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Mult Scler. 2017 Apr;23(4):588-596. doi: 10.1177/1352458516657440. Epub 2016 Jul 11.

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

Author information

1
Division of Neurology, Faculty of Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada.
2
Departments of Psychiatry and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
3
Departments of Psychiatry, Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada.
4
College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada.
5
Departments of Critical Care Medicine & Community Health Sciences, O'Brien Institute for Public Health, and Hotchkiss Brain Institute, University of Calgary, Canada.
6
School of Nursing, Faculty of Health Professions, Dalhousie University, Halifax, NS, Canada.
7
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.

Abstract

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.

KEYWORDS:

Multiple sclerosis; adherence; beta-interferon; glatiramer acetate; health behavior; immunomodulatory therapy

PMID:
27357507
PMCID:
PMC5407504
DOI:
10.1177/1352458516657440
[Indexed for MEDLINE]
Free PMC Article

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