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Adherence to glatiramer acetate treatment for multiple sclerosis: the Brazilian experience

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      Abstract

      Multiple sclerosis is a chronic disease characterized by demyelination and neurodegeneration of the central nervous system. Immunomodulatory treatment is possible at an early stage of the disease, and consists of injections of either beta-interferon or glatiramer acetate. The drugs are not curative, and the need for frequent injections may give rise to a serious problem regarding adherence to treatment. The present study analyzed the database of all Brazilian patients using glatiramer acetate between June 2003 and December 2006 who had enrolled in the patient program run by the pharmaceutical company commercializing the drug. The rate of treatment discontinuation was 10% over this period, and the main reason for suspending the drug was medical decisions (47% of all discontinuations), rather than side effects or the patient’s choice. The present work did not take into consideration the regularity of injections and the main objective was to assess discontinuation. It was concluded that adequate healthcare, education, and a specific program for patients were the factors responsible for this 90% adherence to glatiramer acetate treatment in Brazil.

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      Most cited references 12

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      Interrupted therapy: stopping and switching of the beta-interferons prescribed for MS.

      A retrospective chart review of patients in British Columbia with multiple sclerosis prescribed beta-interferon (IFNbeta) between 1995 and 2001 was carried out to investigate reasons for the interruption of therapy. The highest proportion of interruptions (76/281; 27%) occurred in the first 6 months. The single most common reason was perceived lack of efficacy, cited by 84 of 281 (30%). Gender, disability, and disease duration were identified as factors influencing interruption of IFNbeta therapy.
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        Factors related with treatment adherence to interferon beta and glatiramer acetate therapy in multiple sclerosis.

        Awareness of the factors influencing discontinuation of immunomodulatory drugs (IMD) treatment in multiple sclerosis (MS) can help to find approaches to patient management with the aim of establishing more specific indications and also attaining more optimal patient selection in future clinical trials. To identify the causes that influence adhesion to IMD therapy within the clinical practice in a large cohort of patients with MS. We have studied all MS patients who have initiated IMD in our hospital. All patients took part in training sessions where treatment expectations and side effects were explained and they received training in the administration technique. Reasons for stopping therapy were recorded during follow-up. We studied 632 MS patients (mean follow-up was 47.1 (28.7) months). At the time of analysis, 107/632 patients (17%) were no longer receiving IMD. Almost half of the patients who stopped IMD (52/107) did so within the first two years on therapy. Fifty-six patients stopped IMD because of lack of efficacy. Only 27 patients (4.3%) discontinued treatment for reasons other than inefficacy or side effects. The proportion of patients with secondary progressive MS that stopped IMD therapy was 30%, while only 13.5% of the patients with relapsing remitting MS stopped therapy (P < 0.0001). Expanded Disability Status Scale (EDSS) score at entry was the main factor that predicted interruption of therapy. The proportion of patients interrupting IMD in our centre is low, possibly due to individualized care. Higher EDSS, mainly in the first two years of treatment, is the main factor related with interruption. Close follow-up of these patients would be useful in avoiding early discontinuation of therapy.
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          Stopping beta-interferon therapy in multiple sclerosis: an analysis of stopping patterns.

          Estimates of the beta-interferon (IFNB) stopping rate in relapsing-remitting multiple sclerosis (RRMS) and secondary progressive MS (SPMS) vary and have been mainly derived from multicentre studies. This is a retrospective, hospital chart-based study of 394 patients treated by a single neurologist for up to eight years. The aims of the study were to ascertain the frequency and timing of IFNB discontinuation in a well supported cohort, and to investigate whether the clinical disease type at the initiation of IFNB or the reason for discontinuation influenced stopping rates. The median follow-up was 49 months. The overall IFNB stopping rate was 28% over five years; there was a significant difference between the IFNB stopping rates for RRMS (14%) and SPMS (23%) after three years of follow-up (P =0.0003). Patients stopped IFNB due to side effects after a median of 13 months, and due to failure of therapy after a median of 35 months (P =0.0004). Significantly more patients with SPMS than with RRMS stopped IFNB due to treatment failure (P =0.037). IFNB discontinuation occurred earlier in the treatment course when due to side effects. Stopping IFNB therapy was more common in SPMS and was more often due to treatment failure than side effects.
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            Author and article information

            Affiliations
            [1 ]TEVA Pharmaceutical, Brazil;
            [2 ]Medical School of Universidade Metropolitana de Santos and Reference Center for Multiple Sclerosis of the coastal region of the State of São Paulo (DRS-IV), Brazil
            Author notes
            Correspondence: Yára Dadalti Fragoso Universidade Metropolitana de Santos, Rua da Constituição 374, CEP 11015-470, Santos SP, Brazil, Tel/fax +55 13 32263400, Email yara@ 123456bsnet.com.br
            Journal
            Patient Prefer Adherence
            Patient Preference and Adherence
            Patient preference and adherence
            Dove Medical Press
            1177-889X
            2008
            2 February 2008
            : 2
            : 41-46
            2770403
            19920943
            ppa-2-41
            © 2008 Oliveira et al, publisher and licensee Dove Medical Press Ltd.

            This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

            Categories
            Original Research

            Medicine

            multiple sclerosis, glatiramer acetate, adherence

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