Static and group-based trajectory analyses of factors associated with non-adherence in patients with multiple sclerosis newly-initiating once- or twice-daily oral disease-modifying therapy

Jacqueline A Nicholas; Natalie C Edwards; Roger A Edwards; Anna Dellarole; Luigi Manca; Danielle E Harlow; Amy L Phillips

doi:10.1177/20552173221101150

Static and group-based trajectory analyses of factors associated with non-adherence in patients with multiple sclerosis newly-initiating once- or twice-daily oral disease-modifying therapy

Mult Scler J Exp Transl Clin. 2022 Jun 30;8(2):20552173221101150. doi: 10.1177/20552173221101150. eCollection 2022 Apr-Jun.

Authors

Jacqueline A Nicholas¹, Natalie C Edwards², Roger A Edwards², Anna Dellarole³, Luigi Manca³, Danielle E Harlow⁴, Amy L Phillips⁴

Affiliations

¹ OhioHealth Multiple Sclerosis Center, Columbus, OH, USA.
² Health Services Consulting Corporation, Boxborough, MA, USA.
³ Fair Dynamics Consulting, Milan, Italy.
⁴ EMD Serono, Inc., Rockland, MA, USA.

Abstract

Background: Increased understanding of adherence may facilitate optimal targeting of interventions.

Objective: To utilize group-based trajectory modeling (GBTM) to understand longitudinal patterns of adherence and factors associated with non-adherence in patients with multiple sclerosis (MS) newly-initiating once-/twice-daily oral disease-modifying therapy (DMT) (fingolimod, dimethyl fumarate, or teriflunomide).

Methods: Commercial plan data were analyzed using proportion of days covered (PDC) to evaluate factors associated with non-adherence. GBTM clustered patient subgroups with similar longitudinal patterns of adherence measured by monthly PDC (≥80%) and multinomial logistic regression identified factors associated with adherence trajectory subgroups.

Results: Among 7689 patients, 39.5% were non-adherent to once-/twice-daily oral DMTs. Characteristics associated with non-adherence (PDC<80%) included younger age, female, depression or migraine, switching during follow-up, more frequent dosing, relapse, and absence of magnetic resonance imaging. GBTM elucidated three adherence subgroups: Immediately Non-Adherent (14.9%); Gradually Non-Adherent (19.5%), and Adherent (65.6%). Additional factors associated with adherence (i.e. region, chronic lung disease) were identified and factors differed among trajectory subgroups.

Conclusion: These analyses confirmed that a significant proportion of patients with MS are non-adherent to once-/twice-daily oral DMTs. Unique patterns of non-adherence and factors associated with patterns of adherence emerged. The approach demonstrated how quantitative trajectories can help clinicians develop tailored interventions.

Keywords: Multiple sclerosis; disease-modifying therapy; group-based trajectory modeling; newly-initiating; non-adherence; oral treatment.