Counseling Points Multiple Sclerosis - Winter 2015 - 11

patients-stressing for patients that they're not

tic options for MS. Some newer therapies being

alone in facing these challenges. A first step to

introduced in MS present greater long-term health

addressing adherence problems is to help patients

risks and higher needs for safety monitoring than

identify their own specific barriers to using their

the original injectable therapies. When initiating

therapy as directed. (Table 5).22,33

conversations with patients about starting a new

An increasing number of reminder systems

DMT or a potential switch in therapy, it is impor-

are available to help increase patient adherence

tant to keep in mind the patient's level of health

to medication therapies. Studies in other health

literacy and what he or she is able to compre-

conditions such as diabetes, smoking cessation,

hend and accept in a given encounter. Concepts

and hypertension have shown that cell-phone

related to MS treatment will be totally unfamiliar

text messaging systems that prompt patients with

to most patients, so starting from the beginning

34-36

reminders are effective at increasing adherence.

is necessary whether discussing a new treatment

Some MS-specific Web-based and smart-phone

or switch until the patient has become educated

technologies are available, some of which include

about MS treatments. Discussions about switching

medication reminders. These include Track-

therapies should be initiated with an open mind to

MyShots and the Multiple Sclerosis Association of

the patient's reason for a switch, potential barriers

America's mobile phone app, "Multiple Sclerosis

to certain therapies, and what is practical from a

Self-Care Manager." Even a simple electronic

reimbursement standpoint.

alert programmed into a smartphone may be help-

References

ful to signal the time for taking a medication.

1. Reynolds MW, Stephen R, Seaman C, et al. Healthcare resource utilization following switch or discontinuation in multiple sclerosis patients on
disease modifying drugs. J Med Econ. 2010;13(1):90-98.
2. Schafer JA, Gunderson BW, Gleason PP. Price increases and new drugs
drive increased expenditures for multiple sclerosis. J Manag Care Pharm.
2010;16(9):713-717.
3. Salter AR, Marrie RA, Agashivala N, et al. Patient perspectives on switching disease-modifying therapies in the NARCOMS registry. Patient Prefer
Adherence. 2014;8:971-979.
4. Coyle PK. Switching therapies in multiple sclerosis. CNS Drugs. 2013;
27(4):239-247.
5. Jongen PJ, Hengstman G, Hupperts R, et al. Drug adherence and multidisciplinary care in patients with multiple sclerosis: protocol of a prospective, web-based, patient-centred, nation-wide, Dutch cohort study in glatiramer acetate treated patients (CAIR study). BMC Neurol. 2011;11:40.
6. Tremlett HL, Oger J. Interrupted therapy: stopping and switching of the
beta-interferons prescribed for MS. Neurology. 2003;61(4):551-554.
7. Rio J, Porcel J, Tellez N, et al. Factors related with treatment adherence
to interferon beta and glatiramer acetate therapy in multiple sclerosis.
Mult Scler. 2005;11(3):306-309.
8. Giovannoni G, Southam E, Waubant E. Systematic review of disease-modifying therapies to assess unmet needs in multiple sclerosis: tolerability
and adherence. Mult Scler. 2012;18(7):932-946.
9. Wong J, Gomes T, Mamdani M, et al. Adherence to multiple sclerosis
disease-modifying therapies in Ontario is low. Can J Neurol Sci. 2011;
38(3):429-433.
10. Heesen C, Kasper J, Kopke S, et al. Informed shared decision making
in multiple sclerosis--inevitable or impossible? J Neurol Sci. 2007;259(12):109-117.
11. Caon C, Saunders C, Smrtka J, et al. Injectable disease-modifying therapy
for relapsing-remitting multiple sclerosis: a review of adherence data. J
Neurosci Nurs. 2010;42(5 Suppl):S5-9.

However, one must bear in mind that these "novelty factor" of these technologies may wear off
over time for some patients.

Conclusion
Switching therapies is expected to become more
common with the introduction of more therapeu-

Table 5. Common Barriers to
Adherence in MS22,33
* Unrealistic expectations about the impact of therapy on MS
* Lack of belief in the benefits of therapy
* Fear of or intolerance to injection (with injectable agents)
* Adverse effects/tolerability problems
* Complacency, "treatment fatigue"
* Cognitive decline or declining motor skills
* Change in family or financial circumstances

Winter 2015

Counseling Points Multiple Sclerosis - Winter 2015

Table of Contents for the Digital Edition of Counseling Points Multiple Sclerosis - Winter 2015