Adherence to the immunomodulatory drugs for multiple sclerosis: contrasting factors affect stopping drug and missing doses

Abstract

There were few strong predictors of missed doses, although people with MS consuming more alcoholic drinks per session are at a higher risk of missing doses. Divergent factors influenced the two levels of non-adherence indicating the need for a multifaceted approach to improving IMD adherence. In addition, missed doses should be assessed and incorporated into clinical trial design and clinical practice as poor adherers could impact on clinical outcomes.

Narrative Review of the Literature on Adherence to Disease-Modifying Therapies Among Patients with Multiple Sclerosis

“…Studies included in this review varied in terms of the patient population, with 11 studies examining patients with RRMS only, 16,23,[25][26][27][28][29][30][31][32][33] 12 studies examining patients with any form of MS, 17,18,[34][35][36][37][38][39][40][41][42][43] and only 1 study examining the progressive form of the disease exclusively. 44 Among studies reporting time since MS diagnosis, mean time since diagnosis ranged between 2 and 12 years.…”

“…All prospective studies included patients who were already on some form of DMT prior to assessing adherence (mean years on therapy ranged from 2 to 6 years across studies). [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39]44 Three retrospective studies evaluated adherence specifically among those initiating a DMT, 17,40,42 while the remaining 5 either did not specify prior treatment or included patients who had already received treatment with a DMT. 16,18,41,43 There were 6 different measures used in the literature to measure patient adherence, including 2 variations of the medication possession ratio (MPR; used among 11 studies), the missed dose ratio (MDR; 3 studies), total number of missed doses (2 studies), percentage of days not covered by therapy (2 studies), and no missed doses over a pre-specified time period (7 studies).…”

“…In some studies, patients who were adherent were found to have a lower risk of relapse as well as lower risk of inpatient or ER visits and lower total MS-related costs (excluding pharmacy costs). 16,17,32 Many other chronic conditions have assessed adherence primarily to oral (not injectable) therapies, making direct comparisons of adherence rates difficult. However, in a recent systematic review of medication adherence among patients with rheumatic conditions, 1 study included in the review ciation between greater treatment adherence and a lower risk of MS relapse, 16,17 while one showed a significant association between nonadherence and greater MS-related inpatient utilization and total MS-related medical costs.…”

Non-adherence to Disease-Modifying Treatments in Patients with Multiple Sclerosis

“…Because DMTs require intramuscular or subcutaneous injections, they are difficult to be tolerated for a long time. In a Spanish study, 73% of patients discontinued immunomodulatory medication (23). More to the point, over a quarter of the patients stopped taking their medications, which was associated with lower education levels and previous relapses.…”

The Challenges of Oral Agents as Antineoplastic Treatments

“…This includes antihyperglycemics for diabetes (28.9%), 45 lipid lowering drugs for coronary artery disease (8% to 40.6%), 46,47 statins for acute coronary syndromes (20.0% to 40.1%), 48,49 antipsychotic drugs for psychosis (21.2%), 50 protease inhibitor therapy for HIV (41.0%), 51 and immunomodulatory drugs for multiple sclerosis (27.0%). 52 As stated earlier, adherence for cancer patients ranged from 16% to 100% and these findings will be discussed further in the article on measurement elsewhere in this issue.…”