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Multiple Sclerosis patients’ awareness of disease and compliance to pharmacological treatment with Disease Modifying Drugs (DMDs)

Lara Gitto


Background: Disease-modifying drugs (DMDs) have shown to be effective in reducing the frequency and severity of disease relapses in Relapsing Remitting Multiple Sclerosis (RRMS). Patient decisions to commence pharmacological treatment, to continue it or cease it may be influenced by several factors such as patients’ emotional states and symptoms of the disease.

Materials and Methods: This study employs data from 567 patients’ medical records. The observed patients were referred to a neurological centre in Italy from 2001 to 2008. Initially, data were retrospectively analyzed through a multinomial logit model. Next, 143 patients undergoing treatment with DMDs were interviewed and their probability in proceeding with treatment was estimated through a probit model.

Results: The majority of patients commence treatment with DMDs within 3 months from the diagnosis. Among the factors influencing this choice were: young age, anxiety and some symptoms of the disease. A higher awareness of the benefits obtained from the treatment had a positive impact on its maintenance; a negative impact was exerted, instead, by the need to take other drugs to deal with side effects and by the years of treatment. The estimated probability to continue the treatment with DMDs irregularly is 41.45%.

Conclusions: This study examines the relationship between the time of diagnosis and the successive stages of the disease. As significant expenditure is associated with MS treatment, knowledge of the factors likely to determine the commencement of treatment and of influencing compliance are likely to help in resources planning.


multiple sclerosis; pharmacological treatment; disease modifying drugs (DMDs); compliance; multinomial logit model; probit model.

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Noseworthy, J.H., Lucchinetti, C., Rodriguez, M. & Weinshenker, B.G. (2000). Multiple sclerosis. New England Journal of Medicine 343, 938-952.

Weinshenker, B.G., Bass, B., Rice, G.P., Noseworthy, J., Carriere, W., Baskerville, J. & Ebers, G.C. (1989). The natural history of multiple sclerosis: A geographically-based study. 2. Predictive value of the early clinical course. Brain 112, 1419-1428.

Ziemssen, T. (2009). Multiple sclerosis beyond EDSS: depression and fatigue. Journal of the Neurological Sciences 277 (Supplement 1) S37-S41.

Goodin, D.S. (2014). The epidemiology of multiple sclerosis: insights to disease pathogenesis. Handbook of Clinical Neurology 122, 231-266.

Kantarci, O.H. & Weinshenker, B.G. (2005). Natural history of multiple sclerosis. Neurologic Clinics 23, 17-38.

Ivanova, J.I., Birnbaum, H.G., Samuels, S., Davis, M., Phillips, A.L. & Meletiche, D. (2009). The cost of disability and medically related absenteeism among employees with multiple sclerosis in the US. Pharmacoeconomics 27, 681-691.

IFN-β Multiple Sclerosis Study Group & The University of British Columbia MS/MRI Analysis Group (1995). Interferon beta-1b in the treatment of multiple sclerosis: final outcome of the randomized controlled trial. Neurology 45, 1277-1285.

Jacobs, L.D., Cookfair, D.L., Rudick, R.A., Herndon, R.M., Richert, J.R., Salazar, A.M., Fischer, J.S., Goodkin, D.E., Granger, C.V., Simon, J.H., Alam, J.J., Bartoszak, D.M., Bourdette, D.N., Braiman, J., Brownscheidle, C.M., Coats, M.E., Cohan, S.L., Dougherty, D.S., Kinkel, R.P., Mass, M.K., Munschauer III, F.E., Priore, R.L., Pullicino, P.M., Scherokman, B.J., Weinstock-Guttman, B. & Whitham, R.H. (1996). Intramuscular interferon beta-1a for disease progression in relapsing multiple sclerosis. The Multiple Sclerosis Collaborative Research Group (MSCRG). Annals of Neurology 39, 285-294.

PRISMS (Prevention of Relapses and Disability by Interferon beta-1a Subcutaneously in Multiple Sclerosis) Study Group (1998). Randomised double-blind placebo-controlled study of interferon beta-1a in relapsing/remitting multiple sclerosis. Lancet 352, 1498-1504.

Panitch, H., Goodin, D., Francis, G., Chang, P., Coyle, P., O’Connor, P., Li, D. & Weinshenker, B. (2005). Benefits of high-dose, high-frequency interferon beta-1a in relapsing–remitting multiple sclerosis are sustained to 16 months: Final comparative results of the EVIDENCE trial. Journal of the Neurological Sciences 239, 67-74.

Johnson, K.P. (2007). Control of multiple sclerosis relapses with immunomodulating agents. Journal of the Neurological Sciences 256, S23-28.

Ransohoff, RM. (2007). Natalizumab for multiple sclerosis. New England Journal of Medicine 356, 2622-2629.

Pelletier, D. & Hafler, D.A. (2012). Fingolimod for multiple sclerosis. New England Journal of Medicine 366, 339-347.

Jacobs, L.D., Beck, R.W., Simon, J.H., Kinkel, R.P., Brownscheidle, C.M., Murray, T.J., Simonian, N.A., Slasor, P.J., Sandrock, A.W. & CHAMPS study group (2000). Intramuscular interferon beta-1a therapy initiated during a first demyelinating event in multiple sclerosis. New England Journal of Medicine 343, 898-904.

Comi, G., Filippi, M., Barkhof, F., Durelli, L., Edan, G., Fernandez, O., Hartung, H.P., Seeldryers, P., Soelberg-Sorensen, P., Rovaris, M., Martinelli, F., Homes, O.R. & ETOMS study group (2000). Interferon beta 1a (Rebif) in patients with acute neurological syndromes suggestive of multiple sclerosis: a multi-center, randomized, placebo controlled study. Neurology 54 (Supplement 3) A85-86.

Prosser, L.A., Kuntz, K.M., Bar-Or, A. & Weinstein, M.C. (2003). Patient and community preferences for treatments and health states in multiple sclerosis. Multiple Sclerosis 9, 311-319.

Haas, J. & Firzlaff, M. (2005) Twenty-four-month comparison of immunomodulatory treatments – a retrospective open label study in 308 RRMS patients treated with beta interferons or glatiramer acetate (Copaxone). European Journal of Neurology 12, 425-431.

O’Rourke, K.E. & Hutchinson, M. (2005). Stopping beta-interferon therapy in multiple sclerosis: an analysis of stopping patterns. Multiple Sclerosis 11, 46-50.

Klauer, T. & Zettl, U.K. (2008). Compliance, adherence, and the treatment of multiple sclerosis. Journal of Neurology 255 (Supplement 6) 87-92.

Rieckmann, P., O’Connor, P., Francis, G.S., Wetherill, G. & Alteri, E. (2004). Haematological Effects of Interferon-beta-1a (Rebif) Therapy in Multiple Sclerosis. Drug Safety 27, 745-756.

Rio, J., Porcel, J., Tellez, N., Sanchez-Betancourt, A., Tintorè, M., Jesus Arevalo, M., Nos, C. & Montalban, X. (2005). Factors related with treatment adherence to interferon b and glatiramer acetate therapy in multiple sclerosis. Multiple Sclerosis 11, 306-309.

Twork, S., Nippert, I., Scherer, P., Haas, J., Pöhlau, D. & Kugler, J. (2007). Immunomodulating drugs in multiple sclerosis: compliance, satisfaction and adverse effects evaluation in a German multiple sclerosis population. Current Medical Reserach Opinion 23, 1209-1215.

Manski, C.F. (1977). The structure of random utility models. Theory and Decision 8, 229-254.

McFadden, D. (1981). Econometric models of probabilistic choice. In: Structural Analysis of Discrete Data with Economic Applications (Manski, C.F. & McFadden, D.), pp. 198-269. Cambridge, Massachussets: The MIT Press.

Santoro, D., Gitto, L., Ferraro, A., Satta, E., Savica, V. & Bellinghieri, G. (2011). Vitamin D status and mortality risk in patients with chronic kidney disease. Renal Failure 33,184-191.

Slomka, J., Kypriotakis, G., Atkinson, J., Diamond, P.M., Williams, M.L., Vidrine, D.J., Andrade, R. & Arduino, R. (2012). Factors associated with past research participation among low-income persons living with HIV. AIDS Patient Care and STDs. 26, 496-505.

Traylor, A.H., Schmittdiel, J.A., Uratsu, C.S., Mangione, C.M. & Subramanian, U. (2010). Adherence to cardiovascular disease medications: does patient-provider race/ethnicity and language concordance matter? Journal of General Internal Medicine 25, 1172-1177.

Kobelt, G., Berg, J., Lindgren, P., Fredrikson, S. & Jönsson, B. (2007). Costs and quality of life of patients with multiple sclerosis in Europe. Journal of Neurology, Neurosurgery and Psychiatry 77, 918-926.

Henriksson, F., Fredrikson, S., Masterman, T. & Jönsson, B. (2001). Costs, quality of life and disease severity in multiple sclerosis: a cross-sectional study in Sweden. European Journal of Neurology 8, 27-35.

Jennum, P., Wanscher, B., Frederiksen, J. & Kjellberg, J. (2012). The socioeconomic consequences of multiple sclerosis: a controlled national study. European Neuropsychopharmacology 22, 36-43.

Ford, H.L., Gerry, E., Johnson, M.H. & Tennant, A. (2001). Health status and quality of life of people with multiple sclerosis. Disability and Rehabilitation 23, 516-521.

Freeman, J.A., Hobart, J.C., Langdon, D.W. & Thompson, A.J. (2000), Clinical appropriateness: a key factor in outcome measure selection: the 36 item short form health survey in multiple sclerosis. Journal of Neurology, Neurosurgery and Psychiatry 68, 150-156.

Nortvedt, M., Riise, T., Myhr, K. & Nyland, H.I. (1999). Quality of life in multiple sclerosis: measuring the disease effects more broadly. Neurology 53, 1098-1103.

Nortvedt, M. & Riise, T. (2003). The use of quality of life measures in multiple sclerosis research. Neurology 9, 63-72.

Giammanco, M.D., Polimeni, G., Spadaro, L., Gitto, L., Buccafusca, M. & Bramanti, P. (2014). Validation of the Italian Mishel Uncertainty Illness Scale (MUIS) for Relapsing Remitting Multiple Sclerosis patients. Neurological Sciences 35, 1447-1452.



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