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Treatment discontinuation in multiple sclerosis: The French Web-based survey ALLIANCE
Cécile Donzé1, Lucie Malapel1, Arnaud Kwiatkowski2
1Department of Physical Medicine and Rehabilitation, Saint Philibert Hospital, Lille Catholic Institute Hospital Group, France.
Background:
In multiple sclerosis (MS), treatment discontinuation leads to a higher risk of relapse, poorer quality of life and greater economic impact.
Objective:
The objective of this work is to evaluate treatment discontinuation in MS, the reasons for this and the reasons for treatment resumption.
Methods:
A French national Web-based survey was carried out between May and August 2011. A total of 602 MS patients answered a questionnaire on sociodemographic data, medical follow-up, disease-modifying therapies (DMTs), symptomatic treatments, care given, factors involved in treatment discontinuation and reasons for resuming treatment.
Results:
Among 413 patients using DMTs, 54% have considered discontinuing their treatment, primarily because of anger (61%), side effects (61%) and fatigue (57%). Sixty-eight patients have actually discontinued their treatment because of side effects (43%), lack of observed outcomes (32%), exasperation (29%) or fatigue (29%). The reasons for symptomatic treatment discontinuation were fear of addiction (32%-46%) and lack of efficacy (28%-45%). Physiotherapy was discontinued because of fatigue (37%), stress (34%) or inefficiency (31%). According to patients, treatment discontinuation could have been prevented by psychological support, care team empathy and support from family.
Conclusion:
The major factor that could prevent treatment discontinuation is psychological support. Initiating and monitoring treatment in MS leads to emotional and personality changes, requiring adaptations that may improve compliance.