Adherence to Disease Modifying Treatment Among Multiple Sclerosis Patients from Upper Egypt

Introduction The rate of adherence to disease-modifying treatment (DMT) among patients with multiple sclerosis (MS) is often quite low, despite their proved benefits. DMT adherence is necessary to decrease number of relapses, disease progression and healthcare costs. The aim of the study was to assess the rate of non-adherence to DMT in Upper Egypt and the main factors contributing to non-adherence, hence increase relapse risk and disability progression. Material(s) and Method(s) This was a cross-sectional, multicentric study, with 80 adult patients with remitting relapsing MS (RRMS) recruited from three MS units located in Upper Egypt. Each patient was submitted to the following: complete demographic, clinical data, Expanded disability status score (EDSS), Arabic version of the eight-item Morisky Medication Adherence Scale (MMAS-8), Hamilton depression rating scale (HAM-D), Fatigue Severity Scale (FSS), the Pittsburgh Sleep Quality Index (PSQI) and treatment Satisfaction Questionnaire for Medication. Result(s) Initial DMT used by the studied sample were interferon beta (68.8%), fingolimod (20%), Teriflunomide (5%) and infusion DMT (5.3%). According to MMAS-8 scores, 53 (66.3%) patients were non-adherent to DMT. Non-adherent patients were more likely to be females (p=0.026), with longer disease duration (p=0.038), more frequent relapses (p=0.003), and on injectable DMT (p <0.001). Treatment satisfaction scores were significantly lower among non-adherent patients (p= 0.012) with lower rate of adherence particularly observed in patients who started DMT in earlier years. However, no relation could be found with physical disability, depression, fatigue, or sleep quality. The main reasons for DMT switch were treatment failure (32%), side effects of used drugs or intolerance to injection (26%), forgetfulness (21%), and resource-related problems in obtaining doses (15%). Conclusion(s) DMT non-adherence among MS patients in Upper Egypt is high. females were less likely to adhere than males. Non-satisfaction with DMT, injectable DMT, longer duration of illness alongside increased frequency of relapses; decreased the patient's probabilities for DMT adherence. In the era of expanding DMTs choices, adherence should be assessed carefully to maximize DMT benefits.