Adherence to Dimethyl Fumarate in Treatment-naive and Therapy-switched Individuals with Multiple Sclerosis: A Comparative Study
Batuhan Ayci1, Ogeday Derin Gorkey1, Elif Everest2, Melih Tutuncu1, Sabahattin Saip1, Aksel Siva1, Ugur Uygunoglu1
1Department of Neurology, Istanbul University-Cerrahpasa Cerrahpasa Faculty of Medicine, 2Laboratory of Immune System Biology, Molecular Development of the Immune System Section, National Institute of Health, National Institute of Allergy and Infectious Diseases
Objective:

The objective of the study is to assess dimethyl fumarate (DMF) adherence in individuals with multiple sclerosis (MS) who had received prior treatment and had no treatment before DMF.

Background:

Treatment adherence in MS is crucial for long-term effectiveness and patient outcomes. The reasons for non-adherence have been identified. However, there is limited data on people with a history of prior disease-modifying therapies (DMT) compared to treatment-naïve individuals.

Design/Methods:

A total of 497 individuals with MS who had been treated with DMF, and had at least 6 months of follow-up between Jan 1, 2013 and Dec 31, 2023 were retrospectively included. People with MS were categorized into two groups: those who had received prior treatment (therapy switch) before starting DMF (TS-DMF) and those who were treatment-naive before starting DMF (TN-DMF). Demographic, clinical, radiological, and laboratory data were collected before, at the start of, and after DMF treatment. 

Results:

The mean age was 37.5±11 with 38.6% being male. The mean disease duration was 8.4±6.9 years and EDSS score was calculated as 1.33±0.78. A total of 225 individuals in TS-DMF group and 272 individuals in TN-DMF group were compared. The final EDSS score was significantly lower in TN-DMF group (0.86±1.09) compared to TS-DMF group (1.37±1.62) (p<0.0014). People in TS-DMF group were more likely to discontinue treatment due to ineffectiveness than people in TN-DMF group (p<0.001). TN-DMF group exhibited higher rates of non-adherence with DMF compared to TS-DMF group (p<0.01).

Conclusions:

Non-adherence in DMF treatment is particularly pronounced in patients who had not previously used DMTs. Contributing factors can include challenges in accepting a chronic disease, the burden of a daily medication use in a young age, and the impact of side effects. Enhancing clinical support throughout the treatment process, along with implementing patient-centered education programs, may help improve long-term adherence and overall treatment success.

10.1212/WNL.0000000000211831
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