Contributions
Abstract: P776
Type: Poster
Abstract Category: Therapy - disease modifying - 30 Tools for detecting therapeutic response
Introduction: A number of studies have assessed patient adherence to multiple sclerosis (MS) disease modifying therapy (DMT). Such studies have typically been based on claims data or patient completed research questionnaires. We decided to investigate patient reported DMT adherence in the clinic and its relationship to clinical outcomes.
Methods: The Knowledge Program is a Cleveland Clinic database that electronically captures patient reported outcomes and clinician entered data at each clinic visit. Collected outcomes include the Performance Scales (PS, a measure of MS related disability), European Quality of Life 5 Dimensions (EQ5D), Patient Health Questionnaire 9 (a depression scale), and the timed 25-foot walk. Patient reported DMT adherence over the prior three months is recorded as part of our standard follow-up progress note. The KP was queried for patients with relapsing-remitting MS who had been on DMT for ≥6 months. The primary outcome was the association between baseline adherence and PS scores at 6, 12, 24, and 36 months. Secondary outcomes included the association of adherence with the other metrics listed above. Adequate adherence was defined as taking ≥80% of DMT doses. Adjusted and unadjusted linear regression models were constructed to assess the outcomes. Important covariates were adjusted for including age, gender, race, and DMT.
Results: There were 1,148 patients available for analysis of which 94.9% were defined as adherent. There was adequate data to assess the primary outcome in 501 patients at 6 months, 544 patients at 12 months, 331 patients at 24 months, and 247 patients at 36 months. In the unadjusted models, adherence was only significantly associated with lower PS scores (less disability) at 2 years and lower EQ5D scores (lower quality of life) at one year. In the adjusted models, adherence was not significantly associated with any outcome at any time point.
Conclusions: The proportion of patient who reported adequate adherence to DMT in our study was much higher than in studies based on administrative data or questionnaires, which typically estimate adherence at about 75%. This suggests that patients may not be forthright when reporting DMT adherence to their clinicians, possibly due to a desire to avoid disappointing their care team. The minimal observed effect of adherence on outcomes in our study further supports the notion that patient reported DMT adherence may not be a reliable metric.
Disclosure: Devon S Conway: 'I have received research support paid to my institution by Novartis Pharmaceuticals.'
Maria Cecilia Vieira: 'I am an employee of Novartis Pharmaceuticals.'
Nicolas R Thompson: 'Nothing to disclose.'
Kaila Parker: 'Nothing to disclose.'
Xiangyi Meng: 'I am an employee of Novartis Pharmaceuticals.'
Robert J Fox: 'I have received personal consulting fees from Actelion, Biogen, Genentech, Novartis, and Teva. I have served on advisory committees for Biogen Idec and Novartis, and received clinical trial contract and research grant funding from Biogen and Novartis. I have received research support paid to my institution by Novartis Pharmaceuticals.'
Abstract: P776
Type: Poster
Abstract Category: Therapy - disease modifying - 30 Tools for detecting therapeutic response
Introduction: A number of studies have assessed patient adherence to multiple sclerosis (MS) disease modifying therapy (DMT). Such studies have typically been based on claims data or patient completed research questionnaires. We decided to investigate patient reported DMT adherence in the clinic and its relationship to clinical outcomes.
Methods: The Knowledge Program is a Cleveland Clinic database that electronically captures patient reported outcomes and clinician entered data at each clinic visit. Collected outcomes include the Performance Scales (PS, a measure of MS related disability), European Quality of Life 5 Dimensions (EQ5D), Patient Health Questionnaire 9 (a depression scale), and the timed 25-foot walk. Patient reported DMT adherence over the prior three months is recorded as part of our standard follow-up progress note. The KP was queried for patients with relapsing-remitting MS who had been on DMT for ≥6 months. The primary outcome was the association between baseline adherence and PS scores at 6, 12, 24, and 36 months. Secondary outcomes included the association of adherence with the other metrics listed above. Adequate adherence was defined as taking ≥80% of DMT doses. Adjusted and unadjusted linear regression models were constructed to assess the outcomes. Important covariates were adjusted for including age, gender, race, and DMT.
Results: There were 1,148 patients available for analysis of which 94.9% were defined as adherent. There was adequate data to assess the primary outcome in 501 patients at 6 months, 544 patients at 12 months, 331 patients at 24 months, and 247 patients at 36 months. In the unadjusted models, adherence was only significantly associated with lower PS scores (less disability) at 2 years and lower EQ5D scores (lower quality of life) at one year. In the adjusted models, adherence was not significantly associated with any outcome at any time point.
Conclusions: The proportion of patient who reported adequate adherence to DMT in our study was much higher than in studies based on administrative data or questionnaires, which typically estimate adherence at about 75%. This suggests that patients may not be forthright when reporting DMT adherence to their clinicians, possibly due to a desire to avoid disappointing their care team. The minimal observed effect of adherence on outcomes in our study further supports the notion that patient reported DMT adherence may not be a reliable metric.
Disclosure: Devon S Conway: 'I have received research support paid to my institution by Novartis Pharmaceuticals.'
Maria Cecilia Vieira: 'I am an employee of Novartis Pharmaceuticals.'
Nicolas R Thompson: 'Nothing to disclose.'
Kaila Parker: 'Nothing to disclose.'
Xiangyi Meng: 'I am an employee of Novartis Pharmaceuticals.'
Robert J Fox: 'I have received personal consulting fees from Actelion, Biogen, Genentech, Novartis, and Teva. I have served on advisory committees for Biogen Idec and Novartis, and received clinical trial contract and research grant funding from Biogen and Novartis. I have received research support paid to my institution by Novartis Pharmaceuticals.'