Long-Term Treatment Optimization in Individuals with Multiple Sclerosis Using Disease-Modifying Therapies

Denis, Lorraine; Namey, Marie; Costello, Kathy; Frenette, Jocelyne; Gagnon, Nathalie; Harris, Colleen; Lowden, Diane; McEwan, Lynn; Morrison, W.; Poirier, Josée

doi:10.1097/01376517-200402000-00003

Cited by 23 publications

(15 citation statements)

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“…This drug has entered Phase III trials as a Table 1 Non-adherence to treatment: contributory factors, strategies adopted in MS therapy to address adherence and currently unmet needs for improvement Factors that have a negative effect on adherence to treatment for chronic disease (12,29,33,37,40,41) Time taken to administer Complexity of treatment regimen Difficulty with administration of treatment Adverse effects of treatment Disruption of lifestyle by therapy High frequency of dosing Cost of medication Injection phobia Unrealistic therapeutic expectations Depression Treatment fatigue Approaches that have been applied to improve treatment adherence in MS Co-medication with oral drugs (e.g. acetaminophen, ibuprofen) that reduce flu-like symptoms associated with DMDs (92,93) Auto-injection devices to make self-injection easier (22,94) New formulations of DMDs that do not require refrigeration (95) and reconstitution (7,96) Treatment of depression (38) Implementing educational interventions to improve understanding of rationale, expectations and potential adverse effects (10), including nurse training programmes to optimise injection techniques at treatment initiation (11,97,98) Reinforcement of adherence on a regular basis to encourage use as directed (99)(100)(101) Unmet needs for improving treatment adherence in MS Availability of non-injected therapy Simple treatment regimens Less expensive therapy Improved benefit-to-risk ratio MS, multiple sclerosis; DMDs, disease-modifying drugs.…”

Section: Achieving Optimal Adherencementioning

confidence: 99%

Emerging oral therapies for multiple sclerosis

Cohen

Rieckmann

2007

International Journal of Clinical Practice

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Summary Background: Current disease‐modifying drugs (DMDs) have positively affected the treatment of relapsing–remitting multiple sclerosis (RRMS); however, the requirement for long‐term injections imposes a burden on patients and may lead to reduced adherence in some cases. Furthermore, not all patients respond adequately to current DMDs, suggesting that certain patients require different therapeutic approaches. Therefore, alternative MS treatments with less invasive routes of administration and new modes of action are needed to expand the current treatment repertoire, increase patient satisfaction and adherence, and thereby improve efficacy. Discussion: This review discusses the current unmet need for an orally administered treatment for RRMS, including potential benefits of this route of administration, and implications for improved treatment outcomes. Oral drugs that are currently in Phase II/III clinical development are discussed.

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Section: Achieving Optimal Adherencementioning

confidence: 99%

Emerging oral therapies for multiple sclerosis

Cohen

Rieckmann

2007

International Journal of Clinical Practice

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“…Several well-developed training programs to help patients self-inject have been shown to help alleviate some of the convenience-related problems associated with injectable therapies. [35][36][37] The second most common reason for nonadherence in our cohort (25.9%) was perceived lack of efficacy of the DMTs. This finding is consistent with other results published in the international literature.…”

Section: Figure 2 Reasons For Discontinuation Of Various Disease-modmentioning

confidence: 99%

Adherence to First-Line Disease-Modifying Therapy for Multiple Sclerosis in Kuwait

Alroughani

Thussu

2012

International Journal of MS Care

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The aim of this retrospective study was to determine the rate of nonadherence to disease-modifying therapies (DMTs) among multiple sclerosis (MS) patients in Kuwait and to identify reasons for patient discontinuation of long-term therapy. Using a newly established MS registry at our institution, we collected data on MS patients' demographics, clinical characteristics, disability measures, and continuation or discontinuation of first-line DMTs. Reasons for nonadherence were divided into four categories: adverse events, inconvenience, perceived lack of efficacy, and physician-documented disease progression. Of 212 eligible patients, 40.1% were found to be nonadherent to first-line DMTs. In the nonadherent group, the female-to-male ratio was 1.75:1 and the mean age at disease onset was 26.8 years. Of this group, 69.4% of patients had a relapsing-remitting course, 18.8% had a secondary progressive course, and 11.8% had clinically isolated syndrome. Compared with the adherent group, the nonadherent group had a shorter mean disease duration (P = .014) and a greater likelihood of having Expanded Disability Status Scale (EDSS) scores of 3 or lower (67.1% vs. 48.0%; P = .007). Inconvenience was the most common reason for nonadherence (32.9%), followed by perceived lack of efficacy (25.9%), adverse events (23.5%), and physician-documented disease progression (17.7%). In summary, the rate of nonadherence to first-line DMTs in MS patients at our institution is considered high. Most nonadherent patients had a short disease duration and low EDSS scores. Inconvenience and perceived lack of efficacy were the most common reasons for nonadherence. The results demonstrate a need to improve treatment adherence among MS patients in Kuwait through providing better patient education, improving communication between patients and health-care providers, defining therapy expectations, and instituting new therapeutic techniques. Int J MS Care. 2012;14:17-24.

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“…37,38 Because FLS most often occur during therapy initiation, it is critical that patients be counseled on both the probability of symptoms and their mitigation. Because FLS can occur in long-term users of IFNβ-based DMTs as well, it is important to routinely monitor patient adherence so that clinical staff can intervene as necessary.…”

Section: Discussionmentioning

confidence: 99%

Nurses’ Perspective on Approaches to Limit Flu-Like Symptoms During Interferon Therapy for Multiple Sclerosis

Filipi¹,

Beavin²,

Brillante³

et al. 2014

International Journal of MS Care

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Background: Several interferon beta (IFNβ) formulations are approved for first-line use as disease-modifying therapies to treat patients with multiple sclerosis (MS). Systemic post-injection reactions, often termed flu-like symptoms (FLS), occur in approximately half of all patients treated with IFNβs and can affect adherence to therapy. These symptoms, which include pyrexia, chills, malaise, myalgia, and headaches, usually resolve within 24 hours or persist intermittently following each injection. Because FLS, which usually occur early in the treatment course and diminish over time, are a primary cause of nonadherence to IFNβ therapy, it is important to employ strategies that can attenuate these side effects. Methods: To identify interventions effective in limiting FLS, a panel of United States–based nurses with expertise in MS patient care was convened and a literature review completed. Results: Panel consensus was reached on specific interventions that can attenuate FLS. These prevention and mitigation strategies include dose titration, analgesia, and optimal injection timing, as well as other techniques that panel members have found useful in their clinical practice experience. Conclusions: These measures, in addition to effective patient education, will help to reduce the incidence of FLS secondary to IFNβ therapy, improve patient medication adherence, and positively affect long-term clinical outcomes.

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Long-Term Treatment Optimization in Individuals with Multiple Sclerosis Using Disease-Modifying Therapies

Cited by 23 publications

References 0 publications

Emerging oral therapies for multiple sclerosis

Emerging oral therapies for multiple sclerosis

Adherence to First-Line Disease-Modifying Therapy for Multiple Sclerosis in Kuwait

Nurses’ Perspective on Approaches to Limit Flu-Like Symptoms During Interferon Therapy for Multiple Sclerosis

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