Evans Charity, Marrie Ruth Ann, Zhu Feng, Leung Stella, Lu Xinya, Melesse Dessalegn Y, Kingwell Elaine, Zhao Yinshan, Tremlett Helen
College of Pharmacy & Nutrition, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 5E5, Canada.
Departments of Internal Medicine and Community Health Sciences, University of Manitoba, Health Sciences Centre, GF 543-820 Sherbrook Street, Winnipeg, MB, Canada R3A 1R9.
Mult Scler Relat Disord. 2016 Jul;8:78-85. doi: 10.1016/j.msard.2016.05.006. Epub 2016 May 7.
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.
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.
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.
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.
我们旨在评估加拿大3个省份中，多发性硬化症（MS）疾病修饰治疗（DMT）的最佳依从性和持续性的患病率及预测因素。
我们使用了不列颠哥伦比亚省（BC）、萨斯喀彻温省和曼尼托巴省基于人群的行政数据库。纳入了在1996年1月1日至2011年12月31日（BC）、2014年3月31日（萨斯喀彻温省）或2012年3月31日（曼尼托巴省）期间接受DMT（干扰素-β-1b、干扰素-β-1a和醋酸格拉替雷）治疗的所有个体。使用覆盖天数比例（PDC）来估计一年的依从性。持续性定义为停止DMT治疗的时间。使用回归模型评估依从性和持续性的预测因素；结果通过随机效应荟萃分析进行汇总。
共纳入4830名个体。合并结果时，估计76.4%（95%置信区间：69.1 - 82.4%）的受试者表现出最佳依从性（PDC≥80%）。在曼尼托巴省，初始DMT停药的中位时间为1.9年（95%置信区间：1.6 - 2.1），在BC省为2.8年（95%置信区间：2.5 - 3.0），在萨斯喀彻温省为4.0年（95%置信区间：3.5 - 4.6）。年龄、性别和社会经济地位与依从性或持续性无关。与首次DMT配药前一年就诊次数较少（0 - 3次）的个体相比，就诊次数≥4次的个体更有可能表现出最佳依从性。
我们观察到的依从性高于其他慢性病以及其他非基于人群的MS队列所报告的依从性。进一步研究MS依从性相对较好的原因以及依从性如何影响疾病结局，可能有助于我们对MS的理解，并对其他慢性病的管理有用。
