Addressing Medication Adherence is Crucial in Multiple Sclerosis

In an interview with Pharmacy Times, Megan Scheider, PharmD, discussed pharmacists’ role in addressing medication adherence for patients with multiple sclerosis (MS). Understanding patients’ specific experiences and challenges is crucial to helping them improve medication adherence.

Q: How can pharmacists help patients manage complex medication regimens, particularly given the importance of adherence?

Megan Schneider, PharmD: So, I think one of the most important things for our patients with MS is really trying to help them understand what different types of therapies are used for. I think oftentimes patients can get confused or not really understand why they're taking a disease modifying therapy long term, so explaining to them that we have 3 different categories as far as how to treat patients. So, you know, when the patient has a relapse, we're treating them with steroids, but for long term management we really have to keep them on a disease modifying treatment to try to prevent future relapses. And then also, patients are often going to be on symptomatic treatment to manage any type of symptoms, and that is not going to directly impact the disease. So, it's important for patients to know the different reasons for being on therapy so they have more of a well-rounded picture about why they're on certain things. And then I also think it's really important for patients, if they do have complex regimens, to really look at their regimen to see if all those treatments are necessary. Maybe there are some symptomatic medications that are not working for them, and nobody has asked that question, so I think asking that question and trying to simplify regimens when you can is really important.

Q: In your experience, what are some common medication adherence challenges faced by patients with MS and how can pharmacists help address them?

Megan Schneider, PharmD: So, I think there's a lot of different adherence issues that we have to deal with and trying to understand where patients coming from is going to be the most important. Oftentimes, you know, patients might be just overwhelmed in general about the therapy and talking to them at the beginning to find out what's going to work best for their lifestyle [is important]. So, you might have a patient at the beginning who says, “There's no way I can remember to take a medication twice daily.” And I think that's really important to know ahead of time, so you set that patient up for success and not failure. Oftentimes patients just have difficulty remembering medications, so recommending, you know, calendar reminders or reminders in their phone, pairing it with certain activities like meals can be really beneficial for our patients as far as like maintaining the routine.

Also, too, cost can be impactful for adherence. So, I think making sure that the medications are cost effective for our patients is really important. Helping them apply for any type of copay assistance ahead of time is really beneficial and, again, helps set our patients up for success and not failure when it comes to adherence. Also, too, sometimes patients are having side effects, and that might be impacting their adherence. So, you know, just again, really asking the patient what's going on and trying to understand where they're coming from, and then if it is related to side effects, you can provide mitigating strategies to try to minimize those so that they feel more comfortable taking the medication.

Q: How can pharmacists tailor their approaches for medication management based on the specific form of MS a patient has?

Megan Schneider, PharmD: So, I will say, really, the only thing I can think of when it comes to that is that for patients who have more progressive forms of MS there really are limited disease modifying treatments for them. We really only have one medication approved for primary progressive MS, which is ocrelizumab (Ocrevus; Genentech). So, when it comes to symptom management, that's going to be our focus oftentimes for patients with primary progressive or even non-active secondary progressive MS. But at the same time, our patients with relapsing MS may also have different symptoms like bladder dysfunction or gait issues that we do need to treat symptomatically, as well. So, I think either way, you are going to be treating the patients mostly the same, just with a little bit of difference around the disease modifying therapies they’re on.