One in 5 Patients With MS Don't Adhere to Oral DMDs

Nearly 20% of patients with multiple sclerosis (MS) do not adhere to their daily oral disease-modifying drugs (DMDs), according to a new systematic review and meta-analysis, which also indicated that 1 in 4 patients discontinue their DMDs before 1 year.

The review looked at the behaviors of more than 16,000 patients being treated with daily oral DMDs between January 2010 and April 2018, and the meta-analysis is the first to assess real-world adherence to various oral DMDs among patients with MS.

“Adherence to DMS is an important aspect of optimizing patient care in MS as greater adherence has been associated with improvements in relapse outcomes and quality of life, fewer hospitalizations and emergency room visits, decrease in neuropyschological issues, fewer days of work lost, and lower MS-related medical costs,” wrote the researchers, who highlighted that adherence to newly initiated DMDs over 1 year was associated with a 42% decrease in the likelihood of relapse, a 38% decrease in emergency visits, and 52% decrease in hospitalizations.

Across the 31 studies included in the systematic review, 4 reported the mean medication possession ratio (MPR), 6 reported the proportion of patients with an MPR of at least 80%, 4 reported the mean proportion of days covered (PDC), and 5 reported the proportion of patients with a PDC of at least 80%.

The researchers found that among patients taking either once- or twice-daily oral maintenance DMDs, the overall mean MPR during 1 year of follow-up was 83.3% and the PDC was approximately three-fourths (76.5%). The data also showed that 78.5% of patients had at least an 80.0% MPR and that 71.8% of patients had a PDC that was at least 80.0%.

Meanwhile, pooled 1-year discontinuations showed that 25.4% of patients stopped taking their DMDs before 1 year. Across the studies, the discontinuation rate ranged between 5.1% and 42.3%.

The researchers noted that these results can help inform therapeutic decision making and identify opportunities to address barriers to DMD adherence, which not only improves clinical outcomes but also reaps benefits when it comes to healthcare costs.

“Based on the differences in predicted US mean costs over the 12-month post-initiation period, adherence was estimated to decrease the total annual medical care costs by $5916 per patient (all costs are reported in 2015 US$), including outpatient visits ($2802), emergency visits ($171), and hospitalizations ($1953) compared with nonadherence,” wrote the researchers.

The researchers outlined several factors that typically influence adherence and persistence in chronic illness, including:

• Frequency and complexity of the dosing regimen
• Need for ongoing safety monitoring
• Office visits
• Waiting time associated with dosing
• Prior treatment experience
• Presence or absence of active symptoms at the time of dosing

“Opportunities to address barriers to DMD adherence in patients with MS remain, such as patient education efforts to manage expectations and to emphasize the importance of adherence, implementation of medication support/reminder techniques, simplification of dosing regimens, and reducing the need for specialized administration or monitoring requirements,” wrote the researchers.

Reference

Nicholas J, Edwards N, Edwards R, Dellarole A, Grosso M, Phillips A. Real-world adherence to, and persistence with, one- and twice-daily oral disease-modifying drugs in patients with multiple sclerosis: a systematic review and meta-analysis. BMC Neurol. 2020;20(1):281. doi:10.1186/s12883-020-01830-0