title: How many injections did you miss last month? A simple question to predict interferon β-1a adherence in multiple sclerosis.
abstract: OBJECTIVE
  Adherence to treatment is of utmost importance in multiple sclerosis (MS) to achieve full benefits from disease-modifying treatments. Thus, we investigated predictors of adherence to interferon β-1a.
  
  
  METHODS
  114 relapsing-remitting MS subjects were recruited and followed-up during 1.536 ± 0.961 years. RebiSmart® (Ares Trading SA, Coinsins, Switzerland), an electronic auto-injector, allows real-time recording of adherence which was retrospectively evaluated, and subjects were categorized accordingly: fully adherent (if no doses were missed), early or late missing (if missing the first dose during the first month of observation or later). The occurrence of clinical relapses and the annualized relapse rate (ARR) were prospectively recorded.
  
  
  RESULTS
  Adherence was 95.0 ± 9.0%. Early missing (n = 17, 14.9%) was more likely to be associated with the occurrence of a clinical relapse (OR = 4.155; p = 0.018), but not late missing (n = 54, 47.4%) (OR = 1.454; p = 0.408), as compared to fully adherent (n = 43, 37.7%). Adherence was lower in early missing, as compared to late missing (p < 0.001). The ARR was higher in early missing, as compared to late missing and to fully adherent (p < 0.001).
  
  
  CONCLUSIONS
  MS subjects missing an injection early presented lower adherence, and a fourfold chance of having a relapse, suggesting a simple way to assess and categorize adherence in a clinical, real-life setting, where lack of time often prevents more thorough evaluations.
authors.affiliation: a 1 "Federico II" University, Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology , Naples, Italy +39 08 17 46 37 64 ; +39 08 15 46 36 63 ; moccia.marcello@gmail.com.
authors.forename: Marcello
authors.initials: M
authors.lastname: Moccia
authors.affiliation: b 2 Department of Primary Care and Public Health, Imperial College , London, UK.|c 3 Federico II University, Department of Public Health , Naples, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Palladino
authors.affiliation: a 1 "Federico II" University, Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology , Naples, Italy +39 08 17 46 37 64 ; +39 08 15 46 36 63 ; moccia.marcello@gmail.com.
authors.forename: Cinzia
authors.initials: C
authors.lastname: Russo
authors.affiliation: a 1 "Federico II" University, Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology , Naples, Italy +39 08 17 46 37 64 ; +39 08 15 46 36 63 ; moccia.marcello@gmail.com.
authors.forename: Marco
authors.initials: M
authors.lastname: Massarelli
authors.affiliation: c 3 Federico II University, Department of Public Health , Naples, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Nardone
authors.affiliation: c 3 Federico II University, Department of Public Health , Naples, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Triassi
authors.affiliation: d 4 "Gabriele d'Annunzio" University of Chieti-Pescara, Department of Neuroscience, Imaging and Clinical Sciences , Chieti, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Lugaresi
authors.affiliation: a 1 "Federico II" University, Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology , Naples, Italy +39 08 17 46 37 64 ; +39 08 15 46 36 63 ; moccia.marcello@gmail.com.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Brescia Morra
mesh_terms: D000276:Adjuvants, Immunologic / Q000008:administration & dosage*; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007279:Injections, Subcutaneous; D000068556:Interferon beta-1a / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000175:diagnosis / Q000188:drug therapy*; D011446:Prospective Studies; D012008:Recurrence; D012189:Retrospective Studies; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D000276:Adjuvants, Immunologic; D000068556:Interferon beta-1a
keywords: adherence; interferon; missing; multiple sclerosis; rebismart; relapse