Switching therapy and long-term adherence

#MSBlog: Long-term adherence to DMTs does occur. Can we assume these drugs are effective?

Carvalho AT, Sá MJ. Switching and escalating therapy in long-lasting multiple sclerosis: not always necessary. ISRN Neurol. 2012;2012:451457. doi: 10.5402/2012/451457.

Background: Although therapy switch is common among MSers, sometimes the initial prescribed treatment is maintained for a long period with clinical stability, low disability, and non-significant side effects. 

“I wonder who defined non-significant as being non-significant? MSers or Neurologist or Nurse or Pharma Company?”
Aim: To describe demographic and clinical characteristics of MSers treated in a MS clinic with the same disease-modifying drug (DMD) lasting for >12 years. 

Methods & results: From the cohort of 51 MSers followed with relapse-remitting MS who started an DMD between 1996 and 1999, they found a high percentage (51%) of MSers who were efficiently treated with the first DMD. These MSers were mainly females, with low annualized relapse rate and Multiple Sclerosis Severity Score (MSSS). 

Conclusion: These results may be related to the open and multidisciplinary model of this specific MS clinic organization, which encourages adherence. Identifying characteristics associated with therapy persistence may be useful in developing strategies to improve therapy effectiveness.

“Adherence to injectable treatments long-term is complicated and has to do with the drugs being effective and managing side-effects. It is clear that some MSers do well injectables and tolerate them long-term. These are the MSers who are the most likely to derive the long-term benefits of these drugs, i.e. reduced disability and longer survival. The elephant in the room is those who don’t stay on their treatment; what has happened to them and why? Are  these the ones with cognitive impairment and depression? The ones in wheelchairs? More data please?”

About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.


  • That appears to be an arrogant, crass and unfounded statement to make.What are you implying ?
    Can you please show me the stats ?

    • Also as I understand it, if your disease progresses despite being on dmds you are taken off these anyway?
      Not sure, as my wife has ppms and is one of those in a wheelchair, don't think it was all her own fault,luckily she doesn't have depression or cognitive impairment.

    • Andy, was your wife given any meds at the time of her diagnosis except for the symptomatic ones?

      I am not sure I understood G the way you did but I'd also would like to know what happened to people who abandoned DMTs for good.

    • I wish your wife well. I am terrified to stop Copaxone. I had a terrible flare up a couple months after I started. I have had a smaller flare up since. I have no real difficult side effects. I was in a wheelchair for a brief time and now I am cane aided if I need to traverse uneven terrain.

  • This study does not tell us much as it is open-labelled and self-selecting. If you are doing well on a drug you stay on it. If you are doing badly you tend to stop or switch. Therefore all that open-label studies like this tell us is that you enrich the cohort with responders. All the non-responders end up on other therapies or stopping treatment. We know the failures have a worse prognosis in the long-term. What we need is the data on the group of MSers who did not stay on their therapies.

    • The prior mention with Copaxone is mine. Having RRMS, I have improved since being in a wheelchair. How do I know if it is the Copaxone?

By Prof G



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