Determining If Patient Attitudes Impact Adherence in Different Groups of Patients With MS

Previous research on why patients with multiple sclerosis (MS) adhere to their medications has indicated that it may depend on whether the patient is receiving first-line or second-line therapies, as well as their beliefs about medicine and the illness. A new study from Germany underscores some of those findings.

The researchers, writing in Multiple Sclerosis and Related Disorders, said that the different beliefs held by these 2 groups of patients may impact the understanding of treatment adherence, and that understanding these different attitudes could assist with more effective interventions.

Previous work by the researchers showed that patients on first-line therapies typically did not follow a treatment plan because of “burdensome side effects.” They also had to have the belief that the medicine would be effective in order to be adherent.

Patients on second-line therapy had a different reason for nonadherence: a “lack of perceived medication effectiveness.” By contrast, those who stuck with a recommended plan were more likely to believe in “positive illness beliefs/perceptions” and “the belief in a highly active disease.”

In this study, an online survey on the website of the German MS Society asked about beliefs regarding immune treatments as well as the patients' illness perceptions. Researchers sought to assess these beliefs to test the idea that they are closely connected to adherence behavior.

Demographic factors and self-reported adherence rates were included as variables, as were disability levels as measured by Patient Determined Disease Steps (PDDS).

The 10-item Beliefs About Medicines Questionnaire (BMQ) asks about patients’ beliefs about the necessity of their medication as well as specific concerns about the current medication. In addition, patients were given the Brief Illness Perception Questionnaire in order to assess the patients’ illness perceptions and adaptation to MS. The questionaires were analysed using 2 multivariate analyses of covariance (MANCOVAs).

A total of 1318 individuals accessed the online questionnaires and 625 full data sets were analyzed, including 433 from first-line—treated patients and 192 from second-line–treated patients.

Results of patients using first-line therapies showed that:

• 124 used interferon-beta-1a or —b preparations
• 96 used glatiramer acetate
• 165 used dimethylflumarate
• 48 used teriflunomide

Of those patients taking second-line therapies:

• 70 used natalizumab
• 113 used fingolimod
• 9 used alemtuzumab

There was no difference in rates of adherence or nonadherence between the 2 groups, which was contrary to the hypothesis, and also no difference in age or gender distribution between patients treated in the first-line and second-line.

However, patients on second-line therapy scored higher on the BMQ, indicating that they both felt the medication was necessary but also had more concerns (MANCOVA P = .001 and P = .006). Patients in the second-line also reported a longer disease duration (P = .005) and higher PDDS scores (P < .001). Patients with higher levels of disability also felt that the medication was needed, but they also had concerns.

"For patients having experienced treatment failure the need for another treatment is more obvious than for treatment-naïve patients reflecting on any treatment," the authors noted.

Self-assessed adherence rates were around 70% for oral treatments and injectables irrespective of first line or second line. Nonadherence was below 5% for infusion treatments. However, most patients reported only single omissions.

The authors said follow-up studies are needed in order to have a better understanding about the link between behavioral attitudes and treatment adherence.

Reference

Pust GEA, Untiedt B, Weierstall-Pust R, et al. Medication beliefs in first-line and second-line treated multiple sclerosis patients. Mult Scler Relat Disord. 2020 Jul;42:102144. doi:10.1016/j.msard.2020.102144.