Self-reports by persons with multiple sclerosis are an adequate surrogate for healthcare provider data on disease-modifying therapy and multiple sclerosis type

Patient Experiences with the Impacts of Multiple Sclerosis & Disease-Modifying Therapies

Purpose

Disease-modifying therapies (DMTs) are vital for managing multiple sclerosis (MS), but research using administrative data often excludes patient preferences and factors clinicians consider in treatment decisions. Patient experience data are crucial to understand and improve MS treatment initiation, adherence, and outcomes.

Methods

A cross-sectional survey of US adults with MS or clinically isolated syndrome was conducted online from December 2022 to January 2023 by the MS Coalition. A mixed methods analysis was conducted: logistic regression for quantitative data and thematic analysis of qualitative data.

Results

Among 1,323 participants (median age 55; 78% female), 80% expressed concerns about loss of independence, 65% about financial impacts, 64% about emotional impacts, 57% about relationships, and 42% about careers. Emotional tolls included identity loss, stress from navigating healthcare, and financial strain on families. Concerns varied by age, sex, and disability status. Nearly all participants (97%) reported DMT experience, with 73% having used two or more DMTs. Key factors in initiating DMT included slowing disease progression (92%), preventing relapses (89%), and following medical advice (89%). Financial barriers, such as high out-of-pocket costs, led to treatment delays or discontinuation in 19%. Barriers varied by demographic factors and included stress from medication costs, insurance denials, and fear of losing health coverage. Financial assistance was crucial for many. Half of participants had stopped a DMT due to doctor recommendations, side effects, or insurance issues.

Conclusion

The survey highlights the emotional and financial burdens of living with MS, including concerns about independence and relationships. The findings underscore the need for comprehensive care and provide actionable recommendations for managed care, research, and healthcare providers.

Cognitive impairment predicts medication discrepancies in Huntington's Disease: patient self-report compared to pharmacy records

BACKGROUND

Proper medication reconciliation (= comparing the accuracy of patient-reported medication use with pharmacy records) could prevent potentially dangerous situations such as drug-drug interactions and hospitalization. This is particularly important when patients rely on multiple medications, such as in neurodegenerative disorders like Huntington's Disease (HD). Currently, it is unknown how often medication discrepancies occur in HD patients and which factors contribute to the discrepancies.

OBJECTIVE

Identify prognostic factors of medication discrepancies in HD, using patient-reported medication use and local pharmacy records.

METHODS

With 134 pre- and manifest HD patients, we performed a multivariable logistic regression analysis with medication discrepancy as dependent variable (pharmacy records as reference value) and sex, CAP score, disease status (pre- or manifest HD), number of concomitant medications taken, presence of an informal caregiver, Unified Huntington's Disease Rating Scale-Total Functioning Capacity, unified cognitive Z-score and Problem Behaviors Assessment-short characteristic scores for depression, anxiety, and apathy as independent variables.

RESULTS

Medication discrepancies were reported frequently, both in premanifest (43.2%) and manifest HD subjects (36.7%). Impaired cognition significantly predicted medication discrepancies (beta = -0.688, SE 0.27, p = 0.011). All other variables were non-significant.

CONCLUSIONS

Regardless of HD disease status and stage, patient self-reported medication use is not a reliable source, especially in those with impaired cognitive function. The presence of an informal caregiver and the absence of polypharmacy, depression, anxiety and apathy do not influence self-reported medication accuracy. Objective verification of medication use with HD patients' local pharmacy is recommended.

TRIAL REGISTRATION NUMBER

ICTRP-NL-OMON55123, HD-med, registered 26-Nov-2019.

Factors associated with low health-related quality of life in persons with multiple sclerosis: A quantile-based segmentation approach

BACKGROUND

Improving health-related quality of life (HRQoL) is an important disease management goal in persons with Multiple Sclerosis (PwMS). HRQoL decreases with increasing age and prolonged disease duration; other factors remain less understood.

OBJECTIVE

To identify associations of multiple sclerosis (MS) disease characteristics and symptom burden with low HRQoL.

METHODS

Using the Swiss MS Registry, we applied quantile regression adjusted for age and MS disease duration to determine 25th (low HRQoL) and 75th (high HRQoL) percentiles of the EuroQol-5-Dimension (EQ-5D) distribution for PwMS. We compared PwMS across HRQoL groups by analyzing differences in sociodemographics, symptom burden, MS risk factors, gait impairment, and the MS Severity Score (MSSS), all measured at the same time as HRQoL. The analyses included descriptive methods, multivariable multinomial regression, and simultaneous quantile regression as a sensitivity analysis.

RESULTS

We included 1697 PwMS with median age and time-to-diagnosis of 49 and 9 years. Multivariable regression revealed low HRQoL to be associated with receiving invalidity insurance benefits, reporting depression, muscle weakness, memory problems, pain, and severe gait impairment. The analysis for individuals with available MSSS (n = 937) showed an increasing probability of low HRQoL with higher MSSS.

CONCLUSION

Our segmentation method identified symptom burden and MS severity as factors associated with low HRQoL. Pharmacological and non-pharmacological MS symptom management, especially for depression, fatigue, pain, and muscle weakness, may warrant increased attention to preserve or improve HRQoL.

Exploring the relationship between neurologists and older persons with multiple sclerosis through the lens of social support theory

Background

Although healthcare practitioners (HCPs) are a valuable source of social support, research on support provided by neurologists to older persons with multiple sclerosis (pwMS) remains limited.

Objectives

To explore expectations of pwMS aged 55 years or older regarding MS care and to identify support types, met and unmet needs within their relationship with neurologists.

Methods

Utilizing a mixed-methods approach, we analyzed survey data from Swiss Multiple Sclerosis Registry participants. Quantitative data included Likert scales gauging the importance of various aspects of MS care for pwMS both in and out of neurological care. Qualitative data were derived from three open-ended questions, focusing on neurologist-provided support for pwMS in neurological care. Data underwent descriptive and deductive thematic analysis, using Cutrona and Suhr framework for coding social support.

Results

Among the 286 participants (median age 61.0 years, interquartile range (IQR) 57.0-66.0; median disease duration 23.5 years, IQR 15.0-31.0), 84.6% (N = 244) were under neurological care. Quantitative findings highlighted the significance of HCP expertise and consultation time. Qualitative analysis identified all social support domains in the neurologist-pwMS relationship, with informational support being most prevalent, followed by emotional support. Neurologists' expertise, availability, comprehensive advising, listening, and validation emerged as key themes. Unmet needs were relatively infrequent and concerned insufficient information on complementary medicine, empathy, and understanding of symptoms like fatigue.

Conclusions

Older pwMS see neurologists as adequate providers of comprehensive support and particularly value neurologists' sufficient availability, informational and emotional support. Areas for improvement include attention to complementary medicine and empathy.