression

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