Contributions
Abstract: P699
Type: Poster
Abstract Category: Therapy - disease modifying - Long-term treatment monitoring
Introduction: Estimates of adherence to the injectable disease-modifying therapies (DMTs) for multiple sclerosis (MS) vary widely, possibly due to variation in the definition of adherence. We estimated adherence rates and examined characteristics potentially associated with non-adherence using two practical and clinically relevant definitions.
Methods: Consecutive MS patients were recruited from four MS Clinics across Canada (2010-11) and followed to 2013. At three visits over two years, clinical, demographic, and self-reported information was collected. Questionnaires captured current DMT use, number of missed doses of DMT in the previous 30 days, health behaviours and comorbidities. Perceived cognitive difficulties were assessed using the single attribute scale of the HUI-III. Non-adherence was defined based on self-report in two ways:
1) < 80% of expected doses;
2) any missed doses.
Logistic generalized estimating equation models were used to assess the odds of non-adherence relative to patient characteristics over the full study period, adjusted for confounders.
Results: Of 949 participants, 485 reported use of an injectable DMT and were included in the analysis. Their mean (SD) age was 46(10) years and most (79%) were female. Using the first definition, 107 (22%) participants were non-adherent at least once during the follow-up. Using definition two, this increased to 255 (52%). All three interferon-β products were associated with higher odds of non-adherence (vs glatiramer acetate) using definition one, but this relationship was reversed when using definition two (all p< 0.05). For both definitions, participants with alcohol dependence or perceived cognitive difficulties had higher odds of non-adherence (ORs ranged between 2.1-2.6 for alcohol and 1.4-1.6 for cognition).
Conclusions: Over 1 in 5 individuals reported taking < 80% of the expected DMT dose and over half missed at least one dose during the study. Both alcohol dependence and cognitive difficulties emerged as consistent factors associated with non-adherence; however, the relationship between the different DMT products and non-adherence varied considerably depending on the definition used. We highlight the impact that the definition of adherence can have on rates of adherence and associated characteristics. Ideally, a clinically meaningful and consistent definition of adherence should be established for future studies.
Disclosure: The study was sponsored by the Canadian Institutes of Health Research (CIHR CBG 101829), the Rx & D Health Research Foundation, by a Don Paty Career
Development Award from the MS Society of Canada (to RAM).
Kyla McKay, Charity Evans, and Kirsten Fiest report no disclosures.
Helen Tremlett is the Canada Research Chair for Neuroepidemiology and Multiple Sclerosis. She has received: research support from the National Multiple Sclerosis Society, the Canadian Institutes of Health Research, the Multiple Sclerosis Society of Canada (Don Paty Career Development Award and operating grants); the Multiple Sclerosis Scientific Research Foundation; the Michael Smith Foundation for Health Research (Scholar award) and the UK MS Trust; speaker honoraria and/or travel expenses to attend conferences from the Consortium of MS Centres (2013), the National MS Society (2012, 2014), Teva Pharmaceuticals (2011), ECTRIMS (2011, 2012, 2013, 2014, 2015, 2016), UK MS Trust (2011), the Chesapeake Health Education Program, US Veterans Affairs (2012), Novartis Canada (2012), Biogen Idec (2014), American Academy of Neurology (2013, 2014, 2015). All speaker honoraria are either declined or donated to an MS charity or to an unrestricted grant for use by her research group.
John Fisk receives research grant support from the Canadian Institutes of Health Research, the National Multiple Sclerosis Society, the Multiple Sclerosis Society of Canada, and the Dalhousie Medical Research Foundation; and has received speaker honoraria from EMD Serono (2014).
Scott Patten is a Senior Health Scholar with Alberta Innovates, Health Solutions.
Trudy Campbell has received honoraria from EMD Serono, Teva Canada Innovation, Biogen, Novartis, Genzyme and Roche.
Ruth Ann Marrie receives research funding from: CIHR, Public Health Agency of Canada, Manitoba Health Research Council, Health Sciences Centre Foundation, Multiple Sclerosis Society of Canada, Multiple Sclerosis Scientific Foundation, Rx & D Health Research Foundation, National Multiple Sclerosis Society, and has conducted clinical trials funded by sanofi-aventis.
Abstract: P699
Type: Poster
Abstract Category: Therapy - disease modifying - Long-term treatment monitoring
Introduction: Estimates of adherence to the injectable disease-modifying therapies (DMTs) for multiple sclerosis (MS) vary widely, possibly due to variation in the definition of adherence. We estimated adherence rates and examined characteristics potentially associated with non-adherence using two practical and clinically relevant definitions.
Methods: Consecutive MS patients were recruited from four MS Clinics across Canada (2010-11) and followed to 2013. At three visits over two years, clinical, demographic, and self-reported information was collected. Questionnaires captured current DMT use, number of missed doses of DMT in the previous 30 days, health behaviours and comorbidities. Perceived cognitive difficulties were assessed using the single attribute scale of the HUI-III. Non-adherence was defined based on self-report in two ways:
1) < 80% of expected doses;
2) any missed doses.
Logistic generalized estimating equation models were used to assess the odds of non-adherence relative to patient characteristics over the full study period, adjusted for confounders.
Results: Of 949 participants, 485 reported use of an injectable DMT and were included in the analysis. Their mean (SD) age was 46(10) years and most (79%) were female. Using the first definition, 107 (22%) participants were non-adherent at least once during the follow-up. Using definition two, this increased to 255 (52%). All three interferon-β products were associated with higher odds of non-adherence (vs glatiramer acetate) using definition one, but this relationship was reversed when using definition two (all p< 0.05). For both definitions, participants with alcohol dependence or perceived cognitive difficulties had higher odds of non-adherence (ORs ranged between 2.1-2.6 for alcohol and 1.4-1.6 for cognition).
Conclusions: Over 1 in 5 individuals reported taking < 80% of the expected DMT dose and over half missed at least one dose during the study. Both alcohol dependence and cognitive difficulties emerged as consistent factors associated with non-adherence; however, the relationship between the different DMT products and non-adherence varied considerably depending on the definition used. We highlight the impact that the definition of adherence can have on rates of adherence and associated characteristics. Ideally, a clinically meaningful and consistent definition of adherence should be established for future studies.
Disclosure: The study was sponsored by the Canadian Institutes of Health Research (CIHR CBG 101829), the Rx & D Health Research Foundation, by a Don Paty Career
Development Award from the MS Society of Canada (to RAM).
Kyla McKay, Charity Evans, and Kirsten Fiest report no disclosures.
Helen Tremlett is the Canada Research Chair for Neuroepidemiology and Multiple Sclerosis. She has received: research support from the National Multiple Sclerosis Society, the Canadian Institutes of Health Research, the Multiple Sclerosis Society of Canada (Don Paty Career Development Award and operating grants); the Multiple Sclerosis Scientific Research Foundation; the Michael Smith Foundation for Health Research (Scholar award) and the UK MS Trust; speaker honoraria and/or travel expenses to attend conferences from the Consortium of MS Centres (2013), the National MS Society (2012, 2014), Teva Pharmaceuticals (2011), ECTRIMS (2011, 2012, 2013, 2014, 2015, 2016), UK MS Trust (2011), the Chesapeake Health Education Program, US Veterans Affairs (2012), Novartis Canada (2012), Biogen Idec (2014), American Academy of Neurology (2013, 2014, 2015). All speaker honoraria are either declined or donated to an MS charity or to an unrestricted grant for use by her research group.
John Fisk receives research grant support from the Canadian Institutes of Health Research, the National Multiple Sclerosis Society, the Multiple Sclerosis Society of Canada, and the Dalhousie Medical Research Foundation; and has received speaker honoraria from EMD Serono (2014).
Scott Patten is a Senior Health Scholar with Alberta Innovates, Health Solutions.
Trudy Campbell has received honoraria from EMD Serono, Teva Canada Innovation, Biogen, Novartis, Genzyme and Roche.
Ruth Ann Marrie receives research funding from: CIHR, Public Health Agency of Canada, Manitoba Health Research Council, Health Sciences Centre Foundation, Multiple Sclerosis Society of Canada, Multiple Sclerosis Scientific Foundation, Rx & D Health Research Foundation, National Multiple Sclerosis Society, and has conducted clinical trials funded by sanofi-aventis.