Oral Medications Don't Improve Dose Adherence in Multiple Sclerosis

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Oral Medications Don't Improve Dose Adherence in Multiple Sclerosis
Oral Medications Don't Improve Dose Adherence in Multiple Sclerosis

INDIANAPOLIS — The introduction of oral disease-modifying treatments (DMT) for multiple sclerosis (MS) does not have the effect on treatment adherence that many hoped, despite easier administration, but a boost from technology may help MS patients better adhere to their treatment plans.

The results, from two unrelated studies, were presented in a poster session at the Consortium of Multiple Sclerosis Centers 2015 Annual Meeting.

In a comparison with patients taking injectable drugs, 45% of patients on oral drugs reported missing doses, while only 29% of those taking injectables missed doses.

Caitlin Dionne, RN, of Lahey Outpatient Center in Massachusetts, and colleagues developed the MS Treatment Adherence Questionnaire in order to draw more honest answers about treatment compliance out of MS patients, noting that patient response to direct physician inquiry is often questionable.

The questionnaire includes six questions related to DMT use: number of missed doses in four weeks; reason dose was missed; perceived side effects; ease of administration; and medication satisfaction. In the study, medication types were divided into subcutaneous or intramuscular (SC/IM), monthly IV injections, or oral DMTs.

Between October and November 2014, Dionne and colleagues collected data from 209 patients (75.1% female, 24.9% male; mean age = 50.4 yrs). 

Eighty-nine patients (42.5%) were on oral medication, 90 (43%) on SC/IM, and 30 (14.5%) on IV infusion. Among patients on oral DMTs, 45% reported no missed doses, compared with 70.8% of SC/IM and 93.3% of IV infusion patients (P=0.005). Ease of taking the medication did not seem to affect treatment compliance, as 77%, 60%, and 33% of patients on oral, IV, and SC/IM injections reported ease of use, respectively. Among patients taking oral and SC/IM injections, forgetfulness was among the top reasons for missing a dose. As for how side effects may affect compliance, the majority of patients on IV infusion did not experience adverse events, while 18.6% of orals and 20.2% of SC/IM patients reported them.

The authors speculated that adverse event profiles related to oral DMTs may be at the center of the reason for the poor compliance rates among oral users, despite oral DMTs' association with ease of use.

In another study, researchers from Washington, D.C.'s Veterans Affairs Medical Center evaluated the effects of using a telehealth program on DMT compliance. The preliminary study, which followed 30 patients for six months, compared compliance rates with use of a MS-specific home automated telehealth system (MS HAT) to treatment as usual.

Patients — all who used SC/IM injections — who were assigned to the MS HAT group received text or email reminders to administer their medication through the system, which supports patient self-management, patient-provider communication, and patient education.

Although the MS HAT administration reminders was negatively correlated with syringe counts, the authors noted that as self-report adherence improved, the number of syringes collected increased. Overall, the results suggest that monitoring self-reported adherence through an automated teleheath system is a reliable method of assessing DMT adherence. 

References

  1. Dionne CA et al. Do Oral Disease Modifying Agents (DMTs) Improve Adherence to MS Treatment? a Comparison of Oral and Injectable Drugs. Presented at: Consortium of Multiple Sclerosis Centers Annual Meeting 2015; May 27-30, 2015; Indianapolis, IN.
  2. Settle JR et al. Promoting Multiple Sclerosis Medication Adherence through Telehealth. Presented at: Consortium of Multiple Sclerosis Centers Annual Meeting 2015; May 27-30, 2015; Indianapolis, IN.
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