Connected CareSM for Multiple Sclerosis (MS): Improving Adherence with Managed Therapy for Patients with Indications of Fatigue or Depression

Background: Walgreens Connected Care^SM for MS (CCMS) program provides enhanced management for patients taking MS medications to improve adherence; and was updated in 2013 to assist those taking delayed-release dimethyl fumarate (DMF; also known as gastro-resistant DMF; TECFIDERA^®) for relapsing forms of MS.  The program includes assessments of patient reported side-effects and standardized screenings for depression and fatigue.

Objectives: Examine 9-month adherence levels in relation to the duration of a patient’s managed status and patient reported depression and fatigue; controlling for demographics, medication comorbidities, reported drug side effects, and starter dosage.

Methods: Adherence was measured using PDC (proportion of days covered) for a 9 month follow-up period from index date.  Patient reported side effects and screenings for depression or fatigue were collected through the CCMS assessments.  The study population included Walgreens Central Specialty patients, 18 years or older, initiating therapy between April 2013 and December 2013, and followed through June 2014. Mixed model analysis controlled for patient age, gender, comorbidities, prior use of MS medications, and examined reported side effects, adjunctive medication use, starter dosage, and screening indications combined, and interaction of screenings with managed duration.  There were 1,153 patients with two or more DMF fills, not concurrently on antidepressants or amphetamines, and with CCMS assessment information.

Results: Mean 9-month adherence improved by 42.4% when patients managed within 3 months in the program were compared to those managed over 9 months (p < 0.001).  When patients had indications for depression or fatigue, adherence was significantly lower compared to those without positive screening results (p < 0.001).  The interaction between managed duration and depression/fatigue indication was also significant (p < 0.04), where patients managed within 3 months with a positive screen had a significantly lower PDC (-13.5%), compared to negative screen patients.  However, patients managed over 9 months, and with a positive screen no longer had a significantly lower PDC (-2.3%).

Conclusions: The 9-month DMF adherence rate was significantly improved by the length of patients' participation in CCMS, even for those with positive screening results of depression or fatigue. This study replicated and extended prior research indicating that medication therapy management for MS patients significantly increases adherence to biologic medications.

Research was supported by Biogen, Idec.