title: The impact of betaplus program on patient treatment satisfaction with interferon beta-1b in multiple sclerosis: Multicentric cross-sectional survey in the western Balkan countries.
abstract: BACKGROUND
  Long-term treatment adherence to disease-modifying drugs (DMDs) may have significant impact on clinical outcomes in multiple sclerosis (MS). It has been recently emphasized that low treatment satisfaction (TS) may be an important factor for achieving high rates of treatment adherence. Interferon (IFN) beta-1b was the first DMD approved for the treatment of MS. The aims of our study were to assess TS in subjects with relapsing-remitting (RR) MS treated with IFN beta-1b in Serbia, Montenegro and the Republika Srpska, Bosnia and Herzegovina (B&H), and additionally, to evaluate the impact of patient support program on TS and adherence.
  
  
  METHODS
  This is a cross-sectional survey performed in order to examine TS and adherence with IFN beta-1b in seven MS centers across three countries (Serbia, Montenegro and B&H). Included in the study were 296 adult patients with RRMS treated with IFN beta-1b for at least 6 months. They were invited to complete the Treatment Satisfaction Questionnaire for Medication (TSQM). Additional two treatment adherence questions were also asked. Patient support program (Betaplus®) was available exclusively for patients in Serbia and not for those in Montenegro and the Republika Srpska, B&H. In order to assess the potential impact of this program on TSQM, we combined two groups of patients from Montenegro and B&H and compared their results with those from patients in Serbia. Statistical analysis includes multivariable linear regression analysis in order to assess the differences between three MS patients groups in terms of the TSQM scores, adjusted for potential confounders. For the evaluation of the effects of Betaplus® program, multivariable logistic regression was used, controlling for the same confounding factors.
  
  
  RESULTS
  Each of the TSQM summary scores in all three countries implicated high level of patients' satisfaction. There was statistically significant group difference on the Effectiveness summary score (p=0.001) and the Side effects summary score (p=0.006) between the group of subjects from Serbia and the combined group of subjects from Montenegro and B&H, in favor of the former cohort. There was statistically significant group difference neither on the Convenience summary score nor on the Overall satisfaction summary score. Results of adjusted logistic regression analysis based on the availability of patient support program (dependent variable) implicate that it had the most significant impact on the Effectiveness summary score (p=0.008). According to the correlation coefficients in the total patient cohort, all TSMQ summary scores except Effectiveness significantly correlated with the decreased adherence (Side effects: p=0.037; Convenience: p=0.016; Overall satisfaction: p=0.046).
  
  
  CONCLUSIONS
  TS with IFN beta-1b was high in our MS patients. Additionally, these results have demonstrated that patient support program have significant impact on TS with IFN beta-1b in the Balkan cohort of RRMS patients.
authors.affiliation: Clinic of Neurology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Dr Subotica 6, Belgrade 11000, Serbia. Electronic address: jelena60@eunet.rs.
authors.forename: Jelena
authors.initials: J
authors.lastname: Drulovic
authors.affiliation: Clinic of Neurology, Clinical Center of Montenegro, Ljubljanska bb, Podgorica 81000, Montenegro.
authors.forename: Mirjana
authors.initials: M
authors.lastname: Cukic
authors.affiliation: Clinic of Neurology, Clinical Center of Banja Luka, Dvanaest beba, Banja Luka 78000, Republika Srpska, Bosnia and Herzegovina.
authors.forename: Sanja
authors.initials: S
authors.lastname: Grgic
authors.affiliation: Clinic of Neurology, Military Medical Academy, Crnotravska 17, Belgrade 11000, Serbia.
authors.forename: Evica
authors.initials: E
authors.lastname: Dincic
authors.affiliation: Clinic of Neurology, Military Medical Academy, Crnotravska 17, Belgrade 11000, Serbia.
authors.forename: Ranko
authors.initials: R
authors.lastname: Raicevic
authors.affiliation: Clinic of Neurology, Clinical Center of Vojvodina, Hajduk Veljkova 1-9, Novi Sad 21000, Serbia.
authors.forename: Congor
authors.initials: C
authors.lastname: Nadj
authors.affiliation: Clinic of Neurology, Clinical Center Kragujevac, Zmaj Jovina 30, Kragujevac 34000, Serbia.
authors.forename: Gordana
authors.initials: G
authors.lastname: Toncev
authors.affiliation: Clinic of Neurology, Clinical Center Nis, Bulevar Dr Zorana Djindjica 48, Nis 18000, Serbia.
authors.forename: Slobodan
authors.initials: S
authors.lastname: Vojinovic
authors.affiliation: Clinic of Neurology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Dr Subotica 6, Belgrade 11000, Serbia.
authors.forename: Sarlota
authors.initials: S
authors.lastname: Mesaros
authors.affiliation: Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Visegradska 26A, Belgrade 11000, Serbia.
authors.forename: Darija
authors.initials: D
authors.lastname: Kisic Tepavcevic
authors.affiliation: Clinic of Neurology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Dr Subotica 6, Belgrade 11000, Serbia.
authors.forename: Irena
authors.initials: I
authors.lastname: Dujmovic
authors.affiliation: Clinic of Neurology, Clinical Center of Banja Luka, Dvanaest beba, Banja Luka 78000, Republika Srpska, Bosnia and Herzegovina.
authors.forename: Daliborka
authors.initials: D
authors.lastname: Tadic
authors.affiliation: Clinic of Neurology, Clinical Center Kragujevac, Zmaj Jovina 30, Kragujevac 34000, Serbia.
authors.forename: Svetlana
authors.initials: S
authors.lastname: Miletic-Drakulic
authors.affiliation: Clinic of Neurology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Dr Subotica 6, Belgrade 11000, Serbia.
authors.forename: Jelena
authors.initials: J
authors.lastname: Dackovic
authors.affiliation: Clinic of Neurology, Military Medical Academy, Crnotravska 17, Belgrade 11000, Serbia.
authors.forename: Smiljana
authors.initials: S
authors.lastname: Kostic
authors.affiliation: Clinic of Neurology, Clinical Center of Montenegro, Ljubljanska bb, Podgorica 81000, Montenegro.
authors.forename: Jevto
authors.initials: J
authors.lastname: Erakovic
authors.affiliation: Clinic of Neurology, Clinical Center of Vojvodina, Hajduk Veljkova 1-9, Novi Sad 21000, Serbia.
authors.forename: Lorand
authors.initials: L
authors.lastname: Sakalas
authors.affiliation: Clinic of Neurology, Clinical Center Nis, Bulevar Dr Zorana Djindjica 48, Nis 18000, Serbia.
authors.forename: Dejan
authors.initials: D
authors.lastname: Savic
authors.affiliation: Clinic of Neurology, Clinical Center of Vojvodina, Hajduk Veljkova 1-9, Novi Sad 21000, Serbia.
authors.forename: Vesna
authors.initials: V
authors.lastname: Suknjaja
authors.affiliation: Clinic of Neurology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Dr Subotica 6, Belgrade 11000, Serbia.
authors.forename: Vanja
authors.initials: V
authors.lastname: Martinovic
authors.affiliation: Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Visegradska 26A, Belgrade 11000, Serbia.
authors.forename: Gorica
authors.initials: G
authors.lastname: Maric
authors.affiliation: Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Visegradska 26A, Belgrade 11000, Serbia.
authors.forename: Tatjana
authors.initials: T
authors.lastname: Pekmezovic
mesh_terms: D000276:Adjuvants, Immunologic / Q000627:therapeutic use*; D000293:Adolescent; D000328:Adult; D000368:Aged; D017522:Bosnia and Herzegovina / Q000453:epidemiology; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D000068576:Interferon beta-1b / Q000627:therapeutic use*; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D054548:Montenegro / Q000453:epidemiology; D009103:Multiple Sclerosis / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology*; D015999:Multivariate Analysis; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D055771:Serbia / Q000453:epidemiology; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D000276:Adjuvants, Immunologic; D000068576:Interferon beta-1b
keywords: Adherence; Interferon beta-1b; Multiple sclerosis; Treatment satisfaction