Adherence to disease modifying therapies in patients with multiple sclerosis
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Adherence to disease modifying therapy (DMT) is a challenge for many patients with multiple sclerosis (MS). This three-study dissertation explored factors associated with DMT adherence, which may guide future interventions aimed at improving adherence. Study one was a systematic review focused on factors significantly associated with DMT adherence. Thirty articles were included in the review. Factors across all five domains of the World Health Organization Medication Adherence Model (i.e., social and economic, healthcare system, condition, therapy, and patient domains) were identified. Some of the modifiable factors included patients’ out of pocket cost, family and caregiver support, neurologist discussion of adherence, type of DMT, ease of injection, and satisfaction with treatment. Study two was a qualitative investigation of MS patients’ experiences with their DMT. From the three focus groups with MS patients (n=26) taking injectable and oral DMTs, three major themes emerged: barriers to DMT adherence, facilitators of DMT adherence (currently used), and facilitators of DMT adherence (desired). Overall, participants experienced several DMT-related issues (e.g., administration, storage, memory, lack of motivation), which often directly impacted DMT adherence. However, participants were able to effectively cope or manage some of the DMT-related issues. Participants utilized various strategies, such as industry-sponsored support programs and reminder devices, to improve adherence and expressed their desire for easier DMT administration and ordering processes. Study three was a cross-sectional survey mailed to 600 MS patients to assess DMT adherence and to determine various factors related to it. Of the 489 respondents (81.5% response rate), most (92.9%) were adherent (doses taken/doses prescribed in two week period ≥0.80). Treatment satisfaction, perceived necessity and perceived concern, the primary independent variables, were not significantly associated with DMT adherence in multivariate analyses. Among covariates, age and type of DMT were significant predictors, suggesting that younger patients and those taking injectable DMTs are at higher risk for nonadherence. These studies highlight the complex nature of DMT-taking behavior among MS patients, which is impacted by several factors. Accordingly, future strategies and interventions aimed at improving patient’s medication adherence should be multi-faceted and tailored to the specific issues experienced by individual patients.