Enhancing Adherence and Satisfaction with Disease-Modifying Therapies in Multiple Sclerosis Through Pharmacist-Led Interventions: Interventional Study

The impact of betaplus program on patient treatment satisfaction with interferon beta-1b in multiple sclerosis: Multicentric cross-sectional survey in the western Balkan countries

BackgroundTreatment satisfaction in patients with relapsing-remitting multiple sclerosis (RRMS) may impact adherence and thus clinical outcomes. The objective of this study was to measure the satisfaction of patients with RRMS with injectable disease-modifying therapies (DMTs) and to evaluate the factors associated with treatment satisfaction.Material and methodsIn this observational retrospective study conducted in the neurology departments of 35 hospitals throughout Spain, demographic data, disease characteristics, and information on treatment with injectable DMTs were collected at a single scheduled visit. Treatment satisfaction was assessed using the Treatment Satisfaction Questionnaire for Medication (TSQM), version 1.4. Patients also answered complementary questions about the factors that might affect treatment satisfaction. The data collected were analyzed descriptively. A regression model was used to explore the factors associated with treatment satisfaction.ResultsThe study included 445 patients (mean±SD age, 41±10.2 years; two-thirds women). The percentages treated with each DMT were Avonex 28.5%, Rebif 44 μg 24.5%, Copaxone 22.5%, Betaferon 13.0%, Rebif22 μg 8.3% and Extavia 3.1%. The mean±SD overall satisfaction according to the TSQM was 68.8±18.6 and the highest overall satisfaction was reported for Rebif 22 μg (72.4±20.3) and the lowest for Extavia (61.7±23.7). In the regression analysis, rehabilitation, interference with social life, pain on injection and number of MS treatments received were significantly associated with a decrease in overall TSMQ score. A small but significant negative correlation was found between EDSS scores and TSMQ scores (rho = –0.11, p = 0.02) and effectiveness (rho = –0.17, p<0.001). A perceived inconvenience of injections was reflected by the stated preference of 83% for once-daily oral treatment over other administration routes.ConclusionsPatients on stable injectable DMT therapy were reasonably satisfied with their treatment. Our results suggest that the main source of dissatisfaction with the current treatment is the inconvenience of the administration regimen.

BackgroundAlemtuzumab is approved in the European Union for treating highly active relapsing-remitting multiple sclerosis (RRMS). Patient-reported outcomes measure the treatment impact on quality of life (QoL), including fatigue, a common symptom in multiple sclerosis (MS). Chronic diseases like MS also affect the patient's caregiver. Thus, understanding the impact on both patients and caregivers is essential for a comprehensive view of MS treatment outcomes. MethodsThis multi-center prospective, observational study assessed RRMS patients undergoing alemtuzumab treatment, and their caregivers across three European countries (Denmark, Norway, and Italy). The study visits were conducted at baseline, and at Months 3, 6, 12, 18, 24, and 36 (± 1 month). The primary endpoint assessed the effect of alemtuzumab on MS-related fatigue (Fatigue Scale for Motor and Cognitive Functions [FSMC] score). Secondary endpoints included changes in cognition (Symbol Digit Modalities Test [SDMT]), depression (Beck Depression Inventory-Version II [BDI-II]), QoL (29-item Multiple Sclerosis Impact Scale [MSIS-29]), treatment satisfaction (Treatment Satisfaction Questionnaire for Medication [TSQM]), working capacity/daily life activity (Health-Related Productivity Questionnaire [HRPQ]), and clinical evaluation (number of relapses, improvement in Expanded Disability Status Scale [EDSS] score, and need for re-treatment with alemtuzumab/any other treatment). Exploratory endpoints included caregiver perception of patient's QoL, caregiver QoL, and caregiver burden. The sample size (N=80) was determined based on the 2-sided t-test at 5% significance level. Data were analyzed descriptively. Safety was also evaluated. ResultsOf 87 enrolled patients, 72.4% (n=63) completed all follow-ups. Significant improvement was observed in fatigue (p<0.01), with a median (min, max) FSMC score change of -7.3 (-56.0, 34.0) units at the end-of-study (EOS), and clinically relevant improvement (≥ 9 units) noted in approximately 12.5 months. SDMT (3-5 units, p<0.05), BDI-II (median score of 9.5, i.e., no depression, p<0.01), and MSIS-29 (median change in physical and psychological impact scores -9.2, p<0.01 and -14.8, p<0.001, respectively) improved significantly from baseline to EOS. Global treatment satisfaction (p<0.001), effectiveness (p<0.05), and side effects (p<0.05) significant improved exept at EOS, whereas treatment convenience remained same throughout the study. The percentage of patients with at least one relapse was similar each year of the study (10.8%-13.2%). A statistically significant improvement (p<0.05) in EDSS was reported over time. At EOS, 4.5% patients needed retreatment with alemtuzumab. Caregivers also reported improvement in patients’ QoL over time, but the median change from baseline (physical and psychological impact scores: -10.0 and -14.8, respectively) was not statistically significant (p>0.05). Caregivers reported similar QoL and caregiver burden at baseline and EOS, apart from an increase in emotional QoL. Headache (51.2%), pyrexia (44.2%), and rash (34.9%) were the most common adverse events (AEs). Majority of the AEs were either mild or moderate, apart from 25 severe AEs. Three patients discontinued prematurely, of which one patient died of sepsis related to treatment. ConclusionThis real-world study showed beneficial impact of alemtuzumab on fatigue, cognition, depression, QoL, and treatment satisfaction. Improvement in patient disability, and caregiver-reported outcomes indicated enhanced patients’ QoL.

Treatment satisfaction has been linked with better glycemic control and lower morbidity. The aims of this study were to translate the TSQM-14 questionnaire into a Kurdish version, to validate the TSQM-14 questionnaire, and to evaluate treatment satisfaction. This was a cross-sectional survey study. A convenient sample of 307 diabetic patients was studied. The Treatment Satisfaction Questionnaire for Medication (TSQM-14) was utilized to evaluate treatment satisfaction. Statistical Package for Social Sciences (SPSS) version 20 was applied for authentic statistical study. The mean outcomes of satisfaction area were 52.75 ± 13.12, 13 ± 23.59, 54.86 ± 11.77, and 56.91 ± 15.16 for effectiveness (EFF), side effects (SE), convenience (CONV), and global satisfaction (GS) respectively. Developing patients’ treatment satisfaction will improve treatment management.

Natalizumab (TYSABRI®) 300mg administered intravenously every-4-weeks (Q4W) is approved for treatment of relapsing-remitting multiple sclerosis but is associated with increased risk of progressive multifocal leukoencephalopathy (PML). Extended natalizumab dosing intervals of approximately every-6-weeks (Q6W) are associated with a lower risk of PML. Primary and secondary clinical outcomes from the NOVA randomized clinical trial (NCT03689972) suggest that effective disease control is maintained in patients who were stable during treatment with natalizumab Q4W for ≥12 months and who then switched to Q6W dosing. We compared additional exploratory clinical and patient-reported outcomes (PROs) from NOVA to assess the efficacy of Q6W dosing. Prespecified exploratory clinical efficacy endpoints in NOVA included change from baseline in Expanded Disability Status Scale (EDSS) score, Timed 25-Foot Walk (T25FW), dominant- and nondominant-hand 9-Hole Peg Test (9HPT), and Symbol Digit Modalities Test (SDMT). Exploratory patient-reported outcome (PRO) efficacy endpoints included change from baseline in the Treatment Satisfaction Questionnaire for Medication (TSQM), Neuro-QoL fatigue questionnaire, Multiple Sclerosis Impact Scale (MSIS-29), EuroQol 5 Dimensions (EQ-5D-5L) index score, Clinical Global Impression (CGI)-Improvement (patient- and clinician-assessed) and CGI-Severity (clinician-assessed) rating scales. Estimated proportions of patients with confirmed EDSS improvement were based on Kaplan-Meier methods. Estimates of mean treatment differences for Q6W versus Q4W in other outcomes were assessed by least squares mean (LSM) and analyzed using a linear mixed model of repeated measures or ordinal logistic regression (CGI-scale). Exploratory clinical and patient-reported outcomes were assessed in patients who received ≥1 dose of randomly assigned study treatment and had ≥1 postbaseline efficacy assessment (Q6W group, n=247, and Q4W group, n=242). Estimated proportions of patients with EDSS improvement at week 72 were similar for Q6W and Q4W groups (11.7% [19/163] vs 10.8% [17/158]; HR 1.02 [95% confidence interval [CI], 0.53-1.98]; P=0.9501). At week 72, there were no significant differences between Q6W and Q4W groups in LSM change from baseline for T25FW (0.00, P=0.975), 9HPT (dominant [0.22, P=0.533] or nondominant [0.09, P=0.862] hand), or SDMT (-1.03, P=0.194). Similarly, there were no significant differences between Q6W and Q4W groups in LSM change from baseline for any PRO (TSQM, -1.00, P=0.410; Neuro-QoL fatigue, 0.52, P=0.292; MSIS-29 Psychological, 0.67, P=0.572; MSIS-29 Physical, 0.74, P=0.429; EQ-5D-5L, 0.00, P=0.978). For the EQ-5D-5L, a higher proportion of Q6W patients than Q4W patients demonstrated worsening (≥0.5 standard deviation increase in the EQ-5D-5L index score; P=0.0475). From baseline to week 72 for Q6W versus Q4W, odds ratio (ORs) of LSM change in CGI scores did not show meaningful differences between groups (CGI-Improvement [patient]: OR [95% CI] 1.2 [0.80-1.73]; CGI-Improvement [physician]: 0.8 [0.47-1.36]; CGI-Severity [physician]: 1.0 [0.71-1.54]). No significant differences were observed in change from baseline to week 72 between natalizumab Q6W and Q4W groups for all exploratory clinical or PRO-related endpoints assessed. For the EQ-5D-5L, a higher proportion of Q6W than Q4W patients demonstrated worsening.

The aim of the present study was to evaluate the impact of adverse drug events (ADEs) and treatment satisfaction on antihypertensive medication adherence. A cross-sectional study was conducted in six public hospitals in Ethiopia. We included adult ambulatory patients on antihypertensive medication. Adherence was measured using the eight-point Morisky Medication Adherence Scale, which categorizes as low (0-5), medium (6-7) and high (8) adherence. Treatment satisfaction was measured using the Treatment Satisfaction Questionnaire for Medication (TSQM) version 1.4, which included questions about ADEs. Data were analysed using generalized ordered logistic regression with 95% confidence intervals (CIs). We included 925 out of 968 patients. Overall, 42% of patients scored low, 37% medium and 21% high adherence. Satisfaction with treatment was low, with a mean (standard deviation) TSQM score for global satisfaction of 51 (14). A total of 193 (21%) patients experienced 421 ADEs - mainly dyspeptic symptoms (12%), headache (11%) and cough (11). Experiencing more ADEs reduced the odds of being adherent [low vs. medium/high: odds ratio (OR) OR1 0.77 (95% CI 0.67, 0.89), and low/medium vs. high: OR2 0.55 (05% CI 0.41, 0.73)]. Being more satisfied increased the odds of being adherent [low vs. medium/high: OR1 1.02 (95% CI 1.01, 1.03)]. Taking medication >1year [OR1=2 , 0.60 (95% CI 0.43, 0.83)] and taking calcium channel blockers [OR1=2 0.71 (95% CI 0.54, 0.92)] decreased the odds for both low vs. medium/high and low/medium vs. high adherence. Only one in five patients reported perfect (high) adherence to their antihypertensive treatment regimen. Experiencing ADEs and being dissatisfied with treatment were associated with lower adherence. In addition to addressing treatment satisfaction and drug safety in first-world countries, these should also be addressed in resource-poor settings, within patient consultations, to enhance adherence.

COMORBID PRIMARY HEADACHE: OCCURANCE AND PREVALENCE IN PATIENTS WITH RELAPSING REMITTING MULTIPLE SCLEROSIS

Background and aims: Hypertension (HTN) represents a significant global health concern associated with severe complications, including cardiovascular diseases, stroke, and kidney failure. Effective management and patient satisfaction with treatment are crucial for controlling the condition and preventing premature mortality. This cross-sectional study evaluated factors influencing treatment satisfaction among 319 hypertensive patients across 50 primary healthcare centers in Kerman, Iran, during January and February 2021. Methods: This cross-sectional study focused on patients with HTN who were referred to fifty primary healthcare institutions in Kerman, southeast Iran, between January and February 2021. The 14-item Treatment Satisfaction Questionnaire for Medication (TSQM-14) and the 8-item Morisky Medication Adherence Scale were utilized to evaluate treatment satisfaction and medication adherence, respectively. Bivariate and multiple linear regression models were employed to identify factors associated with treatment satisfaction, which was scored on a scale from 0 to 100, reporting beta coefficients (B) and 95% confidence intervals (CI). Results: In this study, participants with HTN had a mean age of 56.7±13 years. Overall, the average treatment satisfaction among respondents was 61.1±15.0. In the multiple regression model, treatment satisfaction was significantly associated with having a diagnosis of HTN for more than a decade (B=4.9; 95% CI: 1.3-8.6), measuring blood pressure (BP) more than eight times per month (B=8.3; 95% CI: 4.1-12.4), achieving controlled BP (B=6.5; 95% CI: 2.9-10.0), and adhering to treatment (B=5.6; 95% CI: 2.4-8.8). Conclusion: Treatment satisfaction among hypertensive patients is currently suboptimal. Enhancing BP monitoring and medication adherence through targeted interventions has the potential to improve patient satisfaction and promote better long-term health outcomes.

Background: As the average age of multiple sclerosis (MS) population rises globally, unclear guidelines on disease-modifying therapy (DMT) use in older persons with MS (pwMS) contribute to increased variability in clinical practice. The factors driving DMT utilisation in this population are not well understood. We explored DMT utilisation patterns in pwMS aged 55 and older enrolled in the Swiss MS Registry (SMSR), a nationwide observational study with voluntary participation. Methods: We conducted an exploratory analysis using data from SMSR participants who had reported DMT status in the most recent follow-up survey and at least once within the previous 3 years. Participants were categorised and compared by current and past DMT use: (no use), (prior use), (same DMT), (changed DMT) and (initiated DMT). Log-binomial regression identified factors associated with non-use, grouping participants as No DMT (, ) and DMT (). Results: Among 378 participants (mean age 63.2±6.7 years), 206 (54.5%) reported DMT use: 176 (46.6%) continued the same DMT, 20 (5.3%) switched and 10 (2.6%) newly initiated DMT. Among non-users, 54 (14.3%) had stopped treatment, while the rest did not use DMT during the study period. In participants with regular neurological care, longer MS duration (relative risk (RR)=1.018, 95% CI 1.008 to 1.028) and older age (RR=1.016, 95% CI: 1.001 to 1.032) were associated with higher likelihood of DMT non-use, and participants with primary (RR=1.736, 95% CI: 1.175 to 2.565) and secondary progressive MS (RR=1.423, 95% CI: 1.023 to 1.981) were more likely not to use DMTs compared with relapsing-remitting MS. No significant associations were observed in participants without regular neurological follow-up. Conclusions: Despite unclear efficacy and safety, many older pwMS continue DMT use. Use is primarily associated with relapsing-remitting MS, while age and disease duration show only modest or no association.

BackgroundSeveral studies have demonstrated that calcitonin gene-related peptide receptor antagonist monoclonal antibodies (anti-CGRP mAbs) are a safe and effective treatment for migraine prevention. Patients’ perceptions, however, do not always match clinical findings. Numerous studies have evaluated the effects of anti-CGRP mAbs on quality of life, but few have studied treatment satisfaction. This study collected data on patient-reported satisfaction and quality of life after 1 year of anti-CGRP mAb therapy and analyzed effectiveness, safety, and adherence in routine practice.MethodsSingle-center retrospective study of patients with high-frequency episodic migraine (HFEM) and chronic migraine (CM) treated for at least 1 year with the same anti-CGRP mAb. Patients were assessed using the Treatment Satisfaction Questionnaire for Medication (TSQM) at week 52 and the EuroQol 5-Dimension, 5-Level questionnaire (EQ-5D-5 L) and 6-Item Headache Impact Test (HIT-6) at weeks 0, 12, 24, and 52. Effectiveness was assessed through monthly migraine days (MMDs) and HIT-6 results, safety through reports of adverse events (AEs) and reasons for treatment discontinuation, and treatment adherence through the Medication Possession Ratio.ResultsEighty patients (95% women, mean ± SD age, 50 ± 9.9 years) with migraine (70% CM, 30% HFEM) treated with fremanezumab (88.8%), erenumab (6.2%), or galcanezumab (5%) were included. Mean global satisfaction on the TSQM was 77.2 ± 20.8 points. Treatment satisfaction was correlated with a reduction in HIT-6 score (r = 0.372, p < 0.001). At 1 year, significant improvements were observed in the EQ-5D-5L index score and visual analog scale. MMDs decreased significantly by 8.7 ± 7.4 days from baseline to week 52; 52 patients (65%) achieved a ≥ 50% reduction in MMDs. Fifty-three patients (66%) achieved a ≥ 6-point reduction on the HIT-6 (mean reduction, 12.1 ± 9.8 points); the improvement was significant (p < 0.0001) from week 12 onwards. Eighteen patients (22.5%) reported mild AEs and treatment adherence was 100%.ConclusionsPatient satisfaction with anti-CGRP mAb therapy was high in this real-world study and correlated with effectiveness measured by the HIT-6 and significantly improved quality of life. Anti-CGRP mAbs are effective and safe for resistant migraine; they have a quick onset of action and provide lasting relief.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12883-025-04384-1.

Multiple sclerosis (MS) affects approximately 400,000 people in the United States and about 2.1 million people worldwide.1 Although there are 4 forms of MS, over 80% of patients with MS are initially diagnosed with relapsing-remitting MS (RRMS). Of these, about 50% will eventually develop secondary progressive MS (SPMS).2 Disease-modifying therapies (DMT) for MS became available in the 1990s. Currently, there are several injectable and one oral Food and Drug Administration–approved DMT for use in MS. Although cost-of-illness studies in MS have yielded varying results depending on whose perspective is taken, or on the severity of disease and geographic setting, the direct costs associated with MS have increased considerably with the introduction of DMT.3 Concern about the high cost of MS to individuals, health systems, and society has spurred the examination of the cost-effectiveness (CE) of DMT in MS. In this issue of Neurology ®, Noyes and colleagues4 present a CE model evaluating 4 DMT for individuals with RRMS and SPMS. Although the study is multifaceted, their primary focus is on estimating incremental cost-effectiveness ratios (ICERs), the incremental cost associated with each DMT regimen, compared to basic supportive treatment, per quality-adjusted life …

INTRODUCTION:The expanding range of disease modifying therapies (DMT) for relapsing-remitting multiple sclerosis (RRMS) has led to increased interest in the relative effects of different DMTs. Previous mixed treatment comparisons (MTCs) have used different methods to address similar questions highlighting the need for a consistent approach to the assessment of treatments in RRMS.METHODS:We compared the methodology of six published MTCs of DMTs for RRMS identified by a systematic search of the literature. We assessed sources of evidence, DMTs included, outcomes reported and methods of data synthesis.RESULTS:All six MTCs were based on systematic reviews that included randomized controlled trials (RCTs). MS relapse was reported as the rate ratio based on annualised relapse rates (four MTCs) and as odds ratios or relative risk (one MTC each) based on the proportion with relapse. The analysis of relapse included between sixteen and twenty-seven RCTs and seven to twenty DMTs in different MTCs. One MTC reported both disability progression confirmed after three months (CDP3M) and disability progression confirmed after six months (CDP6M) as hazard ratios. One MTC combined CDP3M and CDP6M as a single outcome. One MTC reported only CDP3M based on hazard ratios. Two MTCs reported only CDP6M as either odds ratios or risk ratios (one MTC each). In one MTC the definition of disability progression was not reported. The analysis of disability included between seven and twenty-six RCTs and between six and nineteen DMTs in different MTCs. All six MTCs fitted a random effects MTC model using either Bayesian (four MTCs) or frequentist (two MTCs) methods.CONCLUSIONS:There is substantial heterogeneity between published MTCs in RRMS with regard to inclusion criteria, outcome definitions, effect measures and statistical methods. There is a clear requirement for a consistent approach to health technology assessment of DMTs for RRMS.

The TRaditional versus Early Aggressive Therapy for Multiple Sclerosis (TREAT-MS) trial: design and baseline characteristics of participants.

<h3>Background and Importance</h3> Discrepancies between clinical remission and patients’ perceptions of their symptoms are common in psoriasis. While clinical scores such as PASI provide objective measures of disease activity, they may not fully capture the patient experience. Integrating patient-reported outcomes (PROs) is essential to complement clinical assessments and monitor treatment effectiveness. Adherence to biologic therapies is a key factor influencing long-term outcomes, yet its relationship with PROs remains underexplored in real-world settings. <h3>Aim and Objectives</h3> This study aimed to evaluate treatment adherence and explore its association with PROs in patients with moderate-to-severe psoriasis receiving guselkumab in routine clinical practice in Spain over a 12-month period. <h3>Material and Methods</h3> This was a prospective, observational, multicentre study including 269 adult patients across 39 Spanish dermatology centres. Baseline assessments included Psoriasis Area Severity Index (PASI) and Dermatology Life Quality Index (DLQI). Adherence was measured using Medication Possession Ratio (MPR ≥90%) and the Morisky Medication Adherence Scale (MMAS-8 ≥6). PROs included the Treatment Satisfaction Questionnaire for Medication (TSQM), Hospital Anxiety and Depression Scale (HADS), and Psoriasis Signs and Symptoms Diary (PSSD). <h3>Results</h3> At baseline, mean age was 50.8 years, with a mean psoriasis duration of 16.5 years. Psoriatic arthritis was present in 35.3%, and 81.6% had prior biologic exposure. Mean PASI was 10.1, and DLQI was 9.8. At 12 months, 142 patients (52.8%) completed follow-up. Mean MPR was 96.7%, with 87.3% adherent by MPR and 96.5% by MMAS-8; 88.5% met both criteria. Concordance between MPR and MMAS-8 was low. At baseline, PROs were similar between adherent and non-adherent patients, except for HADS-anxiety (6.7 vs 10.4; p=0.007). At 12 months, trends favoured adherent patients in PSSD signs (21.1 vs 31.7; p=0.098) and HADS-anxiety (5.7 vs 7.9; p=0.076), though not statistically significant. <h3>Conclusion and Relevance</h3> High adherence to guselkumab was observed over 12 months. Preliminary findings suggest a potential association between adherence and improved patient-perceived outcomes, particularly anxiety and symptom burden. Combining objective and subjective adherence measures may enhance sensitivity in detecting these differences. These insights may inform strategies to optimise long-term psoriasis management. <h3>Conflict of Interest</h3> Corporate sponsored research or other substantive relationships: D. Martínez-López is an employee of Janssen-Cilag, the sponsor of this study. The remaining authors have no conflicts of interest to declare.

AimsTo evaluate the psychometric properties of the Adelphi Adherence Questionnaire (ADAQ©) as an adherence measure in a diverse type 2 diabetes mellitus (T2DM) population in routine clinical practice.Materials and MethodsData were drawn from the Adelphi T2DM Disease Specific Programme™, a survey of physicians and adults with T2DM consulting in the United States, February–May 2021. Participants completed the ADAQ and single questions on medication satisfaction and convenience. Latent variable modelling (exploratory/confirmatory factor analyses, item response theory, Mokken scaling and bifactor analyses) assessed ADAQ dimensionality and composite scoring. Differential item functioning (DIF) analyses were conducted between participants taking injectable and non‐injectable therapies, and with <3 or ≥3 long‐term conditions. Correlational analyses with physician‐reported adherence and compliance, and patient‐reported treatment satisfaction, convenience and side‐effects assessed construct validity. ADAQ scores by sociodemographic and clinical factors were also described.ResultsOverall, 1287 people with T2DM were included in this analysis (mean age 56.7 years [standard deviation: 12.8], 54.5% [n = 702] male). Latent variable modelling indicated a unidimensional reflective model fit, with a bifactor model confirming an 11‐question essentially unidimensional composite score. Negligible DIF was found between groups. Cronbach's alpha and McDonald's omega were both ≥0.90. Moderate correlations with physician‐reported adherence and compliance, and patient‐reported medication convenience and satisfaction support construct validity.ConclusionsThe ADAQ shows strong construct validity and high internal consistency reliability within a heterogenous T2DM population with negligible DIF between sub‐groups. Future work should focus on test–retest reliability and detecting change over time.