SAN DIEGO — More than one-third of multiple sclerosis patients missed at least one injection of a first-line disease-modifying therapy over a 4-week period, results from a large multicenter study showed.
The most frequently reported reasons were forgetting to take the injection, not feeling like taking it, and being tired of the shot, Katherine A. Treadaway reported in a poster session at the annual meeting of the American Academy of Neurology.
The study marks the first time that adherence to all four first-line disease-modifying therapies (DMTs) approved for the management of multiple sclerosis—Avonex, Betaseron, Copaxone, and Rebif—were assessed in a multicenter patient population.
Patients who were most compliant with their medication schedule had a higher quality of life, lower rates of depression, and higher levels of hope. Neurologists “need to ask their patients if they're taking their medications and whether the medications are causing problems,” Ms. Treadaway, a licensed clinical social worker at the Multiple Sclerosis Program and Clinical Center, of the University of Texas Southwestern Medical Center at Dallas, said in an interview. “Depression might also be something neurologists can ask about, because we want people to stay on the medications.”
Ms. Treadaway and her associates at 17 sites nationwide recruited patients to participate in a Web-based survey to determine what factors influence adherence to DMT injection schedules. The survey included the Multiple Sclerosis Quality of Life-54 (MSQOL-54), the Beck Depression Inventory (BDI) Fast Screen, the Herth Hope Index, and questions about medication compliance. Study participants were surveyed at baseline, 4 weeks, and 8 weeks.
Adherence was defined as not missing an injection of a DMT in the last 4 weeks. Nonadherence was defined as missing at least one DMT injection in the last 4 weeks.
Of the 798 survey respondents, 77% were female and their median disease duration was 5 years.
Overall, more than one-third of patients were nonadherent, which remained consistent across all three time periods. Adherence rates were 61% at baseline, 63% at 4 weeks, and 64% at 8 weeks.
The top five reasons for nonadherence as reported by patients were forgetting to administer the injection (58%), not feeling like taking the injection (22%), being tired of taking the injection (16%), fatigue (12%), and inconvenience of the dosing schedule (8%). Study patients were allowed to report more than one reason for noncompliance.
Ms. Treadaway also reported that compared with adherent patients, nonadherent patients had significantly worse perceived quality of life based on the MSQOL-54, lower levels of hope based on the Herth Hope Index (39.5 vs. 38.2), and significantly higher depression scores based on the BDI Fast Screen (scores ranged from 2.5 to 3.4 on a scale of 1–21).
“I think education is a big key to keeping people on their [DMT] medications,” she commented. “If they're satisfied and they feel like it's working, they're going to be more adherent.”
Limitations of the study include its observational design and its reliance on patient self-reports, she noted.
The study was supported by an unrestricted grant from Biogen Idec Inc., which manufactures Avonex. Ms. Treadaway disclosed that she has received speaker honoraria from Biogen Idec and from Teva Neuroscience Inc., which manufactures Copaxone.