Review: Optimizing Adherence to Multiple Sclerosis Therapies

Abstract

Disease-modifying drugs (DMDs) have transformed the treatment of relapsing-remitting multiple sclerosis (RRMS). Several studies have shown the benefits of long-term treatment in RRMS; however, all multiple sclerosis (MS) therapies are associated with treatment-related tolerability and safety issues that may challenge patient compliance with therapy. Tolerability issues include flulike symptoms and injection-site reactions for interferon β(IFNβ) and lipoatrophy and systemic postinjection reactions for glatiramer acetate (GA). Altered blood cell counts, depression, and elevated liver enzymes, including rare cases of acute liver injury, are safety issues that have been associated with IFNβand, rarely, systemic anaphylactoid reactions with glatiramer acetate. Common tolerability issues associated with natalizumab are hypersensitivity and postinfusion reactions, and mitoxantrone may cause amenorrhea, nausea, and alopecia. Serious safety issues that have limited the use of natalizumab and mitoxantrone as first-line treatments are progressive multifocal leukoencephalopathy for natalizumab and cardiotoxicity and leukemia for mitoxantrone. Although both tolerability and safety issues can affect patient adherence to therapy, numerous strategies are available to manage tolerability and monitor safety issues. Through careful monitoring of treatment-related safety issues, patient education, and tolerability management strategies, treatment nonadherence can be minimized, thereby maximizing the treatment benefits of DMDs.

Patient adherence to and tolerability of self-administered interferon β-1a using an electronic autoinjection device: a multicentre, open-label, phase IV study

“…ISRs are more commonly associated with sc rather than im injections [8]. As 63% of patients in this study switched from im to sc injections, an increase in ISRs in either this subset of patients or the total patient population would not be unexpected.…”

Practice guideline recommendations summary: Disease-modifying therapies for adults with multiple sclerosis

“…The result of poor adherence is reduced effectiveness and increased health care costs. [20][21][22][23][24][25] Regular interactions and assessments by clinicians facilitate prompt identification and treatment of AEs, increased tolerability of the medication, and safety monitoring. 7,25 Some DMTs for MS have specific risk evaluation and mitigation strategies (REMS) with recommendations for follow-up frequency.…”

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

“…Hydration is also important for many aspects of normal cognitive and physical functioning. 30 Patients should be counseled on the importance of maintaining adequate fluid intake, as well as on the signs of dehydration, such as dry skin, headache, fatigue, irritability, confusion, and reduced urine output. As patients with MS experience urinary bladder symptoms including incontinence, urine leakage, and hesitancy, they may restrict their fluid intake to limit these bladder-related issues.…”

“…29 Based on clinical reports, [29][30][31] the panel recommended that IFNβ injections, in general, be administered in the evening to mitigate FLS. Patients are encouraged to determine when their symptoms peak and administer the injection at the appropriate interval prior to bedtime, thus allowing the worst of the side effects to occur during sleep and to fully resolve prior to waking.…”

“…[20][21][22][23] Flu-like symptoms have been reported in 59% to 88% of patients during the initial dosing period using prefilled syringe preparation 22,32 and in 49% to 57% of patients receiving reconstituted formulations. [20][21][22][23]30,32 In their clinical practice, members of the panel noted that a substantial number of their patients who were switched from lyophilized preparations to prefilled syringes experienced more FLS with…”