Persistence and adherence in multiple sclerosis patients starting glatiramer acetate treatment: assessment of relationship with care received from multiple disciplines.
BACKGROUND
In multiple sclerosis patients, the persistence of, and adherence to, disease-modifying treatment are often insufficient. The degree of persistence and adherence may relate to the care received from various disciplines.


METHODS
In an observational study of 203 patients treated with glatiramer acetate 20 mg subcutaneous daily, we assess the persistence and adherence in relation to the amount of care received in various disciplines. The frequencies and durations of care per discipline were reported by patients online, as were missed doses and eventual treatment discontinuation. The associations between the care provided by neurologists, nurses, psychologists, pharmacists, and rehabilitative doctors and persistence and adherence were the primary outcomes; the associations between care received from general practitioners, occupational therapists, physiotherapists, social workers, dieticians, home caregivers, informal caregivers, other medical specialists, and other caregivers and persistence and adherence were secondary outcomes.


RESULTS
It was found that the 12-month persistence rate was 62% and that 85% of the persistent patients were 95% adherent (missed <5% of doses). Patients who discontinued treatment in the fourth quarter (Q) had received less-frequent and shorter psychological care in Q3 than persistent patients (P=0.0018 and P=0.0022). Adherent patients had received more frequent home care and informal care than nonadherent patients (P=0.0074 and P=0.0198), as well as longer home care and informal care (P=0.0074 and P=0.0318). Associations between care in other disciplines and persistence or adherence were not observed. As to the relationship between adherence and persistence, nonadherence in Q2 was related to discontinuation after Q2 (P=0.0001).


CONCLUSIONS
We obtained no evidence that, in multiple sclerosis patients, persistence of and adherence to disease-modifying treatment are associated with the amount of neurological, nursing, pharmaceutical, or rehabilitative care. However, findings suggest that the treatment of psychological problems in Q3 may relate to persistence and that home care and informal care may relate to adherence.
Department of Community and Occupational Medicine, University Medical Centre Groningen, University Groningen, Groningen, the Netherlands; MS4 Research Institute, Radboud university medical center, Nijmegen, the Netherlands.
Peter Joseph
PJ
Jongen
Department for Health Evidence, Radboud university medical center, Nijmegen, the Netherlands.
Wim A
WA
Lemmens
Department of Neurology, Zuijderland Medisch Centrum Sittard, Sittard, the Netherlands.
Raymond
R
Hupperts
Department of Neurology, St Antonius Hospital, Nieuwegein, the Netherlands.
Erwin Lj
ELj
Hoogervorst
Department of Neurology, Multiple Sclerosis Centre, Westfries Gasthuis, Hoorn, the Netherlands.
Hans M
HM
Schrijver
Department of Neurology, Medisch Spectrum Twente, Enschede, the Netherlands.
Astrid
A
Slettenaar
Department of Neurology, Alrijne Ziekenhuis, Leiderdorp, the Netherlands.
Els L
EL
de Schryver
Department of Neurology, Meander Medisch Centrum, Amersfoort, the Netherlands.
Jan
J
Boringa
Curavista BV, Geertruidenberg, the Netherlands.
Esther
E
van Noort
Department for Health Evidence, Radboud university medical center, Nijmegen, the Netherlands.
Rogier
R
Donders
home care; informal care; nursing; pharmaceutical; psychological; rehabilitative