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...
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| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier España
2025-05-01
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| Series: | Neurología (English Edition) |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2173580825000367 |
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| Summary: | 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. Resumen: Introducción: La adherencia es un factor modificable de respuesta a los tratamientos modificadores de la enfermedad en los pacientes con esclerosis múltiple (EM). Nuestro objetivo es valorar los factores de riesgo asociados a una inadecuada adherencia. Método: Estudio retrospectivo mediante revisión de historias clínicas y revisión de la base de datos de dispensaciones farmacéuticas de pacientes con EM de un hospital terciario desde 2004 hasta 2022. Se ha realizado un análisis de regresión logística multivariante de factores demográficos, clínicos, nosológicos y terapéuticos entre pacientes y tratamientos adherentes y no adherentes. Resultado: Se analizaron 546 tratamientos de 284 pacientes (67.3% de mujeres, edad 38.4 ± 10.0), observándose un 87.5% de adherencia. Los pacientes no adherentes presentaron un mayor EDSS al final del tratamiento, eran más frecuentemente pacientes con esclerosis múltiple secundaria progresiva y tenían en mayor proporción deterioro cognitivo, patología psiquiátrica, polimedicación y consumo de alcohol y drogas. Tras el análisis multivariable resultaron factores de riesgo el deterioro cognitivo (OR: 3.82 (1.51−9.70), P = .005) y el consumo de alcohol y drogas (OR: 22.83 (7.32−71.20), P < .001). Por el contrario, los fármacos orales favorecieron una mejor adherencia (OR 0.29 (0.12−0.75), P = .01). Conclusiones: Entre numerosos factores, el consumo de alcohol o drogas y el deterioro cognitivo son los mayores factores de riesgo de baja adherencia terapéutica en pacientes con EM. |
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| ISSN: | 2173-5808 |