Abstract
BackgroundNonadherence to disease-modifying drugs (DMDs) for multiple sclerosis (MS) is associated with poorer clinical outcomes, including higher rates of relapse and disease progression, and higher medical resource use. A systematic review and quantification of adherence and persistence with oral DMDs would help clarify the extent of nonadherence and nonpersistence in patients with MS to help prescribers make informed treatment plans and optimize patient care.The objectives were to: 1) conduct a systematic literature review to assess the availability and variability of oral DMD adherence and/or persistence rates across ‘real-world’ data sources; and 2) conduct meta-analyses of the rates of adherence and persistence for once- and twice-daily oral DMDs in patients with MS using real-world data.MethodsA systematic review of studies published between January 2010 and April 2018 in the PubMed database was performed. Only studies assessing once- and twice-daily oral DMDs were available for inclusion in the analysis. Study quality was evaluated using a modified version of the Newcastle-Ottawa Scale, a tool for assessing quality of observational studies. The random effects model evaluated pooled summary estimates of nonadherence.ResultsFrom 510 abstracts, 31 studies comprising 16,398 patients with MS treated with daily oral DMDs were included. Overall 1-year mean medication possession ratio (MPR; n = 4 studies) was 83.3% (95% confidence interval [CI] 74.5–92.1%) and proportion of days covered (PDC; n = 4 studies) was 76.5% (95% CI 72.0–81.1%). Pooled 1-year MPR ≥80% adherence (n = 6) was 78.5% (95% CI 63.5–88.5%) and PDC ≥80% (n = 5 studies) was 71.8% (95% CI 59.1–81.9%). Pooled 1-year discontinuation (n = 20) was 25.4% (95% CI 21.6–29.7%).ConclusionsApproximately one in five patients with MS do not adhere to, and one in four discontinue, daily oral DMDs before 1 year. Opportunities to improve adherence and ultimately patient outcomes, such as patient education, medication support/reminders, simplified dosing regimens, and reducing administration or monitoring requirements, remain. Implementation of efforts to improve adherence are essential to improving care of patients with MS.
Highlights
Nonadherence to disease-modifying drugs (DMDs) for multiple sclerosis (MS) is associated with poorer clinical outcomes, including higher rates of relapse and disease progression, and higher medical resource use
Implementation of efforts to improve adherence are essential to improving care of patients with Multiple sclerosis (MS)
Guidelines recommend that clinicians should offer disease-modifying drugs (DMDs) to people diagnosed with relapsing forms of MS (RMS) [1, 2]
Summary
Nonadherence to disease-modifying drugs (DMDs) for multiple sclerosis (MS) is associated with poorer clinical outcomes, including higher rates of relapse and disease progression, and higher medical resource use. Guidelines recommend that clinicians should offer disease-modifying drugs (DMDs) to people diagnosed with relapsing forms of MS (RMS) [1, 2]. DMDs have been shown to reduce the rate of relapse, slow the rate of disease progression, [3–6] and improve long-term outcomes for patients with RMS [7, 8]. It is recommended that clinicians monitor for medication adherence, adverse events, tolerability, safety, and effectiveness of the therapy in people with MS on DMDs [1]. Nonadherence to or nonpersistence with DMD therapy for MS has been associated with poorer clinical outcomes, including higher rates of relapse and disease progression, and higher medical resource use [9, 11–14]. It has been hypothesized that the oral route of DMD administration may offer improved adherence to the injectable route of administration, recent studies have reported that realworld adherence to and persistence with the once- and twice-daily oral maintenance DMDs (i.e., fingolimod, dimethyl fumarate, and teriflunomide) may be similar to that of self-injectable DMDs [11, 15–18]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
