Adherencia al tratamiento en pacientes con esclerosis múltiple: factores de riesgo

Abstract

IntroductionAdherence is a modifiable factor to disease-modifying treatments response in patients with multiple sclerosis (MS). Our objective is to assess the risk factors associated with inadequate adherence. MethodRetrospective study through review of medical records and review of the database of pharmaceutical dispensing of patients with MS of a tertiary hospital from 2004 to 2022. A multivariate logistic regression analysis of demographic, clinical, nosological, and therapeutic factors was performed between adherent and non-adherent patients and treatments. Result546 treatments of 284 patients (67.3% women, age 38.4±10.0 years) were analyzed, observing 87.5% adherence. Non-adherent patients presented a higher EDSS at the end of treatment, were more frequently patients with secondary progressive multiple sclerosis, and had a higher proportion of cognitive impairment, psychiatric pathology, polypharmacy, and alcohol and drug use. After the multivariable analysis, risk factors were cognitive impairment (OR: 3.82 [1.51-9.70], P=.005), and alcohol and drug use (OR: 22.83 [7.32-71.20], P<.001). On the contrary, oral drugs favored better adherence (OR: 0.29 [0.12-0.75], P=.01). ConclusionsAmong many factors, alcohol or drug use and cognitive impairment are the major risk factors for low therapeutic adherence in patients with MS.