Adherence and persistence to self-administered disease-modifying therapies in patients with multiple sclerosis: A multisite analysis

Patients with multiple sclerosis (MS) have more treatment options than ever before. The current treatment landscape includes brand and generic disease-modifying therapies (DMTs) that are patient-administered oral or injectable therapies, or infusions in the home or healthcare setting (Hauser and Cree, 2020). Treatment choice varies by MS disease category, severity, symptoms, response to therapy, side effects, medication tolerance and patient preference (McGinley et al., 2021; Gholamzad et al., 2019). The primary goal of using DMTs in relapsing forms of MS is to reduce MS relapses and disease activity (Rae-Grant et al., 2018). When taken as prescribed, DMTs are effective at reducing relapse rates and slowing disease progression (McGinley et al., 2021).

Medication adherence and persistence to DMTs can impact overall MS disease prognosis. Adherence is defined as the proportion of DMT doses taken as prescribed over a time period, and persistence is the length of time on the DMT (Cramer et al., 2008). Non-persistence to MS DMTs has been reported as 9% within 6-months of initiating therapy, though it may be as high as 25–50% or even greater at 1-year (Evans et al., 2017; Araujo et al., 2022; Johnson et al., 2017). Persistence may be impacted by side effects, cost of medications, overall treatment plans, medication administration route, tolerability, and even strength of patient relationships with healthcare professionals (Celius et al., 2021; Price et al., 2021). Studies show that high adherence to MS DMTs is associated with a 42% reduction in relapse, 38% reduction in hospitalization, and 52% reduction in emergency visits, and 42% reduction in overall medical costs (Pardo et al., 2022; Yermakov et al., 2015). However, recent work highlights suboptimal adherence rates to MS DMTs, around 60%, though adherence has been shown to vary greatly by medication and route of administration (Araujo et al., 2022; Neter et al., 2022).

Though MS DMT adherence rates have been reported as low and variable (61–87%), health system specialty pharmacies (HSSPs) providing comprehensive DMT management have demonstrated significantly higher adherence (>90%) among MS patients (Kozlicki et al., 2022; Lahdenperä et al., 2020). HSSPs integrate specialty pharmacy services within health system specialty clinics, often physically incorporating pharmacy staff within the clinic, and use the same electronic health record as prescribing providers (Stubbings et al., 2021). HSSP pharmacy staff evaluate DMT appropriateness and safety, coordinate medication access, and monitor patients throughout their treatment course (Kozlicki et al., 2022; Habibi and Kuttab, 2016; Hanson et al., 2014). The high adherence seen in this specialty pharmacy model may be due to a number of factors such as close communication among care teams, access to electronic medical records during pharmacy visits and throughout the patient journey, and holistic, patient-centered programs (Zuckerman et al., 2022). Research regarding HSSPs and the treatment of MS have been largely small, single-center studies to date, indicating the need for multisite studies to examine larger populations and heterogenous care profiles to explore persistence and adherence outcomes among HSSPs (Kozlicki et al., 2022). The current evaluation aims to examine adherence and persistence rates, as well as factors related to time to non-persistence, among MS patients treated within four United States HSSPs.

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