Multiple Sclerosis Express Report

From Data Presented at the Consortium of Multiple Sclerosis Centers 19^th Annual Meeting, June 1-5, 2005 in Orlando, Florida

Publication date: 2005-06-30

Multiple Sclerosis—Adherence to Therapy

This report was reviewed for medical and scientific accuracy by Andrew R. Pachner, MD, Professor of Neurology and Neurosciences, University of Medicine & Dentistry of New Jersey—New Jersey Medical School, Newark, New Jersey.

Introduction

Over the past decade, the use of disease-modifying therapies has resulted in significant improvements in the management of patients with multiple sclerosis. Disease-modifying therapies, including interferon beta-1a (Avonex, Rebif), interferon beta-1b (Betaseron), and glatiramer acetate (Copaxone) have demonstrated the ability to reduce relapse rate, slow disease progression and disability, and decrease magnetic resonance imaging (MRI) lesion load in patients with multiple sclerosis. However, despite the beneficial effects of disease-modifying therapies, adherence rates to treatment remain low, with a national average adherence rate of only 54%.¹ Poor patient adherence rates impact treatment efficacy and ultimately disease progression.² In order to receive the full therapeutic benefit of disease-modifying therapies, it is important that patients adhere to their prescribed treatment regimens.

Adherence is a measure of both compliance (taking a medication in the dose and dosing schedule as prescribed) and persistency (maintenance of drug regimen over time).² Where current disease-modifying therapies must be administered by intramuscular or subcutaneous injection, adherence to therapies that must be injected may be difficult, particularly in a chronic disease such as multiple sclerosis where the treatment benefits are not always immediately apparent to the patient. Furthermore, patients also may experience anxiety about injections or experience adverse effects of treatment.

According to the results of studies presented at the Consortium of Multiple Sclerosis Centers 19th Annual Meeting, improved adherence to disease-modifying therapies can be achieved through management strategies such as dose titration, support groups, and individualized counseling.^3-5

Implementation of strategies aimed at improving adherence to disease-modifying therapies can result in significant long-term health benefits for patients with multiple sclerosis. In addition to prescribing and monitoring patient regimens, the neurologist is in a unique position to oversee implementation of support strategies designed to improve patient outcomes.

This Multiple Sclerosis Express Report^TM reviews obstacles to adherence with disease-modifying therapies and current strategies being used to improve adherence among patients with multiple sclerosis.

Factors Influencing Patient Adherence to Therapy

It is important to identify those factors that are most likely to influence adherence to disease-modifying therapies in patients with multiple sclerosis to insure the overall success in their disease management. This was the objective of an ongoing multicenter, retrospective study presented by Katherine Treadaway, LCSW, Department of Neurology, University of Texas Southwestern Medical Center at Dallas Multiple Sclerosis Clinic, Dallas, Texas.²

The study included 709 survey respondents recruited from academic and community multiple sclerosis centers. Patients completed 3 Internet-based surveys which included an analysis of adherence to therapy, satisfaction with therapy, perceived effectiveness of therapy, and quality of life. The majority of patients (63%) had been taking their current disease-modifying therapy for at least 2 years. A total of 228 patients (32%) were currently treated with Avonex, 115 (16%) treated with Rebif, 137 (19%) treated with Betaseron, and 229 (32%) treated with Copaxone.

Overall, 37% of respondents were considered non-adherent to therapy (defined as having missed at least one disease-modifying therapy injection in the previous 4 weeks). Non-adherence rates among patients taking Avonex or Rebif were significantly lower than those receiving Betaseron or Copaxone, Ms. Treadaway reported (Figure 1).