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<p>Sustained adherence to disease-modifying therapies (DMTs) is essential for achieving therapeutic benefit in multiple sclerosis (MS). Despite the availability of effective agents, adherence has been reported as variable and often suboptimal in German cohorts, and the relative influence of clinical, demographic, and pharmacological factors remains insufficiently characterised. This study therefore examined predictors of objective adherence to DMTs in people with MS and the association between subjective and objective adherence. We analysed 795 people with MS (PwMS) receiving oral, subcutaneous, or intramuscular DMTs between October 2020 and September 2021. Objective adherence was measured using the Medication Possession Ratio (MPR), and subjective adherence using a visual analogue scale. Permutation-based multivariable analyses (PERMANOVA) were used to examine associations between predefined predictors and MPR. Objective adherence averaged 88.4% (SD 18.0). Subjective adherence was substantially higher, averaging 95.9% (SD 11.6; median 100%), with a pronounced ceiling effect. Therapy-related characteristics were the only consistent predictors of adherence. Oral agents and intramuscular interferon beta-1a achieved comparable adherence (<i>p</i> = 0.90), both exceeding that of subcutaneous therapies (both <i>p</i> &lt; 0.001); within interferons, intramuscular exceeded subcutaneous administration (<i>p</i> = 0.002). Across active substances, glatiramer acetate showed the lowest adherence and teriflunomide, sphingosine-1-phosphate (S1P) receptor modulators, and dimethyl fumarate the highest (all <i>p</i> &lt; 0.001 vs. glatiramer acetate). Demographic, including socioeconomic, and clinical characteristics, comprising age, sex, income, education, employment, MS subtype, disease duration, and disease activity, showed no measurable association with adherence. Subjective and objective adherence correlated only weakly (Spearman’s ρ = 0.10; <i>p</i> = 0.005). Adherence patterns in MS were largely shaped by pharmacological and administration-related factors rather than by patient demographics or clinical profile. The weak correlation between subjective and objective measures supports complementing patient report with objective adherence indicators in routine care.</p>

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Clinical, demographic, and pharmacological predictors of medication adherence to disease-modifying therapies in multiple sclerosis: a multidimensional analysis of merged survey and claims data

  • 期刊论文

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  • 发表日期：

    2026年5月26日

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  • Ahkash Thavarajasingam,
  • Lara Marleen Fricke,
  • Christian Krauth

摘要

Sustained adherence to disease-modifying therapies (DMTs) is essential for achieving therapeutic benefit in multiple sclerosis (MS). Despite the availability of effective agents, adherence has been reported as variable and often suboptimal in German cohorts, and the relative influence of clinical, demographic, and pharmacological factors remains insufficiently characterised. This study therefore examined predictors of objective adherence to DMTs in people with MS and the association between subjective and objective adherence. We analysed 795 people with MS (PwMS) receiving oral, subcutaneous, or intramuscular DMTs between October 2020 and September 2021. Objective adherence was measured using the Medication Possession Ratio (MPR), and subjective adherence using a visual analogue scale. Permutation-based multivariable analyses (PERMANOVA) were used to examine associations between predefined predictors and MPR. Objective adherence averaged 88.4% (SD 18.0). Subjective adherence was substantially higher, averaging 95.9% (SD 11.6; median 100%), with a pronounced ceiling effect. Therapy-related characteristics were the only consistent predictors of adherence. Oral agents and intramuscular interferon beta-1a achieved comparable adherence (p = 0.90), both exceeding that of subcutaneous therapies (both p < 0.001); within interferons, intramuscular exceeded subcutaneous administration (p = 0.002). Across active substances, glatiramer acetate showed the lowest adherence and teriflunomide, sphingosine-1-phosphate (S1P) receptor modulators, and dimethyl fumarate the highest (all p < 0.001 vs. glatiramer acetate). Demographic, including socioeconomic, and clinical characteristics, comprising age, sex, income, education, employment, MS subtype, disease duration, and disease activity, showed no measurable association with adherence. Subjective and objective adherence correlated only weakly (Spearman’s ρ = 0.10; p = 0.005). Adherence patterns in MS were largely shaped by pharmacological and administration-related factors rather than by patient demographics or clinical profile. The weak correlation between subjective and objective measures supports complementing patient report with objective adherence indicators in routine care.