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

Research output: Contribution to journalArticlepeer-review

17 Scopus citations

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.

Original languageEnglish
Pages (from-to)175-185
Number of pages11
JournalMultiple Sclerosis
Volume24
Issue number2
DOIs
StatePublished - Feb 1 2018

Keywords

  • Pediatric multiple sclerosis
  • adherence
  • parent
  • protective factors
  • psychosocial
  • quality of life

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