Charity Evans1, Ruth Ann Marrie2, Feng Zhu3, Stella Leung4, Xinya Lu5, Dessalegn Y Melesse6, Elaine Kingwell7, Yinshan Zhao8, Helen Tremlett9. 1. College of Pharmacy & Nutrition, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 5E5, Canada. Electronic address: charity.evans@usask.ca. 2. Departments of Internal Medicine and Community Health Sciences, University of Manitoba, Health Sciences Centre, GF 543-820 Sherbrook Street, Winnipeg, MB, Canada R3A 1R9. Electronic address: rmarrie@hsc.mb.ca. 3. Department of Medicine (Neurology), University of British Columbia, UBC Hospital, 2211 Wesbrook Mall, Vancouver, BC, Canada V6T 2B5. Electronic address: f.zhu@stat.ubc.ca. 4. Department of Community Health Sciences, University of Manitoba, Health Sciences Centre, GF 543-820 Sherbrook Street, Winnipeg, MB, Canada R3A 1R9. Electronic address: stellaleung1@gmail.com. 5. Saskatchewan Health Quality Council, 241-111 Research Drive, Saskatoon, SK, Canada S7N 3R2. Electronic address: xlu@hqc.sk.ca. 6. Department of Community Health Sciences, University of Manitoba, Health Sciences Centre, GF 543-820 Sherbrook Street, Winnipeg, MB, Canada R3A 1R9. Electronic address: desyiz@gmail.com. 7. Department of Medicine (Neurology), University of British Columbia, UBC Hospital, 2211 Wesbrook Mall, Vancouver, BC, Canada V6T 2B5. Electronic address: elainejk@mail.ubc.ca. 8. Department of Medicine (Neurology), University of British Columbia, UBC Hospital, 2211 Wesbrook Mall, Vancouver, BC, Canada V6T 2B5. Electronic address: yinshan@msmri.medicine.ubc.ca. 9. Department of Medicine (Neurology), University of British Columbia, UBC Hospital, 2211 Wesbrook Mall, Vancouver, BC, Canada V6T 2B5. Electronic address: helen.tremlett@ubc.ca.
Abstract
OBJECTIVE: We aimed to estimate the prevalence and predictors of optimal adherence and persistence to the disease-modifying therapies (DMT) for multiple sclerosis (MS) in 3 Canadian provinces. METHODS: We used population-based administrative databases in British Columbia (BC), Saskatchewan, and Manitoba. All individuals receiving DMT (interferon-B-1b, interferon-B-1a, and glatiramer acetate) between 1-January-1996 and 31-December-2011 (BC), 31-March-2014 (Saskatchewan), or 31-March-2012 (Manitoba) were included. One-year adherence was estimated using the proportion of days covered (PDC). Persistence was defined as time to DMT discontinuation. Regression models were used to assess predictors of adherence and persistence; results were pooled using random effects meta-analysis. RESULTS: 4830 individuals were included. When results were combined, an estimated 76.4% (95% CI: 69.1-82.4%) of subjects exhibited optimal adherence (PDC ≥80%). Median time to discontinuation of the initial DMT was 1.9 years (95% CI: 1.6-2.1) in Manitoba, 2.8 years (95% CI: 2.5-3.0) in BC, and 4.0 years (95% CI: 3.5-4.6) in Saskatchewan. Age, sex and socioeconomic status were not associated with adherence or persistence. Individuals who had ≥4 physician visits during the year prior to the first DMT dispensation were more likely to exhibit optimal adherence compared to those with fewer (0-3) physician visits. CONCLUSIONS: We observed adherence that is higher than what has been reported for other chronic diseases, and other non-population-based MS cohorts. Closer examination as to why adherence appears to be relatively better in MS and how adherence influences disease outcomes could contribute to our understanding of MS, and prove useful in the management of other chronic diseases.
OBJECTIVE: We aimed to estimate the prevalence and predictors of optimal adherence and persistence to the disease-modifying therapies (DMT) for multiple sclerosis (MS) in 3 Canadian provinces. METHODS: We used population-based administrative databases in British Columbia (BC), Saskatchewan, and Manitoba. All individuals receiving DMT (interferon-B-1b, interferon-B-1a, and glatiramer acetate) between 1-January-1996 and 31-December-2011 (BC), 31-March-2014 (Saskatchewan), or 31-March-2012 (Manitoba) were included. One-year adherence was estimated using the proportion of days covered (PDC). Persistence was defined as time to DMT discontinuation. Regression models were used to assess predictors of adherence and persistence; results were pooled using random effects meta-analysis. RESULTS: 4830 individuals were included. When results were combined, an estimated 76.4% (95% CI: 69.1-82.4%) of subjects exhibited optimal adherence (PDC ≥80%). Median time to discontinuation of the initial DMT was 1.9 years (95% CI: 1.6-2.1) in Manitoba, 2.8 years (95% CI: 2.5-3.0) in BC, and 4.0 years (95% CI: 3.5-4.6) in Saskatchewan. Age, sex and socioeconomic status were not associated with adherence or persistence. Individuals who had ≥4 physician visits during the year prior to the first DMT dispensation were more likely to exhibit optimal adherence compared to those with fewer (0-3) physician visits. CONCLUSIONS: We observed adherence that is higher than what has been reported for other chronic diseases, and other non-population-based MS cohorts. Closer examination as to why adherence appears to be relatively better in MS and how adherence influences disease outcomes could contribute to our understanding of MS, and prove useful in the management of other chronic diseases.
Authors: Archibald de Ceuninck van Capelle; Hanneke van der Meide; Frans J H Vosman; Leo H Visser Journal: PLoS One Date: 2017-08-24 Impact factor: 3.240
Authors: Dessalegn Y Melesse; Ruth Ann Marrie; James F Blanchard; Bo Nancy Yu; Charity Evans Journal: Patient Prefer Adherence Date: 2017-06-28 Impact factor: 2.711