Taking Patient Preferences into Account
Patients’ perceptions and experiences of a range of medication-related factors have a profound impact on adherence. These include medication efficacy, medication adverse events, dosing frequency, and dosing complexity.13 Improved administration of these treatments (eg, reducing dosing frequency) may reduce patient burden and improve adherence.13 A recent study found that increasing the time until disability progression and reducing flu-like symptoms associated with injections were “key drivers” of patient preference.13 Reducing DMT injection frequency was equally important to patients as improvement in efficacy or adverse events related to injections. In particular, a once- or twice-monthly injection schedule was preferred over injections administered daily or three times weekly.13 Reducing the number of relapses was less important to participants than delaying disability progression, so it is important for clinicians to explain that early initiation of treatment and reducing relapses contribute to reduced disability.13
Recently approved oral drugs (ie, dimethyl fumarate, fingolimod, and teriflunomide) have been shown to improve adherence because patients prefer the more convenient route of administration.14 For this reason, starting with an oral first-line agent might be preferable.15 Dimethyl fumarate or teriflunomide are recommended as first-line agents for de novo relapsing-remitting MS.15
Addressing Adverse Events
Adverse events represent one of the most common barriers to adherence.10 Flu-like symptoms and injection-site reactions are particularly common concerns.13 Appropriate injection techniques, lifestyle adjustments, and pharmacologic and nonpharmacologic strategies play an important role in mitigating adverse events and thereby improving adherence.10
Additional interventions to improve adherence can be found in Table 3.