title: Glatiramer acetate treatment persistence - but not adherence - in multiple sclerosis patients is predicted by health-related quality of life and self-efficacy: a prospective web-based patient-centred study (CAIR study).
abstract: BACKGROUND
  In patients with relapsing remitting multiple sclerosis (RRMS) the persistence of and adherence to disease modifying drug (DMD) treatment is inadequate. To take individualised measures there is a need to identify patients with a high risk of non-persistence or non-adherence. As patient-related factors have a major influence on persistence and adherence, we investigated whether health-related quality of life (HRQoL) and self-efficacy could predict persistence or adherence.
  
  
  METHODS
  In a prospective web-based patient-centred study in 203 RRMS patients, starting treatment with glatiramer acatete (GA) 20 mg subcutaneously daily, we measured physical and mental HRQoL (Multiple Sclerosis Quality of Life-54 questionnaire), functional and control self-efficacy (Multiple Sclerosis Self-Efficacy Scale), the 12-month persistence rate and, in persistent patients, the percentage of missed doses. HRQoL and self-efficacy were compared between persistent and non-persistent patients, and between adherent and non-adherent patients. Logistic regression analysis was used to assess whether persistence and adherence were explained by HRQoL and self-efficacy.
  
  
  RESULTS
  Persistent patients had higher baseline physical (mean 58.1 [standard deviation, SD] 16.9) and mental HRQoL (63.8 [16.8]) than non-persistent patients (49.5 [17.6]; 55.9 [20.4]) (P = 0.001; P = 0.003) with no differences between adherent and non-adherent patients (P = 0.46; P = 0.54). Likewise, in persistent patients function (752 [156]) and control self-efficacy (568 [178]) were higher than in non-persistent patients (689 [173]; 491 [192]) (P = 0.009; P = 0.004), but not in adherent vs. non-adherent patients (P = 0.26; P = 0.82). Logistic regression modelling identified physical HRQoL and control self-efficacy as factors that explained persistence. Based on predicted scores from the model, patients were classified into quartiles and the percentage of non-persistent patients per quartile was calculated: non-persistence in the highest quartile was 23.4 vs. 53.2% in the lowest quartile. Risk differentiation with respect to adherence was not possible. Based on these findings we propose a practical work-up scheme to identify patients with a high risk of non-persistence and to identify persistence-related factors.
  
  
  CONCLUSIONS
  Findings suggest that pre-treatment physical HRQoL and control self-efficacy may identify RRMS patients with a high risk of early discontinuation of injectable DMD treatment. Targeting of high-risk patients may enable the efficient use of persistence-promoting measures.
  
  
  BACKGROUND
  Nederlands Trial Register code: NTR2432 .
authors.affiliation: University Medical Centre Groningen, Department of Community and Occupational Medicine, University Groningen, Antonius Deusinglaan 1, 9713, AV, Groningen, The Netherlands. p.j.h.jongen@rug.nl.|MS4 Research Institute, Ubbergseweg 34, 6522, KJ, Nijmegen, The Netherlands. p.j.h.jongen@rug.nl.
authors.forename: Peter Joseph
authors.initials: PJ
authors.lastname: Jongen
authors.affiliation: Department for Health Evidence, Radboud University Medical Centre, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands.
authors.forename: Wim A
authors.initials: WA
authors.lastname: Lemmens
authors.affiliation: St. Antonius Hospital, P.O. Box 2500, 3430, EM, Nieuwegein, The Netherlands.
authors.forename: Erwin L
authors.initials: EL
authors.lastname: Hoogervorst
authors.affiliation: Department for Health Evidence, Radboud University Medical Centre, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands.
authors.forename: Rogier
authors.initials: R
authors.lastname: Donders
mesh_terms: D000328:Adult; D005260:Female; D000068717:Glatiramer Acetate / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D020407:Internet; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000188:drug therapy* / Q000523:psychology; D010455:Peptides / Q000627:therapeutic use; D011446:Prospective Studies; D011788:Quality of Life; D020377:Self Efficacy; D011795:Surveys and Questionnaires; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D007166:Immunosuppressive Agents; D010455:Peptides; D000068717:Glatiramer Acetate
keywords: Adherence; Disease modifying treatment; Glatiramer acetate; Health-related quality of life; Multiple sclerosis; Persistence; Quality of life; Relapsing remitting; Self-efficacy