Adherence to Disease-Modifying Therapies at a Multiple Sclerosis Clinic: The Role of the Specialty Pharmacist

Background: Disease-modifying therapy (DMT) delays disease progression and improves quality of life for patients with multiple sclerosis (MS), but adherence to DMT is often suboptimal. Vanderbilt Specialty Pharmacy (VSP) embeds pharmacists within an outpatient MS clinic to provide medication management and address barriers to adherence. Objective: We evaluated rates and predictors of adherence to DMT among patients with MS at an integrated specialty pharmacy. Methods: We included patients with MS who filled ≥3 DMT prescriptions from VSP during the study period. Adherence was defined as medication possession ratio (MPR) or proportion of days covered (PDC) ≥0.8. Reasons for nonadherence were collected from pharmacy claims and electronic medical records. Results: The study included 653 patients. Average MPR and PDC were 0.93 and 0.94, respectively. Eighty-eight percent of patients achieved MPR ≥0.8; 89% achieved PDC ≥0.8. Using financial assistance and having $0 out-of-pocket cost were associated with higher odds of achieving MPR and PDC ≥0.8 ( P < .05). Of the 12% of patients who were nonadherent, most were unreachable for refills. Conclusions: Ensuring financial assistance and low out-of-pocket costs are associated with high adherence to DMT within an integrated specialty clinic, but more work is needed to address adherence in unreachable patients.

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Impact of specialty pharmacy taking ownership of the prior authorization process of multiple sclerosis specialty medications to increase access to infusible disease-modifying therapy (DMT)

Journal of Drug Assessment ◽

10.1080/21556660.2019.1658304 ◽

2019 ◽

Vol 8 (sup1) ◽

pp. 26-26

Author(s):

Miranda Whetstone ◽

Julie Kidd ◽

Jeffrey Reichard ◽

Lisa Blanchette ◽

Shelley Sigmon

Keyword(s):

Multiple Sclerosis ◽

Prior Authorization ◽

Disease Modifying Therapy ◽

Specialty Pharmacy ◽

Disease Modifying

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Progress in the Management of Paediatric-Onset Multiple Sclerosis

Children ◽

10.3390/children7110222 ◽

2020 ◽

Vol 7 (11) ◽

pp. 222

Author(s):

Aphra Luchesa Smith ◽

Christina Benetou ◽

Hayley Bullock ◽

Adam Kuczynski ◽

Sarah Rudebeck ◽

...

Keyword(s):

Quality Of Life ◽

Multiple Sclerosis ◽

Age At Onset ◽

Disease Modifying Therapy ◽

Quality Of Life Inventory ◽

Effective Care ◽

Disease Modifying ◽

Pre Treatment ◽

Management Approaches

Considerable progress has been made in the understanding and treatment of paediatric-onset multiple sclerosis (POMS); how this has translated into more effective care is less well understood. Here, we evaluate how recent advances have affected patient management and outcomes with a retrospective review of POMS patients managed at two paediatric neuroimmunology centres. Two cohorts, seen within a decade, were compared to investigate associations between management approaches and outcomes. Demographic, clinical and neurocognitive data were extracted from case notes and analysed. Of 51 patients, 24 were seen during the period 2007–2010 and 27 during the period 2015–2016. Median age at onset was 13.7 years; time from symptom onset to diagnosis was 9 months. Disease-modifying therapies were commenced in 19 earlier-cohort and 24 later-cohort patients. Median time from diagnosis to treatment was 9 months for earlier vs. 3.5 months in later patients (p = 0.013). A wider variety of treatments were used in the later cohort (four medications earlier vs. seven in the later and two clinical trials), with increased quality of life and neurocognitive monitoring (8% vs. 48% completed PedsQL quality of life inventory; 58% vs. 89% completed neurocognitive assessment). In both cohorts, patients were responsive to disease-modifying therapy (mean annualised relapse rate pre-treatment 2.7 vs. 1.7, mean post-treatment 0.74 vs. 0.37 in earlier vs. later cohorts). In conclusion, over the years, POMS patients were treated sooner with a wider variety of medications and monitored more comprehensively. However, this hugely uncontrolled cohort did not allow us to identify key determinants for the improvements observed.

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Induction or aggravation of other immune-mediated disorders by disease-modifying therapy in treatment of multiple sclerosis

Iranian Journal of Neurology ◽

10.18502/ijnl.v17i3.372 ◽

2019 ◽

Author(s):

Seyed Mohammad Baghbanian ◽

Mohammad Ali Sahraian

Keyword(s):

Multiple Sclerosis ◽

Interferon Beta ◽

Immunomodulatory Agents ◽

Disease Modifying Drugs ◽

Disease Modifying Therapy ◽

Immune Mediated ◽

Relapsing Remitting ◽

Disease Modifying ◽

Relapsing Remitting Multiple Sclerosis

Interferon beta (IFN-β) and glatiramer acetate (GA) are the primary therapeutic immunomodulatory agents that interfere with relapsing-remitting multiple sclerosis (RRMS), and the most commonly-used drugs as well. Induction or aggravation of other immune-mediated diseases has been reported following INF-β administration. We have reviewed the reported cases to notify the treating physicians about these rare adverse events. Although co-morbid autoimmune disorders have been reported in patients with MS, the pro-inflammatory role of disease-modifying drugs, especially INF-β, could affect and enhance this co-occurrence. Clinical or laboratory autoimmunity histories suggest the use of GA over INF-β as the treatment of choice.

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