Adherence to Disease-Modifying Therapy in Multiple Sclerosis: Part I

Abstract

Multiple sclerosis (MS) is a chronic, debilitating disease for which there is no cure. However, the recent introduction of injectable immunomodulating agents has made it possible to reduce the frequency of relapsing episodes and to possibly slow its progression. The use of these agents is recommended by the National MS Society, however, their true potential cannot be realized if patients do not accept them and healthcare professionals do not promote them. Because MS is unpredictable, and treatments can produce side effects, ensuring adherence to the recommended therapy is a complex and challenging issue. A better understanding of the obstacles to adherence, and the identification of possible solutions, should be of value to nurses, who have numerous opportunities to encourage patients to initiate and continue therapy. This article, which is in two parts, describes the particular problems of treatment adherence, and proposes that the transtheoretical model of behavior change can be useful in achieving treatment goals in MS and in other chronic disease states. This model is based upon the concept that a patient's "readiness for change" is crucial, and that attempts at intervention should be sensitive to the patient's changing conditions and state of mind. Nurses who work with patients with MS and other chronic diseases can apply the model to help their patients accept and adhere to the demands of ongoing treatment.

A multicenter study of the predictors of adherence to self-injected glatiramer acetate for treatment of relapsing-remitting multiple sclerosis

“…Current disease-modifying treatments for MS must be injected, posing special challenges regarding adherence. Injection anxiety is common [13,14] and physical limitations such as poor eye-hand coordination or tremor can make injections difficult to self-administer [15]. In retrospective studies of long-term adherence to betainterferon therapy, continuous therapy was achieved by only 67 [16] to 72% of patients [17].…”

Adherence to Disease-Modifying Therapies in Spanish Patients with Relapsing Multiple Sclerosis: Two-Year Interim Results of the Global Adherence Project

“…It has been observed that DMT might not be effective in those patients with a poor level of adherence in the long term [2]. According to different authors, the main factors that contribute to whether the patient is adherent are related to perceived lack of efficacy, lack of information or too complex information, false hopes of improvement in the disease, problems administering treatment (such as fear of needles or self-injections) and sociocultural factors [8,9]. …”

Évaluation d'un programme d'éducation à l'auto-injection chez des patients atteints de sclérose en plaques rémittente débutant un traitement par interféron bêta-1a intramusculaire

“…En revanche, la conviction du patient de réaliser correctement l'injection est un facteur de bonne observance. Il n'est pas étonnant alors que le soutien à domicile en début de traitement, qui permet notamment au patient d'apprendre les gestes nécessaires à la préparation et à l'injection à domicile [3], contribue également à une meilleure observance. Notre étude a recruté des patients initialement volontaires pour l'auto-injection.…”