Examining adherence, perceptions, and symptoms in patients with Multiple Sclerosis
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Objective: To examine reasons why Multiple Sclerosis (MS) patients may not be adherent to disease-modifying therapies (DMTs). Also, to determine patient perceptions of MS as a disease and DMTs as a source of treatment, and compare these between patients with prior DMT experience and those who were DMT-naïve. Finally, to assess the level of MS symptoms reported in patients taking DMTs, and compare these between DMT users and non-users. Methods: Patients with MS who were affiliated with a regional health plan at any point between January 2005 and December 2010 were asked to fill out a survey, the Multiple Sclerosis Medication Questionnaire (MSMQ). For study purposes, non-adherence was defined as missing any doses in the previous 28 days by the patient. In addition, the MSMQ examined reasons why MS patients do not initiate or discontinue DMT use. For statistical analyses, chi-square tests were performed to detect differences and t-tests and Mann-Whitney U tests to confirm the results. Results: A total of 197 surveys were returned, of which 105 (53.3%) patients were currently on a DMT. Thirty-two (30.5%) of the DMT users were considered non-adherent. Of the non-adherent respondents, the most frequent reason for non-adherence that was at least moderately important was being "too busy" (n=13/29, 44.8%). Amongst patients who were not using a DMT, the most common barrier to DMT use was related to possible side effects of treatment (n=46/79, 58.2%). Analyzing the statements regarding barriers to DMTs revealed significant differences in the proportion of agreement regarding physician's lack of advocacy for DMT use between DMT-naïve patients and those who discontinued DMT use (44.7% vs. 17.1%, respectively, p[less than]0.01), as well as for dislike for using needles (24.3% vs. 46.3%, respectively, p=0.043). In terms of MS symptoms, patients using a DMT generally reported the symptoms posed less of a problem, although significant differences were not seen in chi-square analyses. Conclusion: The injectable nature of most DMTs seems to cause varying degrees of discomfort in MS patients, which may contribute to non-adherence. Reasons given by MS patients for DMT non-adherence in the MSMQ mirror the literature regarding this topic. MS patients who are not currently on DMT may not seek or remain on treatment for various reasons. It appears certain perceptions regarding MS and DMTs are associated with potential DMT use.