Medication Compliance

Recently, an article published in the May 2011 edition of The Canadian Journal of Neurological Sciences caught my eye. The article, “Adherence to Multiple Sclerosis Disease-Modifying Therapies in Ontario is Low,” examined the pattern of use of the oldest and most well-established disease-modifying medications in MS, which include:

• intramuscular interferon beta-1a (i.m. IFNB-1a, Avonex)
• subcutaneous interferon beta-1a (s.c. IFNB-1a, Rebif)
• subcutaneous interferon beta-1b (IFNB-1b, Betaseron)
• glatiramer acetate (Copaxone)

This study surveyed nearly 700 patients who had been started on one of these medications between 2006 —2008. It found that after two years, only 44 percent of patients reported being adherent with the medication on a continual basis. There was no difference in adherence rate between any of the four medications.

There are several reasons why this might be the case. The first and most obvious reason is that patients don’t like taking these medications. They all cause side effects, which do not pose a serious health risk to patients but can be quite burdensome. For them, the cure might be worse than the disease.

Secondly, many patients probably stop taking their medications because they feel well and see no reason to take a medication.  Finally, other patients may stop taking these medications because they are having relapses and conclude that the medications are not working for them. Of course, many patients with MS who feel well might feel that way because of the medications.  Similarly, patients who have relapses while on the medications might have had more had they not been on any medications.

Regardless of the reason why patients stop taking their medications, these numbers are quite sobering for any doctor who treats patients with MS. I certainly know a large number of my patients who cannot tolerate the injectable medications. But I was surprised that 56 percent of patients stopped taking them! I hope that any patient who stopped his medication would be honest with his doctor about it, but I am sure many are embarrassed and are worried about the lecture they might receive.

I cannot emphasize enough how important it is for patients to be honest with their doctors when they are having trouble with their medications. Often a solution can be found. 

Sometimes this means taking anti-inflammatory medications such as Tylenol or Naproxen with the injection. Sometimes this means not taking the full dose of the medication. Other times, changing from an interferon to Copaxone or vice versa can be useful. Other patients may need to abandon the injectable medications and switch to either Tysabri or Gilenya. 

For most patients, I am convinced that a satisfactory medication can be found to treat their MS. And for most patients, I am convinced, their lives will be better off in the long run if they take their medications than if they don’t.