Risk factors for non-adherence to disease-modifying therapy in pediatric multiple sclerosis
Carolyn E Schwartz, Stephanie A Grover, Victoria E Powell, Austin Noguera, Jean K Mah, Soe Mar, Lauren Mednick, Brenda L Banwell, Gulay Alper, Mary Rensel, Mark Gorman, Amy Waldman, Teri Schreiner, Emmanuelle Waubant, E Ann Yeh, Carolyn E Schwartz, Stephanie A Grover, Victoria E Powell, Austin Noguera, Jean K Mah, Soe Mar, Lauren Mednick, Brenda L Banwell, Gulay Alper, Mary Rensel, Mark Gorman, Amy Waldman, Teri Schreiner, Emmanuelle Waubant, E Ann Yeh
Abstract
Background: Adherence to disease-modifying therapies (DMTs) in pediatric multiple sclerosis (MS) is not well understood. We examined the prevalence and risk factors for poor adherence in pediatric MS.
Methods: This cross-sectional study recruited youth with MS from 12 North American pediatric MS clinics. In addition to pharmacy-refill data, patients and parents completed self-report measures of adherence and quality of life. Additionally, patients completed measures of self-efficacy and well-being. Factor analysis and linear regression methods were used.
Results: A total of 66 youth (mean age, 15.7 years) received MS DMTs (33% oral, 66% injectable). Estimates of poor adherence (i.e. missing >20% of doses) varied by source: pharmacy 7%, parent 14%, and patient 41%. Factor analysis yielded two composites: adherence summary and parental involvement in adherence. Regressions revealed that patients with better self-reported physical functioning were more adherent. Parents were more likely to be involved in adherence when their child had worse parent-reported PedsQL School Functioning and lower MS Self-Efficacy Control. Oral DMTs were associated with lesser parental involvement in adherence.
Conclusion: Rates of non-adherence varied by information source. Better self-reported physical functioning was the strongest predictor of adherence. Parental involvement in adherence was associated with worse PedsQL School Functioning and lower MS Self-Efficacy-measured confidence in controlling MS.
Trial registration: ClinicalTrials.gov NCT02234713.
Keywords: Pediatric multiple sclerosis; adherence; parent; protective factors; psychosocial; quality of life.
Conflict of interest statement
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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Source: PubMed