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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

From: 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)

  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 2ndline DMD
  1. 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