Treatment adherence in patients with multiple sclerosis: risk factors

Introduction

Adherence is a modifiable factor to disease-modifying treatments response in patients with multiple sclerosis (MS). Our objective is to assess the risk factors associated with inadequate adherence.

Method

Retrospective study through review of medical records and review of the database of pharmaceutical dispensing of patients with MS of a tertiary hospital from 2004 to 2022. A multivariate logistic regression analysis of demographic, clinical, nosological, and therapeutic factors was performed between adherent and non-adherent patients and treatments.

Result

546 treatments of 284 patients (67.3% women, age 38.4 ± 10.0) were analysed, observing 87.5% adherence. Non-adherent patients presented a higher EDSS at the end of treatment, were more frequently patients with secondary progressive multiple sclerosis, and had a higher proportion of cognitive impairment, psychiatric pathology, polypharmacy, and alcohol and drug use. After the multivariable analysis, risk factors were cognitive impairment (OR: 3.82 [1.51−9.70], P = .005), and alcohol and drug use (OR: 22.83 [7.32−71.20], P < .001). On the contrary, oral drugs favored better adherence (OR 0.29 [0.12−0.75], P = .01).

Conclusions

Among many factors, alcohol or drug use and cognitive impairment are the major risk factors for low therapeutic adherence in patients with MS.