Exploring Adherence to First-Line and Second-Line Immunotherapies in Multiple Sclerosis: An Interview Study

Area of Science:

• Neurology
• Immunology
• Patient Adherence Research

Background:

• Treatment adherence is crucial for managing multiple sclerosis (MS).
• Adherence rates in MS studies range widely (30-90%), influenced by assessment methods and medication types.
• Identifying patient-related factors influencing treatment modification or discontinuation in MS is essential.

Purpose of the Study:

• To identify patient-related factors associated with treatment modification or discontinuation in people with MS.
• To compare these factors between patients receiving first-line and second-line MS treatments.

Main Methods:

• Conducted semistructured interviews with 23 people with MS (11 first-line, 12 second-line).
• Explored medication history, prior experiences, decision-making, adherence behavior, and reasons for adherence/nonadherence.
• Utilized qualitative content analysis with a deductive-inductive approach and quantitative comparison of coding frequencies.

Main Results:

• First-line MS treatment nonadherence linked to burdensome side effects; adherence associated with belief in effectiveness.
• Second-line MS treatment changes/discontinuation related to lack of perceived effectiveness; adherence linked to positive illness beliefs and belief in highly active disease.
• Intentional nonadherence was more prevalent in first-line treatment compared to second-line.

Conclusions:

• Factors influencing treatment adherence in people with MS differ significantly between first-line and second-line therapy.
• Understanding these distinct factors can inform strategies to improve MS management and patient outcomes.