Department of Medicine, Division of Neurology and Centre for Brain Health, University of British Columbia, Vancouver, Canada.
Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, RI, USA.
Mult Scler Relat Disord. 2019 Jan;27:364-369. doi: 10.1016/j.msard.2018.11.004. Epub 2018 Nov 9.
To examine persistence and adherence to the oral disease-modifying therapies (DMTs) for multiple sclerosis (MS).
Population-based health administrative databases in British Columbia, Canada were accessed to identify all individuals filling an oral DMT prescription for MS (fingolimod, dimethyl fumarate, teriflunomide) between January 2011 and December 2015. Predictors of persistence and adherence at 6 and 12 months were assessed using logistic regression, with estimates expressed as adjusted odds ratios (aORs), and 95% confidence intervals (CIs).
Of 858 individuals with ≥6 months of follow-up, the mean age at first prescription was 43.0 (SD:10.3) years; 74.2% were women. By 6 months 11.0% (94/858) had discontinued their initial oral DMT; by 12 months the proportion was 19.6% (113/577). Over 6 and 12 months, among those persisting with their oral DMT, 82.5% (630/764) and 81.7% (379/464) exhibited optimal adherence (proportion of days covered ≥80%). Age, sex, calendar year and comorbidity were not associated with persistence or adherence. Individuals with higher neighbourhood-level socioeconomic status had higher odds of discontinuation within 6 months (aOR = 2.2; 95%CI:1.3-3.7). Those who had previously used another DMT had higher odds of optimal adherence (6 months aOR = 2.4;95%CI:1.6-3.6, and 12 months aOR = 2.4; 95%CI:1.5-3.9).
Approximately 1 in 10 individuals discontinued their first oral DMT within 6 months, and 1 in 5 did so within one year. However, among those who did continue drug, a high proportion (>80%) exhibited optimal adherence. Predictors of persistence or adherence with immediate practical application were lacking; this highlights the challenges in optimizing drug therapy.
研究多发性硬化症（MS）患者对口服疾病修正治疗（DMT）的持续使用和依从性。
本研究通过访问加拿大不列颠哥伦比亚省的基于人群的健康管理数据库，确定了在 2011 年 1 月至 2015 年 12 月期间，使用口服 DMT（芬戈莫德、富马酸二甲酯、特立氟胺）治疗 MS 的患者。使用逻辑回归评估 6 个月和 12 个月时的持续使用和依从性预测因素，使用调整后的优势比（aOR）和 95%置信区间（CI）表示估计值。
在 858 名至少有 6 个月随访的患者中，首次处方时的平均年龄为 43.0（标准差：10.3）岁，74.2%为女性。在 6 个月时，有 11.0%（94/858）的患者停用了初始口服 DMT；在 12 个月时，这一比例为 19.6%（113/577）。在持续使用口服 DMT 的患者中，在 6 个月和 12 个月时，82.5%（630/764）和 81.7%（379/464）的患者表现出最佳的依从性（覆盖天数比例≥80%）。年龄、性别、年份和合并症与持续使用或依从性无关。社会经济地位较高的个体在 6 个月内停药的可能性更高（aOR=2.2；95%CI：1.3-3.7）。那些之前使用过其他 DMT 的患者具有更高的最佳依从性（6 个月时 aOR=2.4；95%CI：1.6-3.6，12 个月时 aOR=2.4；95%CI：1.5-3.9）。
大约每 10 名患者中就有 1 名在 6 个月内停用了第一种口服 DMT，每 5 名患者中就有 1 名在一年内停用。然而，在继续用药的患者中，有很大比例（>80%）表现出最佳的依从性。缺乏与持续使用和依从性有直接实际应用价值的预测因素；这突出了优化药物治疗的挑战。
