“Interestingly, MSers with lower disability and longer disease duration were less adherent. Maybe in this group of MSers they perceive themselves to have more ‘benign MS’ and tend to miss injections. What do you think?”
“Although I am being flippant about this issue it is a major problem and extends into the oral therapies as well. Non-adherence is a big problem and is associated with poorer long-term outcomes. Therefore we need strategies to improve adherence. One strategy is to move all MSers onto an induction therapy or PIRT (pulsed immune reconstitution therapy). PIRTs are given as short courses and once give can’t be reversed. PIRTs by definition have the best adherence rates. However, PIRTs often require adherence with monitoring, for example post-alemtuzumab treated MSers need to have monthly blood and urine tests for at least 48 months after the last infusion. We think poor adherence is a big enough problem in MS that we currently have a grant application being assessed by the MS Society to look at new ways of improving adherence rates. I sincerely hope we get the project funded.”
McKay et al. Determinants of non-adherence to disease-modifying therapies in multiple sclerosis: A cross-Canada prospective study. Mult Scler. 2016 Jun 29. pii: 1352458516657440.
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).
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