Although there currently is no cure for multiple sclerosis, in recent decades, 20+ disease-modifying therapies (DMTs) have become available to patients, offering hope for slowed progression of this unpredictable, degenerative immune disease. While selecting therapy can be overwhelming based on the number of treatments available and the myriad of factors impacting the treatment decision, ensuring that patients adhere to the therapy prescribed is an important consideration.
Adherence, defined as “the extent to which a patient acts in accordance with the prescribed interval and dose of a dosing regimen,” is hard to quantify precisely among MS patients. However, it is estimated to be around 74 to 80 percent but is known to vary widely.
While treatment adherence is important for nearly all medical conditions, it is especially critical for MS patients. A lack of adherence to MS treatment regimens is associated with increased MS-related hospitalizations and relapse, in addition to increased morbidity, mortality and health care costs. A 2015 study showed that “almost 40 percent of patients had some disease activity return when they stopped taking their meds.”
Given the importance of DMTs in managing MS, it’s important to understand why some patients discontinue therapy or take a therapy holiday so that we can understand how to better support them.
Side effects. For injectable therapies, injection-related reactions are a common cause of missing or discontinuing therapy. Reactions can include skin reactions and pain after an injection, as well as difficulties administering the injection. Although not technically a side effect, the fear of needles and general anxiety around the injection can deter patients as well. For oral therapies, side effects related to gastrointestinal issues, such as diarrhea and gastrointestinal discomfort can also lead to non-adherence.
Symptoms. MS therapy works invisibly; rather than relieving symptoms that exists, it aims to prevent or reduce future damage. While on medication, patients may not feel any better than before or notice any visible changes. For this reason, patients might feel that the medication is not working or decide to discontinue therapy.
Comorbidities. Between 15 – 59 percent of people living with MS have one or more comorbidity, or additional medical conditions. In addition to reaching out to third-party payers, health care providers who are prescribing DMTs must coordinate with a range of specialty providers to ensure that their patient’s conditions are managed concurrently in a way that minimizes risk for relapse, which can add to the time involved in securing a prescription. Additionally, people living with MS experience high rates of depression, a condition which has been shown to have a significant negative impact on medication adherence.
Cost. Having MS is expensive. The latest data from the National Multiple Sclerosis Society determined that the cost to the US economy was $63.3 billion in direct medical costs such as prescription drugs. Although treatment expenditures may be covered in part by insurance, MS patients still bear a significant portion of the burden, and the out-of-pocket obligation for people living with MS is only growing.
Payer requirements. In addition to costs, payers may also require specific steps or authorizations for coverage of the therapy selected by the patient and his or her health care provider. Step therapy protocols often require patients to fail certain therapies before receiving coverage for a more expensive or higher-step therapy and can be discouraging for patients in terms of adherence.
We at Octave understand challenges that patients face, why it can be hard to follow through with treatment – and that following through is absolutely critical to improving outcomes.
Our Clinical Insights Program is designed to stay connected with MS patients between visits so that we can provide them all the support they need to achieve their best outcomes. We monitor how they’re doing with taking and tolerating their medication, any symptoms or side effects they might experience, how they participate in day-to-day activities and whether they have infections and relapses. We reach out when we see concerning issues, as well as conducting proactive check-ins to follow up, guide or offer resources. At the same time, we keep the patient’s doctor apprised of key information and connect them between appointments when necessary.
We understand the MS ecosystem and deliver a new standard for managing multiple sclerosis with our precision care solution, enabling an optimal care journey in tune with every person.
