Static and group-based trajectory analyses of factors associated with non-adherence in patients with multiple sclerosis newly-initiating once- or twice-daily oral disease-modifying therapy. Issue 2 (April 2022)

• Record Type: Journal Article
• Authors: Nicholas, Jacqueline A; Edwards, Natalie C; Edwards, Roger A; Dellarole, Anna; Manca, Luigi; Harlow, Danielle E; Phillips, Amy L
• Is Part Of: Multiple sclerosis journal, experimental, translational and clinical. Volume 8:Issue 2(2022)
• Publication Date: 2022-04
• Subjects: Multiple sclerosis -- non-adherence -- disease-modifying therapy -- newly-initiating -- oral treatment -- group-based trajectory modeling; Multiple sclerosis -- Periodicals; 616.834
• DOI: 10.1177/20552173221101150
• Languages: English
• ISSNs: 2055-2173

Abstract

Background: Increased understanding of adherence may facilitate optimal targeting of interventions. Objective: To utilize group-based trajectory modeling (GBTM) to understand longitudinal patterns of adherence and factors associated with non-adherence in patients with multiple sclerosis (MS) newly-initiating once-/twice-daily oral disease-modifying therapy (DMT) (fingolimod, dimethyl fumarate, or teriflunomide). Methods: Commercial plan data were analyzed using proportion of days covered (PDC) to evaluate factors associated with non-adherence. GBTM clustered patient subgroups with similar longitudinal patterns of adherence measured by monthly PDC (≥80%) and multinomial logistic regression identified factors associated with adherence trajectory subgroups. Results: Among 7689 patients, 39.5% were non-adherent to once-/twice-daily oral DMTs. Characteristics associated with non-adherence (PDC<80%) included younger age, female, depression or migraine, switching during follow-up, more frequent dosing, relapse, and absence of magnetic resonance imaging. GBTM elucidated three adherence subgroups: Immediately Non-Adherent (14.9%); Gradually Non-Adherent (19.5%), and Adherent (65.6%). Additional factors associated with adherence (i.e. region, chronic lung disease) were identified and factors differed among trajectory subgroups. Conclusion: These analyses confirmed that a significant proportion of patients with MS are non-adherent to once-/twice-daily oral DMTs. Unique patterns of non-adherence and factors associated with patterns of adherence emerged. The approach demonstrated how quantitative trajectories can help clinicians develop tailored interventions.