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Can Neurologists Predict a Patient’s Nonadherence to DMTs for MS?

Depression may indicate a high risk for nonadherence, while older age may suggest a lower risk.


NASHVILLE—Demographic characteristics, comorbidities, and previous treatments can predict intentional and unintentional nonadherence to disease-modifying therapy (DMT) for multiple sclerosis (MS), according to a study presented at the 2018 CMSC Annual Meeting. Neurologists should consider risk factors for nonadherence to treatment when selecting an appropriate therapy, said the researchers.

Approximately 33% of patients with MS do not adhere to their DMT regimens. Nonadherence results in suboptimal therapeutic efficacy and increased disability and costs. Unintentional nonadherence may result from cognitive impairment or circumstances that the patient does not control directly. Intentional nonadherence, on the other hand, involves a deliberate decision not to take prescribed medication as directed. Factors that predict patient nonadherence to treatment, whether intentional or unintentional, could affect the choice of DMT.

An Observational Study

Mark Gudesblatt, MD, Medical Director of the Comprehensive MS Care Center at South Shore Neurologic Associates in Islip, New York, and colleagues sought to explore factors associated with intentional and unintentional nonadherence to DMT in patients with MS. They conducted an observational, cross-sectional study of patient-reported outcomes (PROs) obtained at a single MS center in the United States during routine clinical care. The assessments included standardized, validated, computerized cognitive testing (NeuroTrax); Expanded Disability Status Scale (EDSS) score; and PROs (ie, Beck Depression Inventory [BDI], Modified Fatigue Impact Scale [MFIS], and Morisky Medication Adherence Scale [MMAS-8]). The investigators also obtained demographic data such as age, gender, marital status, employment, driving capability, and prior DMTs. Patients receiving an infused DMT were excluded from the study.

Mark Gudesblatt, MD

Of 499 patients, 273 (54.7%) met the inclusion criteria. About 76% of participants were female, and the population’s average age was 49. Of the 273 participants, 82 (30.0%) were intentionally nonadherent and 133 (48.7%) were unintentionally nonadherent. Higher depression scores and previous DMTs were associated with a greater risk of intentional nonadherence, as predicted by MMAS-8. Higher MFIS scores were associated with greater risk of unintentional nonadherence.

Increased age was associated with a lower risk of intentional and unintentional nonadherence. EDSS scores, mean NeuroTrax global cognitive summary scores, and MFIS physical subscale scores were not associated with intentional nonadherence. Prior DMT and EDSS scores were not associated with unintentional nonadherence.

How Can Adherence Be Improved?

“Treatment of the underlying cause of nonadherence might be critical to improve quality of life and impact outcomes and adherence,” Dr. Gudesblatt told Neurology Reviews.

“Identifying the risk of nonadherence is critical to the choice of DMT. For example, if self-administered therapy is prescribed to someone who is not adherent, that would be a bad choice,” he added. “If there are multiple risk factors for nonadherence, then the clinician must take this into account in the final discussion of [the] choice … of DMT. This [consideration] will be critical in the long run for preservation of ability and avoiding disability.”

Dr. Gudesblatt and colleagues plan to investigate this topic in longitudinal studies and research the effect of cognition on nonadherence. Neurologists have “so much more to do to better understand patients’ perceptions, improve outcomes, and improve decision making and management,” Dr. Gudesblatt concluded.

Erik Greb

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