Marriage, Education, DMT Affect Patients’ Treatment Adherence

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by Marisa Wexler, MS |

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Among people with relapsing-remitting multiple sclerosis (RRMS), those who are married and have more formal education are more likely to take treatments as recommended, according to a new study from Iran.

The study, “Effects of Disease-Modifying Treatments discontinuation in patients with Relapsing-Remitting Multiple Sclerosis: A 5 Year Prospective Cohort Study,” was published in Multiple Sclerosis and Related Disorders

Disease-modifying therapies, or DMTs, are medications that have been proven in clinical trials to alter the course of MS, slowing disabling symptom buildup and reducing the risk of disease exacerbations. More than a dozen DMTs are approved to treat RRMS.

In general, DMTs are most effective when they are started early on in the course of disease and when a person continues to take them over time as directed, called “adherence.”

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‘Hidden’ Disabilities Fairly Common at RRMS Diagnosis, Study Finds

This study included 288 people newly diagnosed with RRMS, who were followed for five years starting in 2015. Most patients were in their late 20s or 30s; the majority were female (87.8%), married (64.2%), and unemployed (69.5%). Over the study period, 20 women became pregnant and were not included in the main analysis.

Among the remaining 268 patients, the adherence rate for the entire study was 82.5%. After five years, scores on the Expanded Disability Status Scale (EDSS) generally reflected more severe disability in patients who were not adherent to treatment.

“Approximately one in five patients with RRMS does not have an appropriate DMT adherence and does not follow the treatment plans, during the first 5 years of treatment,” the researchers wrote.

The most common reason given for choosing to stop treatment was feeling burned out from the intense therapeutic process that accompanies MS treatment. However, disease symptoms getting worse was the most common reason for restarting treatment.

These results suggest that better patient education — including informing patients that care can prevent further problems — may help more stick to treatment, the researchers said.

The research team conducted statistical tests looking for factors associated with a higher likelihood of adherence. They found that patients who’d had more formal education, or were married, were significantly more likely to remain adherent.

Adherence rates also varied based on the specific DMT. The medicines with the highest rates of adherence were glatiramer acetate (sold as Copaxone and generics), rituximab, and Gilenya (fingolimod).

“In addition DMT type, low educational levels, and being single play a negative role in the continuity of treatment,” the scientists concluded.

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