Fostering adherence to injectable disease-modifying therapies in multiple sclerosis

Abstract

Multiple sclerosis requires long-term management, often with disease-modifying therapies. Poor medication adherence, especially to injectables, can increase relapse and hospitalisation rates and consume healthcare resources. We discuss adherence definitions and terminology and its prevalence in multiple sclerosis (MS). Typical causes of poor adherence in patients with MS include: insufficient efficacy or tolerability, concurrent disorders, and consequences of MS (e.g., forgetfulness, depression, fatigue and poor motor skills). Ways to improve adherence rates are reviewed, focusing on interdisciplinary healthcare teams, good communication between healthcare workers and patients (and their families), ongoing support and digital tools to promote adherence. We consider open communication and continuing education to be key, and that MS nurses have a pivotal role in ensuring patients’ adherence to MS medicines.

Keywords::

• communication
• concordance
• disease-modifying therapy
• education
• healthcare
• multiple sclerosis
• nurse

Financial & competing interests disclosure

A Lugaresi has been an advisory board member for Bayer, Biogen Idec, Merck Serono and Genzyme, received travel grants and honoraria from Bayer, Biogen Idec, Merck Serono, Novartis, Sanofi and Teva, and research grants from Bayer, Biogen Idec, Merck Serono, Novartis, Sanofi and Teva. She has also received travel and research grants from the Associazione Italiana Sclerosi Multipla and was a consultant of ‘Fondazione Cesare Serono’. F Patti has received personal honoraria for advisory and speaking activities by Almirall, Bayer, Biogen Idec Italia, Merck Serono, Novartis, Sanofi Genzyme and TEVA. He has received research grants from FISM and MIUR. MR Rottoli has received travel grants and honoraria from Bayer, Biogen Idec, Merck Serono, Novartis, and research grants from Bayer, Biogen Idec, Merck Serono. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties. Writing assistance was provided by R Clark (Dunchurch, Warwickshire, UK) and M Sintzel (Zurich, Switzerland) on behalf of Bayer S.p.A., Bayer Healthcare, Milan.

Key issues

• The chronicity and symptoms of multiple sclerosis (MS) challenge patients’ ability to remain motivated to keep taking their medication.

• Poor adherence to therapeutic regimens is associated with increased rates of relapse and hospitalisation, and greater use of healthcare resources.

• Efforts to improve adherence per se should not be neglected.

• ‘Adherence’ rather than ‘compliance’ has to be pursued, as it implies an active and collaborative role of the patient rather than just following medical instructions, with a higher potential for treatment success.

• Adherence is distinct from persistence, encompassing stopping and starting drug treatment, missed doses and short ‘drug holidays’ rather than a mere duration of treatment.

• Typical causes of poor adherence in patients with MS encompass insufficient efficacy and tolerability, concurrent disorders (e.g., mental disorders, including sub-threshold depressive disorders) and consequences of MS (e.g., forgetfulness, depression, fatigue, and poor motor skills).

• Ways of improving adherence rates should focus on the need for interdisciplinary healthcare teams, good communication between healthcare workers and patients (and their families), realistic expectations, ongoing support, treatment of concurrent disorders and use of educational digital tools to promote adherence.

• Open communication and continuing education are possibly the most important aspects to ensure high adherence rates for MS patients.

• MS nurses have a pivotal role in ensuring patients’ adherence.

Notes