Haase Rocco, Kullmann Jennifer S, Ziemssen Tjalf
Center of Clinical Neuroscience, Neurological Clinic, University Clinic Carl Gustav Carus Dresden, TU Dresden, Germany.
Genzyme, a Sanofi company, Neu-Isenburg, Germany.
Ther Adv Neurol Disord. 2016 Jul;9(4):250-63. doi: 10.1177/1756285616634247. Epub 2016 Mar 15.
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.
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.
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.
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.
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.
通过长期按规定服药可提高临床疗效，从而对多发性硬化症（MS）进行积极改善，但研究表明，很大比例的患者并未按规定服药。
我们在临床实践条件下评估了MS患者对当前疾病改善治疗的满意度和依从性。我们比较了满意度的不同方面及其内在关系，并以探索性方式确定了预测因素。
复发缓解型多发性硬化症患者的治疗满意度（THEPA-MS）是一项于2013年和2014年在德国开展的非干预性前瞻性横断面研究，纳入了临床孤立综合征或复发缓解型MS患者。我们采用标准化方法，通过患者报告结局（药物治疗满意度问卷）以及医生评分来记录满意度和依从性。
在3312例平均年龄为43.7岁的患者中，73.3%为女性，根据扩展残疾状态量表得出的平均残疾水平为2.29；13.3%的患者在记录时未接受任何药物治疗，21.3%的患者接受肌肉注射干扰素β1a，20.7%的患者接受皮下注射干扰素β1a，17.0%的患者接受皮下注射干扰素β1b，23.7%的患者接受醋酸格拉替雷。依从率在60%（终生）至96.5%（当前药物治疗）之间。在副作用和便利性评分方面发现了当前药物之间的差异，但在有效性、满意度和依从性方面未发现差异。更高的总体满意度和有效性与更少的复发、更长的用药持续时间、更低的残疾评分以及不存在多种副作用相关。
在患者满意度、有效性、副作用、便利性和依从性的关联模型中，必须解决患者的个体需求和担忧。在副作用和治疗便利性方面发现了大多数差异。因此，改善这两个领域似乎是提高依从性水平最有前景的直接方法。
