Abstract
Background
Premature discontinuation and poor treatment adherence are problems in chronic conditions, such as multiple sclerosis in which patients must take long-term treatment in order to receive maximum benefit from their medication. The Assessing needs In Multiple Sclerosis (AIMS) study explored factors related to premature treatment discontinuation and patients’ experiences of subcutaneous (sc) interferon (IFN) β-1a treatment in the UK.
Methods
A questionnaire-based survey was integrated into the Bupa Home Healthcare patient-support program, which delivers sc IFN β-1a to patients in their home. Data were collected via patient questionnaires incorporated into routine clinical care and administered upon registration of a new patient by the coordinator, following initial delivery of treatment, prior to each delivery during therapy and at the end of treatment. Univariate and multivariate analyses were performed to identify factors associated with premature discontinuation.
Results
Data were collected from 2,390 patients (1,267 new; 1,123 existing) from 59 UK prescribing centers (November 2006–April 2011). Following the first delivery of sc IFN β-1a, 94% (1,149/1,225) of patients had received training, and 73% (818/1,120) reported that they had no concerns. In total, 24% of new patients discontinued therapy by the end of the study. In the univariate model, none of the candidate variables tested were significant predictors of treatment discontinuation. The strongest predictors of discontinuation in multivariate analyses were lack of information prior to starting treatment and patients feeling unwell on treatment and geographic region (P<0.05 for each variable).
Conclusion
This study suggests that patients feeling well on treatment and provision of high-quality information are the main determinants of persistence with sc IFN β-1a therapy. A package of care that targets these issues should therefore be considered when initiating sc IFN β-1a therapy.
Acknowledgments
The authors thank Tony Felton, Lal Ashby, Satellite for data management and analysis, Complete Regulatory Writing for preparing the clinical study report, and John Wiltshire and Dominic Jack of Caudex Medical, Oxford, UK (supported by Merck Serono Ltd, UK, an affiliate of Merck KGaA, Darmstadt, Germany, and Bupa Home Healthcare, Harlow, Essex, UK), for assistance in the preparation of this manuscript. This study was supported by Merck Serono Ltd, UK, an affiliate of Merck KGaA, Darmstadt, Germany; and Bupa Home Healthcare, Harlow, Essex, UK.
Author contributions
MS was involved in the design of the analysis, interpretation of data and review of the manuscript. DR was involved in the planning of the statistical analysis and the composition of, and revisions to, the manuscript. LP was involved in study management, critically revising and approving the manuscript. GLS was involved in design, advising on conduct of study, analysis and interpretation of data, and reviewing the manuscript. All authors gave final approval of the version for publication.
Disclosure
MS was an employee of Bupa Home Healthcare, Essex, UK, at the time of the study. DR has received honoraria, and/or speaking fees, and/or support to attend meetings and/or served on advisory boards for the following companies: Merck Serono, Biogen Idec, Sanofi, Teva Pharmaceuticals, Genzyme, Novartis, Bayer Schering and Pfizer. LP and GLS were employees of Merck Serono Ltd, UK, at the time of the study.