Glatiramer acetate treatment persistence - but not adherence - in multiple sclerosis patients is predicted by health-related quality of life and self-efficacy: a prospective web-based patient-centred study (CAIR study)

Table 4 Step-wise approach to identify RRMS patients with a high risk (>50%) of early injectable DMD treatment discontinuation and to guide persistence improving measures

	To be assessed	Tool	Outcome	Action
Step 1	Physical HRQoL Control self-efficacy	MQoL-54 MSSES	Predictive score	If score in lowest quartile (>50% discontinuation risk) → 2A & 2B
Step 2A	Depression & anxiety Fatigue Bladder	HADS MFIS Actionable	Diagnostic scores	If score(s) abnormal → further diagnosis and therapy If MSSES score(s) low → therapy?
Step 2B	Prognosis	1) Clinical 2) MRI 3) CSF	Prognostic indicators	If prognosis unfavourable > consider 2^ndline DMD

MS multiple sclerosis, DMD disease modifying drug, HRQoL health-related quality of life, MSQoL-54 Multiple Sclerosis Quality of Life-54, MSSES Multiple Sclerosis Self-Efficacy Scale, HADS Hospital Anxiety and Depression Scale, MFIS Modified Fatigue Impact Scale, MRI magnetic resonance imaging, CSF cerebrospinal fluid