Study Cites Factors Linked to Treatment Adherence

People with multiple sclerosis (MS) who experienced relapses in the previous year are more likely to have better adherence to their current treatment regimen, a cross-sectional study reports.

The research also identified associations between treatment adherence and a lower body mass index (BMI), and between better perceived mental health and greater engagement in clinical care.

Pinpointing factors that cause MS patients to stop taking their medication may lead to the development of strategies that enhance engagement and ultimately improve quality of life.

The study, “Adherence to Therapy, Physical and Mental Quality of Life in Patients with Multiple Sclerosis,” was published in the Journal of Personalized Medicine.

MS is characterized by a wide range of symptoms including fatigue, emotional and cognitive issues, and pain that can affect patients’ quality of life significantly. Previous reports have indicated that psychological and social factors such as coping, mood, or social support have a greater influence on quality of life than the extent of nerve damage caused by MS.

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Following the treatment regimen as prescribed, a measure called adherence, is critical to improving long-term quality of life and survival in MS patients. Poor compliance leads to frequent relapses and a greater need for hospitalizations. Yet, nearly three-quarters of patients report missing at least one dose of their disease-modifying therapies.

A group of researchers from Italy have now sought to identify psychological, social, and clinical factors that affect compliance, with the goal of eventually improving MS patients’ adherence to treatment.

A total of 237 Italian-speaking MS patients were selected randomly from public online groups, Facebook pages, forums, and communities dedicated to people with MS. Patients were asked to complete a survey regarding their age, gender, education, and clinical history.

The questionnaire included several validated clinical measures, including: the Patient Health Engagement, which evaluates the level of patient engagement in their care; the Modified Social Support Survey, which measures patients’ perception of their social support; and the Morisky Green Levine Scale to assess patients’ medication-taking behavior.

Patients also answered questions about their health-related quality of life, which generated scores for perceived physical health and mental health, and about how well their doctor was participating in disease management.

Most participants in the study were women (73%), with an average age of 45 years. More than 75% of patients had attended at least high school and more than 60% had a job. Relapsing-remitting MS was the most frequent form of MS, and the majority of patients had experienced no relapses in the previous year.

The data showed that having had relapses in the previous year increased the odds of a better adherence to current therapy by 2.37 times.

“The present study shows that patients whose disease had relapsed in the year before the survey were more likely to exhibit a better adherence,” the researchers wrote. “We interpret this as greater attention to their health condition being prompted by recent painful and stressful episodes.”

However, a higher BMI — an indicator of body fat — reduced the likelihood of adherence to treatment. Since compliance is related to personal motivation, the team suggested that higher BMIs may be a sign of lower self-esteem or depression, leading to poorer adherence.

“This association needs to be confirmed in further studies but might mean that focused interventions on overweight could lead to better adherence to therapy and clinical prescriptions in MS patients,” they added.

Results also showed that patients with better perceived mental health were significantly more likely (nearly six times more) to be engaged in their care. And being or having been in a long-term relationship increased the odds of having good perceived mental health.

Having a job was significantly associated with a better perceived physical health, while older age and having progressive forms of MS were associated with worse physical health.

“In conclusion, our findings could help in the management of MS patients, promoting behavioral interventions that take the psychological and socio-demographic peculiarities of each patient into account with a view to improving their adherence,” the researchers wrote.

“Our results underscore the well-known importance of enhancing patients’ engagement as a strategy to improve their compliance with therapy and help them cope better with such a challenging and unpredictable chronic disease as MS,” they concluded.