Baseline predictors of persistence to first disease-modifying treatment in multiple sclerosis

Acta Neurol Scand. 2017 Aug;136(2):116-121. doi: 10.1111/ane.12705. Epub 2016 Oct 30.

Abstract

Objectives: Patients with multiple sclerosis (MS) require lifelong therapy. However, success of disease-modifying therapies is dependent on patients' persistence and adherence to treatment schedules. In the setting of a large multicenter observational study, we aimed at assessing multiple parameters for their predictive power with respect to discontinuation of therapy.

Materials and methods: We analyzed 13 parameters to predict discontinuation of interferon beta-1b treatment during a 2-year follow-up period based on data from 395 patients with MS who were treatment-naïve at study onset. Besides clinical characteristics, patient-related psychosocial outcomes were assessed as well.

Results: Among patients without clinically relevant fatigue, males showed a higher persistence rate than females (80.3% vs 64.7%). Clinically relevant fatigue scores decreased the persistence rate in men and especially in women (71.4% and 51.2%). Besides gender and fatigue, univariable and multivariable analyses revealed further factors associated with interferon beta-1b therapy discontinuation, namely lower quality of life, depressiveness, and higher relapse rate before therapy initiation, while higher education, living without a partner, and higher age improved persistence.

Conclusions: Patients with higher grades of fatigue and depressiveness are at higher risk to prematurely discontinue MS treatment; especially, women suffering from fatigue have an increased discontinuation rate.

Keywords: depression; fatigue; interferon beta-1b; multiple sclerosis; prediction analysis; therapy persistence.

MeSH terms

  • Adjuvants, Immunologic / therapeutic use*
  • Adult
  • Cohort Studies
  • Depression / diagnosis
  • Depression / drug therapy
  • Depression / psychology
  • Fatigue / diagnosis
  • Fatigue / drug therapy
  • Fatigue / psychology
  • Female
  • Follow-Up Studies
  • Humans
  • Interferon beta-1b / therapeutic use*
  • Male
  • Medication Adherence / psychology*
  • Middle Aged
  • Multiple Sclerosis / diagnosis
  • Multiple Sclerosis / drug therapy*
  • Multiple Sclerosis / psychology*
  • Predictive Value of Tests
  • Prospective Studies
  • Quality of Life / psychology
  • Treatment Outcome
  • Young Adult

Substances

  • Adjuvants, Immunologic
  • Interferon beta-1b