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Adherence to the immunomodulatory drugs for multiple sclerosis: contrasting factors affect stopping drug and missing doses
Tremlett, H and van der Mei, IAF and Pittas, F and Blizzard, CL and Paley, G and Dwyer, T and Taylor, BV and Ponsonby, AL (2008) Adherence to the immunomodulatory drugs for multiple sclerosis: contrasting factors affect stopping drug and missing doses. Pharmacoepidemiology and Drug Safety, 17 (6). pp. 565-576. ISSN 1053-8569
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Background Long-term immunomodulatory drug (IMD) treatment is now common in multiple sclerosis (MS). However,
predictors of adherence are not well understood; past studies lacked lifestyle factors such as alcohol use and predictors of
missed doses have not been evaluated. We examined both levels of non-adherence—stopping IMD and missing doses.
Methods This longitudinal prospective study followed a population-based cohort (n=199) of definite MS patients in
Southern Tasmania (January 2002 to April 2005, source population 226 559) every 6 months. Baseline factors (demographic,
clinical, psychological and cognitive) affecting adherence were examined by logistic regression and a longitudinal analysis
(generalized estimating equation (GEE)).
Results Of the 97 patients taking an IMD (mean follow-up=2.4 years), 73% (71/97) missed doses, with 1 in 10
missing>10 doses in any 6-month period. Missed doses were positively associated with alcohol amount consumed per
session ( p=0.008). A history of missed doses predicted future missed doses ( p<0.0005). Over one-quarter (27/97) stopped their current IMD, which was associated with lower education levels ( p=0.032) and previous relapses ( p=0.05). No
cognitive or psychological test predicted adherence.
Conclusions There were few strong predictors of missed doses, although people with MS consuming more alcoholic drinks
per session are at a higher risk of missing doses. Divergent factors influenced the two levels of non-adherence indicating
the need for a multifaceted approach to improving IMD adherence. In addition, missed doses should be assessed
and incorporated into clinical trial design and clinical practice as poor adherers could impact on clinical outcomes.
|Keywords:||multiple sclerosis; adherence; compliance; immunomodulatory treatment; beta-interferon; glatiramer acetate|
|Journal or Publication Title:||Pharmacoepidemiology and Drug Safety|
|Page Range:||pp. 565-576|
|Identification Number - DOI:||10.1002/pds.1593|
The definitive published version is available online at: http://interscience.wiley.com
|Date Deposited:||09 Dec 2008 22:23|
|Last Modified:||18 Nov 2014 03:54|
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