Medication adherence and health outcomes in persons with multiple sclerosis treated with dimethyl fumarate

TEC-ADHERE: Real-World Persistence and Adherence on Dimethyl Fumarate in Patients with Relapsing-Remitting Multiple Sclerosis in the French OroSEP Patient-Support Program

INTRODUCTION

Treatment persistence and adherence are essential for achieving therapeutic goals in patients with multiple sclerosis (MS). OroSEP is an independent patient-support program (PSP) in France for patients with relapsing-remitting MS (RRMS) receiving oral disease-modifying therapies.

METHODS

TEC-ADHERE (NCT04221191; 08/19/2019-09/15/2022) was a prospective, non-interventional, phase 4 study to assess the effect of OroSEP on persistence and adherence to dimethyl fumarate (DMF; Tecfidera™) in patients with RRMS. Outcomes were compared for patients in OroSEP versus non-OroSEP patients who received their neurologists' standard of care (SoC). Patients initiated DMF at month 0 (M0); follow-up visits occurred at M3 and M6. Primary outcome was persistence at M6. Secondary outcomes included persistence at M1 and M3, adherence at M6 (Girerd questionnaire), anxiety (Generalized Anxiety Disorder Assessment), patient satisfaction at M6 (Treatment Satisfaction Questionnaire for Medication), patient and neurologist satisfaction with OroSEP participation, and adverse events (AEs).

RESULTS

Per-protocol population included 341 patients (OroSEP, n = 135; SoC, n = 206). Persistence was similar for OroSEP vs SoC (M6, 75.9% vs 76.6%; M1, 96.0% vs 92.4%; M3, 85.5% vs 89.0%). At M6, mean adherence was higher for OroSEP (5.4) vs SoC (4.7; p < 0.0001), and good adherence (Girerd score = 6) was achieved by more OroSEP patients (55.7%) than SoC patients (29.6%; p < 0.01). Mean anxiety scores were lower in the OroSEP group than in the SoC group at baseline (7.1 vs 8.8; p = 0.02) and M6 (3.4 vs 6.1; p < 0.001). Mean satisfaction scores at M6 were higher for OroSEP (77.4) vs SoC (64.2; p < 0.01). Most neurologists (n = 11/14) agreed that OroSEP helped improve adherence. Treatment-related AEs occurred in 62 (36.3%) OroSEP patients and 76 (42.9%) SoC patients; most common were flushing, diarrhea, hot flush, and abdominal pain.

CONCLUSION

These outcomes support the value of PSPs in encouraging adherence, alleviating anxiety, improving patient satisfaction, and supporting patients to be more independent in managing MS.

TRIAL REGISTRATION

ClinicalTrials.gov identifier, NCT04221191.

Factors Influencing Drug Prescribing for Patients With Hospitalization History in Circulatory Disease-Patient Severity, Composite Adherence, and Physician-Patient Relationship: Retrospective Cohort Study

BACKGROUND

With countries promoting generic drug prescribing, their growth may plateau, warranting further investigation into the factors influencing this trend, including physician and patient perspectives. Additional strategies may be needed to maximize the switch to generic drugs while ensuring health care system sustainability, focusing on factors beyond mere low cost. Emphasizing affordability and clarifying other prescription considerations are essential.

OBJECTIVE

This study aimed to provide initial insights into how patient severity, composite adherence, and physician-patient relationships impact generic switching.

METHODS

This study used a long-term retrospective cohort design by analyzing data from a national health care database. The population included patients of all ages, primarily older adults, who required primary-to-tertiary preventive actions with a history of hospitalization for cardiovascular diseases (ICD-10 [International Statistical Classification of Diseases, Tenth Revision]) from April 2014 to March 2018 (4 years). We focused on switching to generic drugs, with temporal variations in clinical parameters as independent variables. Lifestyle factors (smoking and drinking) were also considered. Adherence was measured as a composite score comprising 11 elements. The physician-patient relationship was established based on the interval between physician change and prescription. Logistic regression analysis and propensity score matching were used, along with complementary analysis of physician-patient relationships, proportion of days covered, and adherence for a subset of the population.

RESULTS

The study included 48,456 patients with an average follow-up of 36.1 (SD 8.8) months. The mean age was 68.3 (SD 9.9) years; BMI, 23.4 (SD 3.4) kg/m2; systolic blood pressure, 131.2 (SD 15) mm Hg; low-density lipoprotein cholesterol level, 116.6 (SD 29.3) mg/dL; hemoglobin A1c (HbA1c), 5.9% (SD 0.8%); and serum creatinine level, 0.9 (SD 0.8) mg/dL. Logistic regression analysis revealed significant associations between generic switching and systolic blood pressure (odds ratio [OR] 0.996, 95% CI 0.993-0.999), serum creatinine levels (OR 0.837, 95% CI 0.729-0.962), glutamic oxaloacetic transaminase levels (OR 0.994, 95% CI 0.990-0.997), proportion of days covered score (OR 0.959, 95% CI 0.948-0.97), and adherence score (OR 0.910, 95% CI 0.875-0.947). In addition, generic drug rates increased with improvements in the HbA1c level band and smoking level (P<.01 and P<.001). The group with a superior physician-patient relationship after propensity score matching had a significantly higher rate of generic drug prescribing (51.6%, SD 15.2%) than the inferior relationship group (47.7%, SD17.7%; P<.001).

CONCLUSIONS

Although physicians' understanding influences the choice of generic drugs, patient condition (severity) and adherence also impact this decision. For example, improved creatinine levels are associated with generic drug choice, while stronger physician-patient relationships correlate with higher rates of generic drug use. These findings may contribute to the appropriate prescription of pharmaceuticals if the policy diffusion of generic drugs begins to slow down. Thus, preventing serious illness while building trust may result in clinical benefits and positive socioeconomic outcomes.

Psychometric evaluation of the 5-item Medication Adherence Report Scale questionnaire in persons with multiple sclerosis

The 5-item Medication Adherence Report Scale (MARS-5) is a reliable and valid questionnaire for evaluating adherence in patients with asthma, hypertension, and diabetes. Validity has not been determined in multiple sclerosis (MS). We aimed to establish criterion validity and reliability of the MARS-5 in persons with MS (PwMS). Our prospective study included PwMS on dimethyl fumarate (DMF). PwMS self-completed the MARS-5 on the same day before baseline and follow-up brain magnetic resonance imaging (MRI) 3 and 9 months after treatment initiation and were graded as highly and medium adherent upon the 24-cut-off score, established by receiver operator curve analysis. Health outcomes were represented by relapse occurrence from the 1st DMF dispense till follow-up brain MRI and radiological progression (new T2 MRI lesions and quantitative analysis) between baseline and follow-up MRI. Criterion validity was established by association with the Proportion of Days Covered (PDC), new T2 MRI lesions, and Beliefs in Medicines questionnaire (BMQ). The reliability evaluation included internal consistency and the test-retest method. We included 40 PwMS (age 37.6 ± 9.9 years, 75% women), 34 were treatment-naive. No relapses were seen during the follow-up period but quantitative MRI analysis showed new T2 lesions in 6 PwMS. The mean (SD) MARS-5 score was 23.1 (2.5), with 24 PwMS graded as highly adherent. The higher MARS-5 score was associated with higher PDC (b = 0.027, P<0.001, 95% CI: (0.0134-0.0403)) and lower medication concerns (b = -1.25, P<0.001, 95% CI: (-1.93-(-0,579)). Lower adherence was associated with increased number (P = 0.00148) and total volume of new T2 MRI lesions (P = 0.00149). The questionnaire showed acceptable internal consistency (Cronbach α = 0.72) and moderate test-retest reliability (r = 0.62, P < 0.0001, 95% CI: 0.33-0.79). The MARS-5 was found to be valid and reliable for estimating medication adherence and predicting medication concerns in persons with MS.