OVERVIEW
With an average age at onset of approximately 30 years and a typical course that is characterized by gradually progressing irreversible disability, multiple sclerosis (MS) presents many significant treatment challenges.1 Among the most important of these challenges is helping patients to remain adherent to their long-term medication treatment with disease-modifying therapies (DMTs). Agents such as interferon ß, glatiramer acetate, and natalizumab play an important role in therapy by providing immunomodulating effects. These effects significantly reduce the frequency of MS exacerbations, and may also slow the gradual accumulation of long-term disability.2,3 Despite the benefits of DMT, adherence to treatment is an issue for many patients. A recent study, that examined adherence to interferon ß-1a (intramuscular and subcutaneous formulations) or glatiramer acetate among patients with healthcare insurance in the United States, showed a decrease in adherence of approximately 50% after only 1 year. The study also showed a low overall adherence to all of the first-line DMTs.4 Medication possession ratios, which represent the number of days of medication supply divided by the number of days in the year, were approximately 0.7 to 0.8 for the various DMTs during the first year after beginning therapy. This suggests that even patients with health insurance frequently do not administer their medication as prescribed. The obstacles that patients with MS face in adhering to their long-term treatments include the need for regular self-injection, adverse effects of treatment, insurance or other economic barriers, cognitive impairment, and depression.5
Helping patients to remain adherent to long-term therapy has increasingly been recognized as an important goal of therapy for patients with MS. A large body of research from other chronic diseases has clearly demonstrated the importance of specific factors that would improve long-term adherence to care. These factors include patient education, the patient-provider relationship, overcoming economic barriers, and medication therapy management.6 Other studies also have shown that improving adherence in patients with chronic conditions such as elevated cholesterol, type 2 diabetes, hypertension, and depression reduces overall treatment costs. These costs are reduced due to better management of complications, which decreases the need for hospitalization.7,8 Clinical researchers have just begun to examine methods that might be that adapted to the treatment of MS in order to improve adherence to treatment and therefore reduce some MS-related treatment costs.9
This University of Tennessee Advanced Studies in Pharmacy journal club module provides managed care pharmacists with brief, focused reviews of recent publications and ECTRIMS 2010 annual meeting abstracts that have examined barriers to adherence and strategies to help patients with MS obtain the greatest benefit from their treatment. The studies selected for this journal club describe how the roles of certain factors, which include disease therapy management and other programs to improve DMT adherence, the role of insurance type, out-of-pocket payments, and depression, affect patients’ adherence. These brief reviews will provide an overview of new data about the long-term management of patients with MS.
References
1. Vukusic S, Confavreux C. Natural history of multiple sclerosis: risk factors and prognostic indicators. Curr Opin Neurol. 2007;20:269-274.
2. Johnson KP, Due DL. Benefits of glatiramer acetate in the treatment of relapsing-remitting multiple sclerosis. Expert Rev Pharmacoecon Outcomes Res. 2009;9:205-214.
3. Metz LM, Patten SB, Archibald CJ, et al. The effect of immunomodulatory treatment on multiple sclerosis fatigue. J Neurol Neurosurg Psychiatry. 2004;75:1045-1047.
4. Kleinman NL, Beren IA, Rajagopalan K, Brook RA. Medication adherence with disease modifying treatments for multiple sclerosis among US employees. J Med Econ. 2010;13:633-640. [Epub ahead of print]
5. Patti F. Optimizing the benefit of multiple sclerosis therapy: the importance of treatment adherence. Patient Prefer Adherence. 2010;4:1-9.
6. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353:487-497.
7. Sokol MC, McGuigan KA, Verbrugge RR, Epstein RS. Impact of medication adherence on hospitalization risk and healthcare cost. Med Care. 2005;43:521-530.
8. Katon W, Cantrell CR, Sokol MC, et al. Impact of antidepressant drug adherence on comorbid medication use and resource utilization. Arch Intern Med. 2005;165:2497-2503.
9. Tan H, Yu J, Tabby D, Devries A, Singer J. Clinical and economic impact of a specialty care management program among patients with multiple sclerosis: a cohort study. Mult Scler. 2010;16:956-963.
GOAL
To provide managed care pharmacists with up-to-date information on treatment adherence and medication therapy management for patients with MS.
INTENDED AUDIENCE
This activity is designed for managed care pharmacists. No prerequisites required.
LEARNING OBJECTIVE
The University of Tennessee College of Pharmacy takes responsibility for the content, quality, and scientific integrity of this CPE activity. Upon the conclusion of this activity, the participant should be able to:
- FORMULATE strategies to promote patient adherence and optimize the utilization of MS therapies.
CPE INFORMATION
Accreditation Statement
The University of Tennessee College of Pharmacy is accredited by the Accreditation Council for Pharmacy Education to provide continuing education for pharmacists.
Credit Designation Statement
The University of Tennessee College of Pharmacy is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. Successful completion of this knowledge-based educational activity will provide 1.5 contact hours credit (0.15 CEUs). A statement of CPE credit will be available online immediately following successful completion of the activity. Successful completion includes participating in the activity, completing a self-assessment instrument with a score of at least 70%, and completing an evaluation instrument. If you score less than 70% on the self-assessment instrument, you will be allowed to complete the examination one additional time. ACPE Program #0064-0000-10-223-H04-P.
The estimated time to complete this activity: 1.5 hours.
Release date: December 31, 2010. Expiration date: December 31, 2011.
Fee: There is no fee for this educational activity.
STEERING COMMITTEE
Full Disclosure Policy Affecting CME Activities
As an accredited provider by the Accreditation Council for Pharmacy Education (ACPE), it is the policy of The University of Tennessee College of Pharmacy to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or a sponsor has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. The Steering Committee reported the following:
Jacci Bainbridge, PharmD (Chair)
Associate Professor
Department of Clinical Pharmacy
University of Colorado at Denver
Health Sciences Center
Denver, Colorado
Dr Bainbridge reports receiving grants/research support from the National Institutes of Health; and serving on advisory boards for Bayer and TEVA Pharmaceuticals.
Melody Ryan, PharmD, MPH, BCPS, CGP
Associate Professor
Department of Pharmacy Practice and Science
University of Kentucky College of Pharmacy
Department of Neurology
University of Kentucky College of Medicine
Lexington, Kentucky
Dr Ryan reports having no significant financial or advisory relationships with corporate organizations related to this activity.
Sheldon J. Rich, RPh, PhD
President – SJR Associates, LLC
Clinical Assistant Professor – University of Michigan
Adjunct Assistant Professor – Wayne State University
Palm Beach Gardens, Florida
Dr Rich reports serving as a consultant for Serono and TEVA Neuroscience.
Off-Label Product Discussion
In accordance with ACPE Criteria for Quality, the audience is advised that authors in this CPE activity may include reference(s) to unlabeled, unapproved, or investigational uses of therapeutic agents or biomedical devices. The authors will inform the reader of when they discuss or reference an unapproved, unlabeled, or investigational use of therapeutic agent or biomedical device.
DISCLAIMER
The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of The University of Tennessee College of Pharmacy name implies review of educational format, design, and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse effects, before administering pharmacologic therapy to patients.
GRIEVANCE POLICY
A participant, sponsor, faculty member, or other individual wanting to file a grievance with respect to any aspect of an educational activity sponsored or cosponsored by The University of Tennessee College of Pharmacy may contact the Associate Dean for Continuing Education in writing. The grievance will be reviewed and a response will be returned within 45 days of receiving the written statement. If not satisfied, an appeal to the Dean of the College of Pharmacy can be made for a second level review.
JOURNAL CLUBS
Please complete the pre-test, read the following journal clubs, and complete the post-test and evaluation to receive CPE credit for this activity.
Pre-Test
Stockl KM, Shin JS, Gong S, et al. Improving patient self-management of multiple sclerosis through a disease therapy management program. Am J Manag Care. 2010;16:139-144.
Tan H, Yu J, Tabby D, et al. Clinical and economic impact of a specialty care management program among patients with multiple sclerosis: a cohort study. Mult Scler. 2010;16:956-963.
Dor A, Lage MJ, Tarrants ML, Castelli-Haley J. Cost sharing, benefit design, and adherence: the case of multiple sclerosis. Adv Health Econ Health Serv Res. 2010;22:175-193.
European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) 2010 Annual Meeting Summaries
- Association between Depression and Compliance in Multiple Sclerosis
- Natalizumab Dosing Suspension: Are We Helping or Hurting?
- Reasons for Non-adherence to Long-term Medication in Patients Suffering From Multiple Sclerosis
Post-Test
