The Academy of Managed Care Pharmacy's 24th Annual Meeting and Showcase: Management of MS medications to improve adherence rates

While nonadherence to medications is problematic for many chronic diseases, multiple sclerosis (MS) appears near the top of the list, following diabetes and depression. Daniel S. Bandari, MD, medical director and founder, Multiple Sclerosis Center for Southern California and Research Group, led a recent panel discussion at the Academy of the Managed Care Pharmacy's 24th Annual Meeting, in San Francisco, on "Analyzing and Applying the Evidence to Improve Cost/Benefit and Risk/Benefit Outcomes for Multiple Sclerosis."

With a plethora of barriers to compliance and adherence-cognitive and financial issues, absence of symptoms, and perceived lack of efficacy-it was easy to see why there is so much resistance to drugs for MS.

In a 2011 survey reported in Patient Preference and Adherence, Dr Bandari cited that 31% of overall respondents using disease-modifying therapy (DMT) reported taking a deliberate break from treatment for 1 day or longer, and 19% said they stopped taking their medication completely. Side effects from treatment ranked as the number 1 reason. In another report in 2011, missed doses in general were attributed primarily to forgetfulness, he said.

Unfortunately, nonadherence to DMT has a large impact on resource utilization and costs, generating more hospitalizations, emergency department visits, and MS relapses.

Dr Bandari suggested a number of solutions to manage tolerability of MS medications often due to flu-like symptoms:

He also pointed out adopting proper injection techniques, such as use of electronic autoinjectors-ideal for patients with needle phobias, meticulous site rotation, and use of room-temperature solutions, and warm compresses before and after injection.

Currently, nearly 3,000 patients are enrolled in the Therapy Optimization in Multiple Sclerosis (TOP MS) study. As the largest prospective phase 4 study for the disease, it is analyzing an MS population receiving both treatment and medication therapy management via specialty pharmacies. Results are expected late 2012.