Biopsychosocial Comparison of Adherent and Nonadherent Multiple Sclerosis Patients

Abstract

OBJECTIVE: Between 30-50% of patients with relapsing remitting multiple sclerosis (RRMS) prematurely discontinue disease modifying therapies (DMTs). Despite this, relatively little is known about clinical factors that may contribute to poor adherence in MS. This study sought to explore clinical characteristics associated with poor medication adherence among RRMS patients who have chosen to discontinue DMTs against medical advice. Specifically, we examined perceived social support, emotional functioning, and clinical disease-related characteristics in a group of nonadherent RRMS patients who discontinued DMTs against medical advice and a group of adherent RRMS who have taken at least 80% of prescribed DMT doses for two months preceding study enrollment. METHODS: The current study recruited 50 adherent RRMS patients from an MS specialty clinic in the Midwest to demographically match an existing sample of nonadherent patients who participated in a recently completed clinical trial. Participants underwent a neurological exam and completed a battery of tests and questionnaires assessing social, emotional, and disease-related characteristics. The current study sought to achieve the following aims: 1. Examine differences in perceived social support between adherent and nonadherent RRMS patients. We hypothesized that nonadherent MS patients would report receiving less provider support and less social support than adherent MS patients. 2. Examine the role of depressive symptoms in patients deciding to discontinue DMTs against medical advice. We hypothesized that nonadherent patients would endorse more symptoms of depression and more frequently meet criteria for a major depressive episode than adherent patients. iv 3. Examine clinical disease-related characteristics between DMT adherent and nonadherent RRMS patients. We hypothesized that nonadherent MS patients would have greater disability than adherent patients. RESULTS: The sample included 129 RRMS patients (50 adherent, 79 nonadherent). Adherent patients reported greater perceived autonomy support from their treatment providers than nonadherent participants, F(1, 124) = 28.170, p < 0.001, partial η² = .185 and exhibited less disability than nonadherent patients, F(1, 124) = 4.251, p < 0.05, partial η² = 0.033. No significant differences were identified in perceived social support, self-reported depressive symptoms, or clinical depression between adherent and nonadherent groups. CONCLUSIONS: This was the first study to examine factors associated with nonadherence among RRMS patients who discontinued DMTs against medical advice. The results of this study suggest that greater perceived autonomy support from treatment providers may increase the likelihood of DMT adherence. These findings emphasize the important role of positive patient-provider relationships for improving medication adherence among RRMS patients who have prematurely discontinued treatment against medical advice. Results may inform future interventions aimed at improving treatment adherence among patients who demonstrate poor adherence, as well as those who prematurely discontinue DMTs against medical advice. Future research may want to elucidate the role of perceived provider autonomy support among nonadherent patients and explore interventions aimed at improving provider autonomy support.