CC11
Multiple Sclerosis & Adherence: A Community Based Analysis of a Problem in MS Care
Multiple Sclerosis & Adherence: A Community Based Analysis of a Problem in MS Care
Friday, May 29, 2015
Griffin Hall
Background: Multiple Sclerosis (MS) can cause significant disability. Many Disease Modifying Therapies (DMT) are approved to treat relapsing MS (RRMS). DMT’s vary in route and frequency of required administration. Adherence impacts DMT efficacy. Suboptimal injectable DMT adherence (<75% at 1-2yrs), and oral DMT safety monitoring adherence (<75%) are reported. Identifying low adherence patients are critical. Treatment adherence may be important but not considered related to both MS DMT choice and efficacy. Multiple factors impact prescribed DMT adherence. Identifying and addressing factors that affect adherence may improve outcome. Exploring non-adherence magnitude may improve awareness of this issue. Economic impact of MS is related to many factors, (unemployment, disability and DMT cost). These costs demand: high adherence, high efficacy and safety. Treatment efficacy and safety are successful if adherence allows.
Adherence measures rely on: direct observation, self-report, and pharmacy records (medication retention, refill frequency). Paradigms related to treatment: choice, safety, and escalation/induction are impacted by adherence. Morisky Medication Adherence questionnaires (MMA) have been extensively studied for adherence analysis to treatment in multiple disease states. Predicted adherence has also been correlated with clinical outcomes and disease costs. MS, a chronic condition, requires chronic treatment adherence. The magnitude of non-adherence is unclear.
Objectives: To investigate RRMS population (RRMSp) adherence profile.
Methods: Single site, cross sectional retrospective analysis of RRMSp who completed a validated standardized questionnaire in routine clinical care. Adherence was evaluated by a 4 point questionnaire. Morisky Medication Adherence Scores (MMAS-4) define adherence: high, medium, and low.
Results: 272 RRMS patients over 11 months (2012-13) completed MMAS-4, 83% female, average age ~50yo, 21% no DMT/between DMT, 4% oral DMT, 26% injectable DMT, 49% infusion DMT. 237/272 (87.13%) high adherence, 35/272 (12.87%) medium adherence, and no low adherence (MMAS-4).
Adherence measures rely on: direct observation, self-report, and pharmacy records (medication retention, refill frequency). Paradigms related to treatment: choice, safety, and escalation/induction are impacted by adherence. Morisky Medication Adherence questionnaires (MMA) have been extensively studied for adherence analysis to treatment in multiple disease states. Predicted adherence has also been correlated with clinical outcomes and disease costs. MS, a chronic condition, requires chronic treatment adherence. The magnitude of non-adherence is unclear.
Objectives: To investigate RRMS population (RRMSp) adherence profile.
Methods: Single site, cross sectional retrospective analysis of RRMSp who completed a validated standardized questionnaire in routine clinical care. Adherence was evaluated by a 4 point questionnaire. Morisky Medication Adherence Scores (MMAS-4) define adherence: high, medium, and low.
Results: 272 RRMS patients over 11 months (2012-13) completed MMAS-4, 83% female, average age ~50yo, 21% no DMT/between DMT, 4% oral DMT, 26% injectable DMT, 49% infusion DMT. 237/272 (87.13%) high adherence, 35/272 (12.87%) medium adherence, and no low adherence (MMAS-4).
Conclusions: RRMSp reflect 13% medium and 87% high adherence. Literature and Clinical experience suggest sub-optimal adherence to prescribed DMT may be more common. Analysis of RRMSp non-adherence needs further exploration. Poor adherence can impact care, choice of DMT, as well as efficacy and safety of the DMT chosen. Understanding predictors of adherence is important.