Multiple sclerosis (MS) is a disease characterised by recurrent attacks on the brain and spinal cord. In many countries, relapsing MS is treated with disease modifying therapies (DMTs) which suppress the relapses and prevent the lesions that occur in the brain and spinal cord. These medications are most beneficial when people take them regularly as recommended. This is known as adherence.
The reasons people stop taking their medications or do not take them as recommended are varied. They can include concerns about how effective the medication is, dislike of the side effects, inconvenience of the treatment, needle phobia and forgetting. In some countries, the cost associated with a medication can also be a factor.
A recent study from Canada, published in the journal Multiple Sclerosis and Related Disorders, has investigated the effect of not taking your medication as recommended and found that it can have an impact not only on the management of MS-related health, but also on a person’s general health.
The researchers studied 2864 people from Alberta, Canada who were taking a range of oral (fingolimod, teriflunomide and dimethyl fumarate), injectable (interferon-beta, glatiramer acetate), and infusion (natalizumab) medications, between 2002 and 2014.
They found that people with MS that adhered to treatment regimens were 20% less likely to see a doctor (GP or specialist). Specifically, they were 30% less likely to see their GP for MS related reasons, and 18% less likely to see their GP for any reason. The adherent people were 10% less likely to see a specialist (such as a neurologist) for MS related reasons, and 20% less likely to see a specialist for any reason. They were also 50% less likely to require hospitalisation for any reason than those that were not taking their medication as recommended.
Generally, most people (about 66%) were taking their medications as directed. Those that were non-adherent were more likely to be younger (<35 years), depressed and/or suffering from bi-polar disorders. The older ages groups (>35 years), women, and those taking an injectable, were more likely to stop taking their medications all together.
During the study, the researchers also noted that many people on an injectable or infusion medication switched to an oral medication. Those taking an oral medication did not switch, and once a person switched to an oral medication they much less likely to switch again. Of interest, is that when people changed medications, they were often slightly more adherent.
In a similar, smaller, study from the USA, published in The Journal of the American Osteopathic Association, researchers found that people who took their MS medications as directed were less likely to have depression and had less disability than those not taking their medications as recommended.
These studies show that there is better management of both MS and non-MS related health issues when people with MS are taking their MS medications as directed. In practice, this research can also help doctors and people with MS to understand the importance of adherence and identify individuals who may be at risk of not taking their medications as directed. Understanding these reasons can help doctors and patients to tailor treatment decisions so that not only the most effective medication is chosen, but also the one that the individual is going to find easiest to stick with.