Exploring Novel Reasons for Nonadherence to Disease-Modifying Therapies


Schoor R, Bruce A, Bruce J, et al. Reasons for non-adherence and response to treatment in an adherence intervention trial for relapsing-remitting multiple sclerosis patients [published online November 28, 2018]. J Clin Psychol. 2018. doi: 10.1002 / jclp.22725.


Although there is currently no treatment for multiple sclerosis (MS), disease-modifying therapies (DMTs) can decrease rates of relapse and disease progression; However, patients may choose not to initiate DMT use or to discontinue use. The results of a large, multinational, multicenter study showed that that 40% of patients stopped taking DMTs within 2.7 years of starting treatment. DMTs were perceived lack of efficacy and side effects.1

DMTs for reasons that are not logical or rational. The authors of this study hypothesized that these patients cite irrational reasons for avoiding and / or avoiding being constantly reminded of their disease. Avoidance coping is common in patients who have chronic diseases such as MS. Coping and medication adherence in MS patients have not been previously evaluated.1


18 years of age with relapsing-remitting MS, who were not using DMTs in this exploratory study initiating DMTs in the future. Patients received Motivational Interviewing-Cognitive Behavior Therapy (MI-CBT) sessions aimed at promoting treatment initiation or re-initiation.

MI-CBT session. Reasons for not using DMTs. Two post-MI-CBT outcomes were evaluated: 1) treatment initiation or re-initiation (self-reported by the patient and physician ). DMTs were correlated with worse outcomes after MI-CBT.1

The results of this study were 1) establish criteria for coding the main reason why patients were not using DMTs, 2) the clinical and psychological characteristics of the avoidance coping group with the other groups and evaluate the avoidance coping group could be identified using self-reporting measures, and 3) evaluate outcomes in the other groups.1


Based on the recordings, investigations determined that there were 4 primary causes of nonadherence to DMTs: 1) patient perception of a mild MS disease course (6.4%); 2) costs of DMTs (14.1%); 3) side effects associated with DMTs (37.2%); and 4) avoidance coping (42.3%). Because of the small number of patients who have cited mild MS in the course of non-adherence, this group was omitted from further analysis.1

Demographic and clinical characteristics: Of the 78 patients who met the inclusion criteria for this exploratory analysis, the majority of patients were female (88.5%), Caucasian (82.1%), well educated (92.3% reported attending some college), and had used DMTs previously (89.7 %). Mean age was 45.64 years, mean disease duration 11.42 years, and mean Expanded Disability Status Scale (EDSS) score was 2.91.1

There were no significant between-group differences in age, gender, ethnicity, education, disease duration, or number of exacerbations in the previous 2 years. There were between-group differences in EDSS scores (P = .028), prior DMT use (P = .031), and use of interferon (IFN) beta-1a (P = .004). A post hoc analysis showed that the avoidance coping group had the lowest mean EDSS scores; however, this difference was not significant. Post hoc analysis also revealed that the side effect group was DMTs previously, compared with the cost group (P = .017). IFN-beta-1a (Also, compared with patients in the avoidance coping group,P = .004). No significant differences in the use of other types of DMTs were observed between groups.1

Psychological characteristics: Multiple Sclerosis Treatment Adherence Questionnaire: "dissatisfaction with medication"P = .021) and "side effects of medication" (P = .013). In-between and the patient was currently and regularly seeing an MS provider (P = .001), as the patient planned to visit MS provider in the next 6 months (P = .008), and communication with the patient's MS provider (P = .038). Post hoc analyses revealed that the side effect group reported greater dissatisfaction with medication and was compared to the other groups. "I can not afford medications" with the group "I can not afford medications".P = .038) and was more likely to have plans to see an MS physician in the next 6 months (P = .004). Also, patients in the side group were more likely to be currently seeing an MS physician compared with patients in the other groups (P = .004).1

outcomes: Significant differences were observed between groups in motivation, confidence, and the decision to initiate treatment with DMTs. Post hoc analyses showed that the side effect group and cost group had higher motivation compared with the avoidance coping group (P = .023 vs side effect group; P = .003 vs cost group). Follow-up analysis using dummy coding showed greater motivation among patients in the cost groupP = .008). Post hoc analysis of the avoidance of the DMT in the next 2 weeks (P = .021) and that the avoidance coping group was less likely to be decided to initiate or re-initiate DMTP = .019).1


A sizable number of patients with MS provides implausible rationalizations for not taking DMTs, which the authors of this study attribute to avoidance coping. In this analysis, no patient characteristics were identified that would distinguish the avoidance coping group from others (ie, cost or side effects). Furthermore, this analysis revealed reasons why patients may decide to take DMTs that have not been previously identified in published literature. DMTs for avoidance coping reasons as well as strategies to promote initiation or re-initiation of DMTs in this patient population.1


1. Schoor R, Bruce A, Bruce J, et al. Reasons for non-adherence and response to treatment in an adherence intervention trial for relapsing-remitting multiple sclerosis patients [published online November 28, 2018]. J Clin Psychol. 2018. doi: 10.1002 / jclp.22725.