EvergreenHealth MS Center
The phrase “blood, sweat and tears” might bring back memories of the 1960’s jazz-rock band by the same name, or perhaps the famous speech of Sir Winston Churchill when he used those words in warning the British people of the hardships to come in fighting WWII. The term actually has Biblical origins and means to do “hard work and effort in difficult circumstances”. We’ve come a long way in MS therapy, now with ten FDA approved drugs. People who work in the MS healthcare field can say with confidence that the MS drugs can truly make a difference in how well a person with MS does over the long term. However, no drug works unless it is taken, and that requires commitment, motivation and sometimes blood, sweat and tears.
There are basically three reasons to take one of the MS drugs if it is prescribed by a doctor or nurse practitioner:
Drugs don’t work if you don’t take them. This brings us to the term adherence, which is defined as the percentage of doses taken as prescribed, over a set time period. For MS injectable drugs, adherence rates ranging from 41% to 88% have been reported. One study reported that an 85% adherence threshold maximized a patient’s benefits from interferon-beta therapy. Below that, people did not get as much benefit. For research purposes, we typically say that 80% is the cut-off for adherence. At a lower level, a person is categorized as “non-adherent” and not getting the full treatment. Non-adherence has been associated with higher rates of relapse and hospitalization in MS.
Several studies have found that forgetting to administer the drug is the most common reason for non-adherence. The second most common reason for non-adherence is typically injection-related pain, fatigue or anxiety with the injectable drugs and side-effects with the oral drugs. Other barriers to adherence include denial of illness, disruption of lifestyle/inconvenience, cost of treatment or insurance hurdles, unrealistic expectations about what the drug will do, physical limitations to administration, cognitive impairment, depression, loss of confidence in the drug, and simply being tired of therapy, a.k.a. treatment fatigue.
Here is what you can do to help yourself to stay on therapy.
Here are a few practical tips to help adherence to your medication:
For oral drugs, tips for adherence include establishing a routine time of day for taking a medication, using a mediset or pillbox to keep the drugs sorted out, and jotting down the reasons why you may miss doses to identify a pattern and help find a solution. The three FDA-approved oral drugs are not supposed to be kept in the refrigerator - room temperature is good. They may be taken with food and food may reduce some of the side effects. Whatever drug you are on, ask your healthcare team for specific recommendations about how to take your treatment.
To summarize the key points of this article, there is good evidence supporting all approved drugs. Adherence is important and staying motivated really helps to keep you on track. Winston Churchill fought the war with tenacity. Apply that approach to treating MS. Remember that the biggest problem is FORGETTING to take the drug. Take steps to make it easier to remember. Get help if you are having problems with your drug or not taking it. Discuss it with your nurse or doctor.