A multicenter study of the predictors of adherence to self-injected glatiramer acetate for treatment of relapsing-remitting multiple sclerosis
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Treatment with disease-modifying immunomodulators is recommended for patients with relapsing-remitting MS (RRMS). However, continuous adherence to treatment with these injected therapies can be challenging. The main objective was to examine the predictors of adherence to glatiramer acetate using a study model derived from Prochaska’s transtheoretical model of change. We conducted a 12-week, prospective, observational study. Potential predictors included readiness stage, MS self-efficacy, decisional balance (pros and cons of self-injection), and injection competence. Adults with RRMS, either treatment-naïve (TN) or treatment-experienced (TE), taking glatiramer acetate for the first time were studied. Interventions (including injection training) were implemented to promote adherence. The evaluable population included 146 TN patients and 88 TE patients who had previously discontinued beta-interferons. Adherence rates did not differ between TN and TE groups (86% for both at week 12); however, predictors of adherence did. For TN patients, greater functional self-efficacy, higher self-injection competence at baseline, and improvement in self-injection competence over the first month of therapy predicted adherence. For TE patients, lower body mass index and longer duration of MS predicted adherence. Interventions to improve self-efficacy and self-injection competence should be a priority when treating TN patients. Behavioral predictors of adherence in TE patients warrant further study.
KeywordsAdherence Multiple sclerosis Glatiramer acetate Self-injection Readiness Self-efficacy
We want to acknowledge the entire READY Trial Study Group: James D. Burkholder, MD, Cheryl Ruppenthal, NeuroCare Center, Canton, OH; Robert M. Cain, MD, Laura Sowers, SC, Associated Neurological Specialties, Austin, TX; Martha A. Cline, MD, Neurological Associates, Boise, ID; James S. Cook, MD, Carrie Doub, CRC, Midwest Neurology, Danville, IN; George H. Dooneief, MD, MPH, Kim Roy, RN, The Neurology Group, Norristown, PA; Howard D. Ehrenfeld, MD, Beverly A Johnson-Finley, CRMA, CRC, Neurology & Headache Specialists, Atlanta, GA; Patricia A. Fodor, MD, Christen Kutz, MS, PA-C, Colorado Springs Neurological Associates, Colorado Springs, CO; Edward J. Fox, MD, Lori Mayer, RN, MS Clinic of Central Texas, Round Rock, TX; Stuart Fox, MD, Cynthia Gross, SC, Neuroscience Center of Northern NJ, Morristown, NJ; Suzanne K. Gazda, MD, Ceil Price, SC, Neurology Clinic of San Antonio, San Antonio, TX; Matthews W. Gwynn, MD, Melody Morgan, SC; Neurotrials Research, Atlanta, GA; Barry A. Hendin, MD, Lynne E. Flynn, CCRC, Phoenix Neurological Associates, Phoenix, AZ; W. David Honeycutt, MD, Laura Honeycutt, RN, Neurology Associates, Maitland, FL; Bruce L. Hughes, MD, Judy Green, RN, CRC, Ruan Neurology Clinical Research Center, Des Moines, IA: Samuel Hunter, MD, PhD, Janet Brown, FNP, Advanced Neurosciences Institute, Nashville, TN; Pieter Kark, MD, Diane Austin, RN, Neurological Consultations, Syracuse, NY; Michael Kaufman, MD, Priscilla Russo, BSN, Carolinas MS Center, Charlotte, NC; Seth M. Keller, MD, Binnece J. Green, RN, APNC, Neurology Consultants of Burlington County, Medford, NJ; Peter R. Kinkel, MD, Cindy Heitman, RN, Kinkel Neurologic Center, Williamsville, NY; Robert D. Martinez, MD (Deceased), Judy Boe, SC, Lourdes MS Center, Lafayette, LA; Michael Newmark, MD, Jennifer Marvel, SC, Kelsey-Seybold Clinic, Houston, TX; Gabriel Pardo, MD, Sherry Cadenhead, RN, MS Center at Mercy, Oklahoma City, OK; Gareth Parry, MD, Deb Lascewski, RN, University of Minnesota, Minneapolis, MN; Allan Perel, MD, Diane Lee, RN, Alpha Neurology, Staten Island, NY; Richard A. Sater, MD, PhD, Pamela Sater, SC, High Point Neurological Associates, High Point, NC; Christopher Sheppard, MD, Patricia Blake, RN, Oak Clinic for MS, Uniontown, OH; Dee Silver, MD, Sonia Casillas, CRC, Coastal Neurological Medical Group, La Jolla, CA; James P. Simsarian, MD, Carol Saunders, RN, Neurology Center of Fairfax, Fairfax, VA; Shelly Porter Smith, ANP, Sharon Goss, SC, Neurological Associates, Richmond, VA; Michael R. Stein, MD, Gina A. Paderon, CCRC, Neurological Research Institute of the East Bay, Walnut Creek, CA; Anthony P. Turel, Jr., MD, Jamie Lewson, CRC, Geisinger Medical Center, Danville, PA; Howard Zwibel, MD, Helen Ortega, RN, Neurologic Center of South Florida, Miami, FL; Douglas Denney, PhD, Statistical Consultant, University of Kansas, Lawrence, KS; MerriKay Oleen-Burkey, PhD, Team Leader, and Lillian Pardo, MD, Medical Director, Teva Neuroscience, Kansas City, MO, and the Data Management Center: Phase 4 Health, Toronto, Ontario, Canada. Debbie Due, PhD, NeuroScribe Medical Writing, LLC, contributed to the development of this paper. The study was funded by Teva Neuroscience.
- 1.Medical Advisory Board of the National Multiple Sclerosis Society (2005) Disease management consensus statement—treatment recommendations for physicians. US Neurology Review. Touch Briefings, London, pp 47–50Google Scholar