How well MS patients adhere to treatment tied to certain factors

People with multiple sclerosis (MS) who experience a greater number of more severe flare-ups, also known as relapses, are more likely to take their medications regularly, but less likely to keep taking them over time, a review study has found.

Other factors associated with better treatment adherence and persistence (continued use) include older age and previous use of a disease-modifying therapy (DMT). In turn, factors such as higher education, unwanted side effects, and modifiable factors such as alcohol consumption are linked with poorer medication adherence and persistence.

“Insights into the modifiable factors associated with adherence and persistence could guide treatment decisions and help improve adherence and clinical outcomes,” researchers wrote.

The study, “Factors Associated With Disease-Modifying Therapy Adherence and Persistence in Multiple Sclerosis: A Scoping Literature Review,” was published in the International Journal of MS Care.

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Treatment adherence important for better outcomes

MS affects the brain and spinal cord, causing problems with movement, balance, and vision. There are many treatments options for MS, including medications, which can help manage symptoms and slow down disease progression.

However, many patients find it hard to follow their treatment plan or take their prescribed medications regularly and over long periods of time. When this happens, treatment may be less effective, leading to worse outcomes.

What makes patients fail to remain on treatment is unclear, which has led a team of researchers in the U.S. to review the literature to understand why some patients are better at following their treatment plan than others.

The team identified 58 published studies involving a total of 103,450 patients in the U.S., Europe, Canada, Australia, and other countries; 36 studies evaluated adherence and 30 studies evaluated persistence to treatment with DMTs.

Adherence refers to how well patients follow their doctor’s instructions about when, how much, and how often to take a medication. Persistence refers to sticking to the treatment for as long as it had been prescribed.

Insights into the modifiable factors associated with adherence and persistence could guide treatment decisions and help improve adherence and clinical outcomes.

Most of the studies examined self-injectable medications

The majority of studies (41 studies) evaluated only self-injectable medications given into the muscle or under the skin. Two studies evaluated only oral therapies — such as dimethyl fumarate (sold as Tecfidera and generics), fingolimod (marketed as Gilenya and others), and teriflunomide (sold as Aubagio among others) — one study that evaluated only the infusion therapy Tysabri (natalizumab), and 14 studies that assessed more than one type of DMT.

“As oral and infusion DMTs have emerged in the MS treatment landscape in recent years, understanding the unique factors that may influence adherence and persistence to these therapies has become increasingly important,” the team wrote.

The factors influencing adherence and persistence to treatment differed across DMT categories, results show.

Among those taking self-injectable treatments, older patients and those who experienced a greater number or more severe relapses were more likely to adhere to treatment, but relapses tended to be associated with worse persistence. How patients perceived the benefits of self-injectable DMTs, in turn, was linked to treatment persistence.

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More education, body mass, alcohol intake linked to worse treatment adherence

On the other hand, factors such as higher education, increased body mass, alcohol consumption, and side effects from the medication were linked with worse adherence and/or persistence in the studies assessing self-injectable therapies.

In addition, one study found that patients who paid more than $200 out of pocket for their DMTs were up to seven times more likely to stop taking their self-injectable medications.

Regarding oral medications, having previously received another medication was linked with better treatment adherence, but living in wealthier regions was associated with worse persistence. In turn, persistence with an infusion DMT was linked with the doctor’s judgment on whether the patient should continue the medication.

“Multiple factors were identified as potentially affecting adherence and/or persistence across the types of DMTs,” the team concluded.

“Although many factors … cannot be altered by patients or health care providers, the findings inform possible patient subgroups warranting attention and monitoring,” the researchers added.