Recognizing nonadherence in patients with multiple sclerosis and maintaining treatment adherence in the long term

Abstract

Context: Patients with multiple sclerosis (MS) face many challenges. One significant challenge is long-term adherence to disease-modifying therapy (DMT). Four of the 6 currently available DMTs involve self-injection, and all cause adverse events of varying degrees of severity. Although effective, the benefit of DMTs is difficult to determine on an immediate basis. Healthcare providers must play a major role in recognizing nonadherence and identifying strategies to promote adherence.

Evidence acquisition: We conducted a literature search of the MEDLINE database using the search terms "adherence" and "multiple sclerosis" to gather data from relevant studies investigating adherence among patients with MS.

Evidence synthesis: Barriers to maintaining treatment adherence in patients with MS include forgetting the medication, injection anxiety, perceived lack of efficacy, coping with adverse events, and issues with complacency and treatment fatigue. An open and honest healthcare provider-patient relationship is a core element in maintaining motivation and adherence in patients with MS. In addition, continuous education and consistent reinforcement of the value of treatment are essential strategies in the maintenance of treatment adherence. Other strategies to promote adherence include management of treatment expectations and minimization of adverse events.

Conclusions: The chronic nature of MS makes treatment adherence challenging in patients with long-standing disease. Patients and healthcare providers need to work together to establish open lines of communication and a trust-based therapeutic relationship to ensure that patients have the knowledge and skills they need to adhere to long-term MS therapy.

Figure 1

Number and percentage of patients with MS discontinuing interferon beta or glatiramer acetate treatment each year over 8 years follow-up (n = 107). Reproduced from Rio J, Porcel J, Téllez N, et al. Factors related with treatment adherence to interferon beta and glatiramer acetate therapy in multiple sclerosis. Mult Scler. 2005;11:306–309, by permission of Sage Publications Ltd.

Figure 2

Reasons for interrupted interferon therapy.

Figure 3

Interactions between patients, physicians, and healthcare system that can contribute to nonadherence. Reproduced from Osterberg L and Blaschke T. Adherence to medication. N Engl J Med. 2005;353:487–497, by permission of Massachusetts Medical Society. All rights reserved.