European Study Finds Patients With MS Adhere Better to Oral Therapies

August 23, 2020

Adherence to multiple sclerosis (MS) therapy is linked with improved clinical outcomes, better quality of life, lower health care costs, and other benefits.

Patients with multiple sclerosis (MS) in Finland had better adherence to treatment with oral disease‐modifying therapies (DMTs) rather than injectable ones, according to a recent study.

The study, conducted in Finland, examined adherence DMTs for active MS between 2005 to 2018. Adherence to MS therapy is linked with improved clinical outcomes, better quality of life, lower health care costs, and other benefits.

In Finland, an estimated 10,000 to 11,000 individuals have MS, but until now the impact of the entry of oral therapies on treatment adherence and persistence there has not been known.

Researchers used the nationwide population‐based dataset from the Drug Prescription Register of the Social Insurance Institute.

A cohort was identified using the Drug Prescription Register of Social Insurance Institute; most of the 7474 patients were female (72.2%) with a mean age of 38.9 years. All patients had at least 2 prescription of glatiramer acetate (GA), beta‐interferons, teriflunomide, or delayed‐release dimethyl fumarate (DMF). Adherence was calculated using proportion of days covered (PDC) (cutoff ≥0.8).

Time to non‐persistence was calculated by the number of days on index DMT treatment before the first treatment gap (≥90 days) or switch and analyzed with time‐to‐event methodology.

From 2005 to 2013, 2 types of DMTs were noted: beta‐interferons and glatiramer acetate. The number of patients starting a DMT ranged from 518 in 2006 to 665 patients in 2008. About one‐third of those patients started on GA and two‐thirds were prescribed beta‐interferons.

In 2014, teriflunomide prescriptions for 132 patients began in 2014 and delayed‐release dimethyl fumarate prescriptions began in 2015 for 468.

There was a noticeable increase in the total number of patients initiating or switching a DMT in 2015 (n = 1104) and 2016 (n = 1118) compared with previous years.

In 2018, use of GA began by 86 (13.5%) patients, beta‐interferons by 83 (13.1%) patients, teriflunomide by 185 (29.1%) patients, and dimethyl fumarate by 281 (44.3%) patients.

PDC was more than 80% for all 4 therapies: GA, 0.87 [0.17]; beta‐interferons, 0.88 [0.15]; dimethyl fumarate, 0.89 [0.14]; and teriflunomide [0.93].

For adherence frequencies, GA was 78.4%; beta‐interferons, 81.3%; dimethyl fumarate, 86.9%; and teriflunomide, 91.7%.

A patient’s age, the type of DMT and the starting year, sex, and the hospital district independently affected adherence, according to the analysis: Patients receiving teriflunomide and dimethyl fumarate, males, and older patients were more likely to persist on treatment.

There was no difference in persistence between those prescribed teriflunomide and dimethyl fumarate, or between GA and beta‐interferons.

The authors noted that DMT adherence varies. Another recent study, this one in the United States, found that nearly 20% of patients with MS are not adherent to MS therapy.

“Given its impact on patient outcomes and healthcare resources, the importance of adherence to DMTs should be discussed as part of patient‐centered medical care and shared decision‐making,” the authors concluded.


Lahdenperä S, Soilu‐Hänninen M, Kuusisto HM, Atula S, Junnila J, Berglund A. Medication adherence/persistence among patients with active multiple sclerosis in Finland. Acta Neurol Scand. Published online June 19, 2020. doi:10.1111/ane.13301