Therapy satisfaction and adherence in patients with relapsing-remitting multiple sclerosis: the THEPA-MS survey

Abstract

Background: Improved clinical effectiveness and therefore positive modification of multiple sclerosis (MS) with basic therapy can be achieved by long-term regular intake of drugs as prescribed but investigations have shown that a high percentage of patients do not take their medications as prescribed.

Objectives: We assessed the satisfaction and adherence of patients with MS with their current disease-modifying treatment under clinical practice conditions. We compared different facets of satisfaction as well as their internal relationship and identified predictors in an exploratory manner.

Methods: Therapy satisfaction in patients with relapsing-remitting multiple sclerosis (THEPA-MS) was a noninterventional, prospective cross-sectional study performed throughout Germany in 2013 and 2014, and included patients with clinically isolated syndrome or relapsing-remitting MS. We applied a standardized approach to document satisfaction and adherence by patient-reported outcomes (Treatment Satisfaction Questionnaire for Medication) as well as by physician ratings.

Results: Of 3312 patients with a mean age of 43.7 years, 73.3% were women and the mean level of disability according to the Expanded Disability Status Scale was 2.29; 13.3% did not receive any medication at the time of documentation, 21.3% received interferon β1a intramuscularly, 20.7% had interferon β1a subcutaneously, 17.0% had interferon β1b subcutaneously and 23.7% had glatiramer acetate. Adherence rates varied between 60% (lifetime) and 96.5% (current medication). Differences between current medications were found for side effects and convenience scores but not for effectiveness, satisfaction and adherence. Higher global satisfaction and effectiveness were associated with fewer relapses, longer duration of medication, lower disability score and the absence of several side effects.

Conclusion: In a connected model of patient satisfaction, effectiveness, side effects, convenience and adherence, patients' individual needs and concerns have to be addressed. Most differences were found with respect to side effects and convenience of treatment. Therefore, an improvement in these two domains seems to be the most promising proximate approach to elevate adherence levels.

Keywords: convenience; multiple sclerosis; patient adherence; patient satisfaction; patient-centred outcomes research; quality of life; side effects; treatment effectiveness.

Figure 1.

Regression tree analysis of global satisfaction (TSQM, N = 2935). DMD, disease-modifying drug; EDSS, Expanded Disability Status Scale; IFN, interferon; i.m., intramuscular; s.c., subcutaneous; TSQM, Treatment Satisfaction Questionnaire for Medication.

Figure 2.

Regression tree analysis of effectiveness (TSQM, N = 2952). DMD, disease-modifying drug; EDSS, Expanded Disability Status Scale; IFN, interferon; i.m., intramuscular; s.c., subcutaneous; TSQM, Treatment Satisfaction Questionnaire for Medication.

Figure 3.

Regression tree analyses of side effects (TSQM, N = 2680). GA, glatiramer acetate; IFN, interferon; i.m., intramuscular; MS, multiple sclerosis; s.c., subcutaneous; TSQM, Treatment Satisfaction Questionnaire for Medication.

Figure 4.

Regression tree analyses of convenience (TSQM, N = 2708). IFN, interferon; GA, glatiramer acetate; i.m., intramuscular; s.c., subcutaneous; TSQM, Treatment Satisfaction Questionnaire for Medication.