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Adherence to the immunomodulatory drugs for multiple sclerosis: contrasting factors affect stopping drug and missing doses


Tremlett, H and Van der Mei, IAF and Pittas, F and Blizzard, CL and Paley, GA and Dwyer, T and Taylor, BVM and Ponsonby, AL, Adherence to the immunomodulatory drugs for multiple sclerosis: contrasting factors affect stopping drug and missing doses, Pharmacoepidemiology and Drug Safety, 17, (6) pp. 565-576. ISSN 1053-8569 (2008) [Refereed Article]

DOI: doi:10.1002/pds.1593


Background: Long-term immunomodulatory drug (IMD) treatment is now common in multiple sclerosis (MS). However, predictors of adherence are not weil understood; past studies lacked lifestyle factors such as alcohol use and predictors of missed doses have not been evaluated. We examined both levels of non-adherence - stopping IMD and missing doses. Methods: This longitudinal prospective study followed a population-based cohort (n = 199) of definite MS patients in Southern Tasmania (January 2002 to April 2005, source population 226 559) every 6 months. Baseline factors (demographic, clinical, psychological and cognitive) affecting adherence were examined by logistic regression and a longitudinal analysis (generalized estimating equation (GEE)). Results: Of the 97 patients taking an IMD (mean follow-up=2.4 years), 73% (71/97) missed doses, with 1 in 10 missing > 10 doses in any 6-month period. Missed doses were positively associated with alcohol amount consumed per session (p = 0.008). A history of missed doses predicted future missed doses (p < 0.0005). Over one-quarter (27/97) stopped their current IMD, which was associated with lower education levels (p = 0.032) and previous relapses (p = 0.05). No cognitive or psychological test predicted adherence. Conclusions: There were few strong predictors of missed doses, although people with MS consuming more alcoholic drinks per session are at a higher risk of missing doses. Divergent factors influenced the two levels of non-adherence indicating the need for a multifaceted approach to improving IMD adherence. In addition, missed doses should be assessed and incorporated into clinical trial design and clinical practice as poor adherers could impact on clinical outcomes. Copyright © 2008 John Wiley & Sons, Ltd.

Item Details

Item Type:Refereed Article
Research Division:Biomedical and Clinical Sciences
Research Group:Neurosciences
Research Field:Neurology and neuromuscular diseases
Objective Division:Health
Objective Group:Clinical health
Objective Field:Clinical health not elsewhere classified
UTAS Author:Van der Mei, IAF (Professor Ingrid van der Mei)
UTAS Author:Pittas, F (Dr Fotini Pittas)
UTAS Author:Blizzard, CL (Professor Leigh Blizzard)
UTAS Author:Paley, GA (Ms Glenys Paley)
UTAS Author:Taylor, BVM (Professor Bruce Taylor)
ID Code:53443
Year Published:2008
Web of Science® Times Cited:63
Deposited By:Menzies Institute for Medical Research
Deposited On:2008-12-09
Last Modified:2009-05-28

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