Browsing School, Graduate by Author "Culpepper, William"
Effectiveness of practice guidelines for disease modifying therapy in multiple sclerosis within the Veteran's Health AdministrationCulpepper, William; Magder, Laurence S. (2009)Background: Multiple Sclerosis (MS) is a chronic, degenerative neurologic disorder and is the most common neurologic disorder in young adults; however, its etiology has yet to be fully elucidated. The efficacy of disease modifying therapy (DMT) has been documented, but compliance is an issue and only one study appears in the literature that specifically assessed the effectiveness of DMT. Objectives: This study had four objectives: 1) enroll a large cohort of veterans with MS into the VHA MS Surveillance Registry (MSSR); 2) assess the representativeness of the MSSR as compared with other published MS cohorts; 3) assess how well DMT practice guidelines are applied across the VHA system; and 4) assess the effectiveness of DMT in the treatment of MS. Methods: A cross-sectional, mail-based survey was administered to a stratified, random sample of 3,905 VHA users with MS. Detailed demographic and clinical data were collected as well as patient-reported outcomes assessing disability and QOL. Results: There were 1,227 respondents (31% response rate) that were enrolled into the VHA MS Surveillance Registry (MMSR). Respondents did not differ from non-respondents or from the larger VHA MS population with regard to demographics or region and the MSSR cohort was very similar in demographic and clinical characteristics when compared with other published MS cohorts. Overall, 86% of eligible patients had tried at least one DMT and 72% were compliant with therapy. In general, a dose-response type of association was found such that low DMT compliance was associated with increased disability, more MS-related symptoms, and poorer physical QOL compared with high DMT-compliance. DMT-use was not associated with the psychological QOL scale. Conclusions: The MSSR provides a representative cohort of veterans with MS that reflects the larger VHA MS population and adequately represents the general MS population as well. The DMT-use rates observed in this study exceeded those in other studies and provide a system-wide assessment that could contribute to the development of a national benchmark criterion. This study is only the second to provide empirical support for the effectiveness of DMT in a "real world" cohort of MS patients and highlights the importance of patient compliance. Additional research is needed regarding the factors associated with compliance to ensure therapeutic benefit in all DMT users.