Make sure you take your medication: poor adherence

Poor DMT adherence; a big problem in MS. #MSBlog #MSResearch

“Compliance or adherence is a major factor with DMTs in all diseases, MS is not exception. The study below supports other data sets that poor adherence with injections leads to poorer outcomes. Are you surprised? Almost all MSers on injectable DMTs miss a few injections, some quite a lot. What can be done about it? Education, education, education. You can also use technology for example text or email reminders or you can use intelligent devices to improve adherence. The RebiSmart device from Merck-Serono is one such example. Merck-Serono are so confident about their device improving adherence they are even offering a rebate on the cost of the drug if MSers are not compliant more than a certain percentage of the time.”

“The data below has implications for treat-2-target of NEDA. If you your failing your treatment because if non-adherence surely this needs to be addressed before you switch or escalate? Will switching to an oral therapy help? I suspect not as the data on oral therapies in general are as bad if not worse than the data on injectables when it comes to adherence. At least with natalizumab you can guarantee the MSer is having their monthly infusion. Similarly with induction therapies once you have had the therapy you have had it. Poor adherence to maintenance therapies is another reason to support or choose induction therapies.”

“Are you taking your DMTs as prescribed?”

Epub: Prosperini et al. From High- to Low-Frequency Administered Interferon-Beta for Multiple Sclerosis: A Multicenter Study. Eur Neurol. 2014 ;71(5-6):135-143.

Objectives: To investigate whether clinical and magnetic resonance imaging (MRI) outcomes of MSers who required a reduction of administration frequency of interferon-beta (IFNB) were similar to those of MSers who did not. 

Methods: We identified three subgroups of MSers under treatment for 24 months with subcutaneous (sc) high-frequency IFNB-1a or -1b: those continuing to receive IFNB according to the drug label (recommended frequency group), those reducing the administration frequency of sc IFNB-1a or -1b (reduced frequency group), and those switched to once weekly intramuscular (im) IFNB (switched group). All MSers were followed for further 24 months. The occurrence of relapse, MRI activity and disability worsening were considered as outcome measures. 

Results: We identified 308 MSers, 201 in the recommended frequency group, 70 in the reduced frequency group, and 37 in the switched group. MSers in the reduced frequency group had increased risk for relapses (HR = 1.95, p < 0.001) and MRI activity (HR = 1.41, p < 0.001), while MSers in the switched group had increased risk for relapses (HR = 1.67, p = 0.012), but not for MRI activity (HR = 1.26, p = 0.08) than those in the recommended frequency group. Predictors for disease activity re-start after the reduction of IFNB administration frequency were younger age, higher pre-IFNB relapse rate, and reducing sc IFNB frequency to twice weekly rather than switching to im IFNB-1a once weekly. 

Conclusion: Our findings discourage the reduction of sc IFNB administration frequency, especially in younger MSers with a higher pre-IFNB relapse rate. However, switching to im IFNB-1a may be considered in some selected cases.

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.

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