MS Speaks

While looking over the literature on MS over the years, I've been aware of how often studies are done to determine whether MS patients take the disease-modifying drugs and if so, whether we stay on them. Below is an example of the kind of concern that is being investigated.  It shows that over 2 years of injectable disease-modifying therapy, nearly one-quarter of 485 MS patients were "non-adherent."  That strikes me as a fairly high non-adherence rate for the DMDs.

From Multiple Sclerosis Journal, June 30, 2016:

Determinants of non-adherence to disease-modifying therapies in multiple sclerosis: A cross-Canada prospective study

Kyla A McKay
Division of Neurology, Faculty of Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada

Helen Tremlett
Division of Neurology, Faculty of Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada

Scott B Patten
Departments of Psychiatry and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

John D Fisk
Departments of Psychiatry, Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada

Charity Evans
College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada

Kirsten Fiest
Departments of Critical Care Medicine & Community Health Sciences, O’Brien Institute for Public Health, and Hotchkiss Brain Institute, University of Calgary, Canada

Trudy Campbell
School of Nursing, Faculty of Health Professions, Dalhousie University, Halifax, NS, Canada

Ruth Ann Marrie
Departments of Internal Medicine and Community Health Sciences, Health Sciences Centre, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
for the CIHR Team in the Epidemiology and Impact of Comorbidity on Multiple Sclerosis (ECoMS)
Departments of Internal Medicine and Community Health Sciences, Health Sciences Centre, College of Medicine, Faculty of Health Sciences, University of Manitoba, GF 543-820 Sherbrook Street, Winnipeg, MB R3A 1R9, Canada.

Background:

Poor adherence to the disease-modifying therapies (DMTs) for multiple sclerosis (MS) may attenuate clinical benefit. A better understanding of characteristics associated with non-adherence could improve outcomes.

Objective:

To evaluate characteristics associated with non-adherence to injectable DMTs.

Methods:

Consecutive patients from four Canadian MS Clinics were assessed at three time points over two years. Clinical and demographic information included self-reported DMT use, missed doses in the previous 30 days, health behaviors, and comorbidities. Non-adherence was defined as <80% of expected doses taken. We employed generalized estimating equations to examine characteristics associated with non-adherence at all time points with findings reported as adjusted odds ratios (OR).

Results:

In all, 485 participants reported use of an injectable DMT, of whom 107 (22.1%) were non-adherent over the study period. Non-adherence was associated with a lower Expanded Disability Status Scale score (0–2.5 vs 3.0–5.5, OR: 1.80; 95% confidence interval (CI): 1.06–3.04), disease duration (>5 vs <5 years, OR: 2.23; 95% CI: 1.10–4.52), alcohol dependence (OR: 2.14; 95% CI: 1.23–3.75), and self-reported cognitive difficulties, measured by the Health Utilities Index-3 (OR: 1.55; 95% CI: 1.08–2.22).

Conclusions:

Nearly one-quarter of participants were non-adherent during the study. Alcohol dependence, perceived cognitive difficulties, longer disease duration, and mild disability status were associated with non-adherence. These characteristics may help healthcare professionals identify patients at greatest risk of poor adherence.

[Emphasis added.]

The abstract can be seen here.