Armada Summit CE Session: The Importance of Adherence for Multiple Sclerosis Patients

Role of specialty pharmacies in treatment of multiple sclerosis discussed during annual Armada summit.

Specialty pharmacies need to take an active role in the treatment of multiple sclerosis (MS) patients due to the effect of the disease on cognitive abilities, according to Mitra Habibi, PharmD, a clinical pharmacist at the University of Illinois Hospital and Health Sciences System.

Dr. Habibi presented a continuing education session on managing treatment and adherence in MS patients on May 6, 2014, at the annual Armada Health Care Specialty Pharmacy Summit and Expo in Las Vegas. The program was sponsored by the Pharmacy Times Office of Continuing Professional Education and the Specialty Pharmacy Association of America, and is supported by educational grants from Questcor Pharmaceuticals, Inc, and Teva Pharmaceuticals.

During the session, Dr. Habibi reviewed therapeutic strategies for slowing disease progression, common side effects and mitigation strategies associated with therapies for MS, and how to identify and educate patients about relapse.

“When someone is diagnosed with MS we have a very long talk with them, tell them all of the available medications and the frequency of hospitalization,” Dr. Habibi told the audience. “We want the patients to have reliable, or the right expectations. We tell them that even if they start medication today, these medications are not going to decrease what has happened already.”

A chronic, progressive, and immune-mediated neurological disorder, MS affects 400,000 patients in the United States and is typically diagnosed in individuals between the ages of 20 and 50 years. While there are no direct associations known, bacterial or viral infections may be important factors, according to Dr. Habibi.

“In a patient with 1 or multiple risk factors, something gets triggered and the patient’s own immune system gets activated, and basically what it does is it goes after the myelin sheaths,” she said.

MS has 4 classifications: relapsing-remitting MS (the most common), secondary progressive MS, primary progressive MS, and progressive/relapsing MS. The disease can cause problems with cognition, motor skill problems, mood disorders, bladder and bowel symptoms, and fatigue.

These conditions make detailed communication with patients vital to adherence.

Dr. Habibi related an anecdote involving an MS patient she was advising who had just received their medication. She told the patient to take the drug twice daily, but following a few more instructions the patient had already forgotten how many times they were supposed to take their medication each day.

“If you speak with these patients over the phone you have to keep in mind that they need more attention, with remembering and focusing on the material as the disease progresses and becomes worse and worse,” Dr. Habibi said. “It affects their independence, their employment, their mood, and their quality-of-life.”

Holding down a job is a particular issue for MS patients, with 81% of patients employed at the onset of the disease compared with only 54% who are still employed by year 7. Dr. Habibi noted that 72.7% of those unemployed at year 7 were cognitively impaired at baseline.

Common drug therapies include interferon β-1a (Avonex, Rebif); interferon β-1b (Betaseron, Extavia); glatiramer acetate (Copaxone); natalizumab (Tysabri); mitoxantrone (Novantrone); fingolimod (Gilenya); teriflunomide (Aubagio); and dimethyl fumarate (Tecfidera).

These therapies carry a number of adverse side effects, particularly interferons, which can cause flu-like symptoms. Due to the combined impact of cognitive problems and adverse events from medications, Dr. Habibi stressed the importance of strong communication with the patient throughout the process.

“Patient compliance is very important,” she said. “Patients will be more likely to adhere to the medications if you get them involved in the decision-making part of it. So we let the patient decide the first medication they’re going to start.”

Click here for more information on CE sessions offered by the Pharmacy Times Office of Continuing Professional Education for specialty pharmacy.