Non-compliance with disease modifying therapies in patients with Multiple Sclerosis: A qualitative analysis.

Publication date: Feb 21, 2020

Factors associated with adherence to disease modifying therapies (DMT) in patients with Multiple Sclerosis (MS) have been reported before, but little has been studied on compliance to a physician’s initial treatment recommendations. The objective of this study was to assess the factors associated with compliance to physician recommended treatment in treatment-na”ive patients with MS.

We studied a cohort of patients with MS followed at an academic MS center in Toronto, Canada between January 2015 and May 2018. We used log-binomial models to identify patient-level factors (age, sex, and smoking history), and MS-specific clinical details (delay in diagnosis, and age at diagnosis) associated with compliance.

Of the 332 patients, 256 (77.1%) were recommended DMT and 80 (31.3%) did not follow the recommendation. The most common causes for refusal to initiate DMT were: personal preference to not embark on a medication (46.2%), wishing to use a conservative approach (22.5%) or use of complementary medical approaches (18.8%). Twenty-one () patients who initially were compliant to treatment recommendations subsequently stopped DMT against medical advice. The two most common reasons for this nonadherence included adverse effects (61.8%) and personal preference (19.0%). Every year delay in the diagnosis of MS was associated with a lower risk of compliance (risk ratio 0.97, 95% CI, 0.94-1.00).

Non-compliance to DMT recommendation in patients with MS in a Canadian practice is sizable, due to patients’ own perspectives of disease and their belief in alternative complementary medicine.

Stratos, K., McGarragle, K., Thistle, J., Vyas, M.V., and Lee, L. Non-compliance with disease modifying therapies in patients with Multiple Sclerosis: A qualitative analysis. 20484. 2020 Mult Scler Relat Disord (41):

Concepts Keywords
Binomial Therapies Multiple Sclerosis
Canada MS
Canadian Complementary medicine
Cohort Health
Complementary Medicine Articles
Conservative Multiple sclerosis
DMT Amines
Multiple Sclerosis Adherence
Nave N,N-Dimethyltryptamine
Physician Compliance
Qualitative Analysis
Risk Ratio


Type Source Name
disease MESH Multiple Sclerosis
drug DRUGBANK Dimethyltryptamine
disease MESH diagnosis
disease MESH Risk factor


Original Article

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