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Khedr EM, Mahmoud DM, Hussein HB, Malky IEL, Mostafa SS, Gamea A. Treatment satisfaction with disease-modifying therapy is the only predictor of Adherence among multiple sclerosis patients from Upper Egypt. Sci Rep 2024; 14:7027. [PMID: 38528018 DOI: 10.1038/s41598-024-57116-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 03/14/2024] [Indexed: 03/27/2024] Open
Abstract
Despite the proven efficacy of the disease-modifying therapy (DMT) for multiple sclerosis (MS), the rates of non-adherence are frequently high. We aimed to evaluate the rate of non-adherence to the first DMT in Upper Egypt and identify different contributing factors. Out of 310 patients, ninety-seven adult patients with RRMS were recruited from three MS units located in Upper Egypt and were subjected to the following: complete clinical history, expanded disability status score (EDSS), Eight-item Morisky Medication Adherence Scale (MMAS-8), abbreviated Treatment Satisfaction Questionnaire for Medication-9 (TSQM-9), Hamilton depression scale, Fatigue Severity Scale (FSS) and the Pittsburgh Sleep Quality Index (PSQI). According to MMAS-8 scores, 63 (64.9%) of patients were non-adherent to their first DMT. Non-adherent patients are more likely to have longer disease duration (p = 0.002), longer duration on first DMT (p = 0.030), first DMT-start date before 2019 (p = 0.040), and lower treatment satisfaction scores (p = 0.016). However, there was no significant relation with physical disability, depression, fatigue, or sleep quality. On the regression analysis model, a lower treatment satisfaction score was the only predictor of DMT non-adherence (p = 0.012). Despite expanding DMT options, non-adherence among MS patients in Upper Egypt is high. Treatment satisfaction with DMT is the only predictor of adherence among MS patients of Upper Egypt. Adherence and satisfaction with the prescribed DMT should be assessed carefully to maximize DMT benefits.
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Affiliation(s)
- Eman M Khedr
- Department of Neuropsychiatry, Faculty of Medicine, Assiut University Hospital, Asyût, Egypt.
- Neuropsychiatric Department, Faculty of Medicine, Aswan University Hospital, Aswân, Egypt.
| | - Doaa M Mahmoud
- Department of Neuropsychiatry, Faculty of Medicine, Assiut University Hospital, Asyût, Egypt
| | - Hussein B Hussein
- Neuropsychiatric Department, Faculty of Medicine, South Valley University, Qena University Hospital, Qena, Egypt
| | - Islam E L Malky
- Neuropsychiatric Department, Faculty of Medicine, South Valley University, Qena University Hospital, Qena, Egypt
| | - Sarah S Mostafa
- Department of Neuropsychiatry, Faculty of Medicine, Assiut University Hospital, Asyût, Egypt
| | - Ayman Gamea
- Neuropsychiatric Department, Faculty of Medicine, South Valley University, Qena University Hospital, Qena, Egypt
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Effects of Disease-Modifying Treatments discontinuation in patients with Relapsing-Remitting Multiple Sclerosis: A 5 Year Prospective Cohort Study. Mult Scler Relat Disord 2022; 63:103857. [DOI: 10.1016/j.msard.2022.103857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 04/23/2022] [Accepted: 05/05/2022] [Indexed: 11/20/2022]
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Alhazzani A, Alqahtani M, Alamri N, Sarhan L, Alkhashrami S, Alahmarii M. Treatment satisfaction and adherence to medications among multiple sclerosis patients in Saudi Arabia. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2019. [DOI: 10.1186/s41983-019-0095-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Schlegel V, Leray E. From Medical Prescription to Patient Compliance: A Qualitative Insight into the Neurologist-Patient Relationship in Multiple Sclerosis. Int J MS Care 2018; 20:279-286. [PMID: 30568565 DOI: 10.7224/1537-2073.2017-043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Approximately 12 disease-modifying treatments are available worldwide for patients with relapsing multiple sclerosis (MS). These recent therapeutic advances have led to major changes in patient and neurologist attitudes toward drug prescription. Herein, we aimed to characterize patient choice regarding treatment for MS and identify how neurologists assess and monitor patient compliance during follow-up. Methods In 29 patients with MS, we observed visits to their neurologist to understand how questions related to compliance were addressed in the doctor-patient relationship. Face-to-face interviews were conducted with 15 of the 29 patients to discuss how they dealt with their drug prescription from a patient-centered perspective. Results Of the 15 patients with MS, nine were offered a choice of treatment. However, we found that neurologists were not always willing to consider the patients' input. Even if physicians attempt to align treatment choice with patient preferences to ensure compliance, preferences are often assumed rather than solicited from patients. Furthermore, patients may be unwilling to make their own treatment decisions. Various ways for neurologists to assess compliance during visits were also identified. Noncompliance can be considered as a way for patients to communicate their preferences and demonstrate involvement in their drug therapy, and it can lead to a renegotiation of the current treatment course. Conclusions These findings suggest that the neurologist-patient relationship has a great influence on patient compliance throughout the MS disease course.
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Kołtuniuk A, Rosińczuk J. Adherence to disease-modifying therapies in patients with multiple sclerosis. Patient Prefer Adherence 2018; 12:1557-1566. [PMID: 30197506 PMCID: PMC6112814 DOI: 10.2147/ppa.s175095] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic, inflammatory progressive demyelinating disease of the central nervous system. MS is one of the main causes of disability among young adults, and its management is a serious challenge for the healthcare system. PURPOSE The main purpose of this study was to examine adherence to first-line disease-modifying therapy (DMT) in MS patients using the self-report Multiple Sclerosis Treatment Adherence Questionnaire (MS-TAQ). MATERIALS AND METHODS The participants consisted of 226 MS patients (166 women and 60 men) who were treated with first-line immunomodulatory DMT. This study used a questionnaire designed by the authors, which contained questions about sociodemographic data, and the Polish version of the MS-TAQ. RESULTS The overall adherence was 76.5% according to the first criterion (missed ≥1 injection or tablet). There were no statistically significant differences due to sociodemographic variables between adherent and nonadherent patients. However, patients taking Avonex® significantly more often belonged to the adherent group (P=0.042). The most frequently mentioned reasons why nonadherent patients forget to take the drug included the following: too busy in their daily activities, indisposition to take the drug, unwillingness to take the drug, interference with daily activities, and dissatisfaction with the drug. The degree of adherence among MS patients treated with immunomodulatory drugs is high; however, some patients do not take medications regularly. CONCLUSION Due to the utility of the MS-TAQ, the caregivers of MS patients are able to quickly and easily assess the occurrence of side effects, ways to cope with them, and the occurrence of barriers to taking medication.
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Affiliation(s)
- Aleksandra Kołtuniuk
- Department of Nervous System Diseases, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland,
| | - Joanna Rosińczuk
- Department of Nervous System Diseases, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland,
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Treatment satisfaction across injectable, infusion, and oral disease-modifying therapies for multiple sclerosis. Mult Scler Relat Disord 2017; 18:196-201. [PMID: 29141809 DOI: 10.1016/j.msard.2017.10.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 08/31/2017] [Accepted: 10/04/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND The recent approval of oral disease-modifying therapies (DMTs) for multiple sclerosis (MS) has provided patients with a new route of therapy administration. Little research has compared patients' experiences with and perceptions of injectable, infusion and oral MS therapies. METHODS Three hundred fifty-seven treated MS patients enrolled in the CLIMB study completed the Treatment Satisfaction Questionnaire for Medication (TSQM). The TSQM provides information regarding perceived effectiveness, side effects, convenience and overall satisfaction. The patients were treated with either interferon beta-1a intramuscular (IFNβ-1a IM) (n = 40), interferon beta-1a subcutaneous (IFNβ-1a SC) (n = 45), glatiramer acetate (GA) (n = 118), natalizumab (NTZ) (n = 44), fingolimod (n = 66), or dimethyl fumarate (BG-12) (n = 44). Multivariable linear regression models were used to compare treatment satisfaction across all DMTs and between patients treated with injectable (n = 203), infusion (n = 44), and oral (n = 110) DMTs. All models were adjusted for sex, age, EDSS, and time on treatment. RESULTS Patients taking oral DMTs reported significantly higher convenience scores compared to patients taking either injectable or infusion DMTs. The adjusted difference in the mean overall convenience score was 26.87 (95% CI: 21.4, 32.34) for the comparison of orals and injectables and 17.53 (95% CI: 11.15, 23.9) for the comparison of orals and infusion. In addition, the proportion of patients reporting a side effect was significantly lower for orals compared to injectables (adjusted OR= 0.35; 95% CI: 0.18, 0.68) and infusion compared to injectables (adjusted OR= 0.14; 95% CI: 0.05, 0.35). CONCLUSION Patients reported treatment with the oral medications as more convenient than the injectable and infusion DMTs.
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Kürtüncü M, Tuncer A, Uygunoğlu U, Çalişkan Z, Paksoy AK, Efendı H, Kocaman AS, Özcan C, Terzı M, Turan ÖF, Saıp S, Karabudak R, Sıva A. Differences Between General Neurologists and Multiple Sclerosis Specialists in the Management of Multiple Sclerosis Patients: A National Survey. Noro Psikiyatr Ars 2017; 56:269-272. [PMID: 31903035 DOI: 10.5152/npa.2017.19387] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 02/21/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction The management of multiple sclerosis (MS) has become more complicated after the introduction of new diagnostic and treatment options. Despite the abundance of guidelines, the experience of physicians still plays a major role in the management of patients. This study aimed to define differences in behavior patterns between general neurologists (GNs) and MS specialists (MSSs). Methods We conducted a survey of 36 questions to 318 neurologists, including 33 MSSs. The survey covered topics including laboratory investigations, pregnancy, and treatment. Results Our study found many differences between GNs and MSSs in terms of management, the most important being treatment initiation and switching. GNs had a tendency to initiate treatment later than MSSs however, they tended to switch treatment faster. Our study also showed that GNs ordered magnetic resonance imaging (MRI) more frequently than MSSs, even if patients were clinically stable. Moreover, although GNs more frequently relied on MRI, they did not consider brain atrophy as an important measure in the follow-up of their patients. Furthermore, GNs considered replacement therapy less often than MSSs, even in patients with vitamin D deficiency. Discussion Our study revealed important discrepancies between the management patterns of GNs and MSSs in MS patients. These findings suggest the need for a national education program for GNs on MSSs.
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Affiliation(s)
- Murat Kürtüncü
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aslı Tuncer
- Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Uğur Uygunoğlu
- Department of Neurology, Faculty of Medicine, Istanbul University Cerrahpaşa, Istanbul, Turkey
| | | | | | - Hüsnü Efendı
- Department of Neurology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Ayşe Sağduyu Kocaman
- Department of Neurology, Faculty of Medicine, Acıbadem University, Istanbul, Turkey
| | - Cemal Özcan
- Department of Neurology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Murat Terzı
- Department of Neurology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Ömer Faruk Turan
- Department of Neurology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Sabahattin Saıp
- Department of Neurology, Faculty of Medicine, Istanbul University Cerrahpaşa, Istanbul, Turkey
| | - Rana Karabudak
- Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Aksel Sıva
- Department of Neurology, Faculty of Medicine, Istanbul University Cerrahpaşa, Istanbul, Turkey
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