Around half of all multiple sclerosis (MS) patients that are eligible for treatment do not receive it and one in five of those patients that do begin therapy, delay doing so because of fear and anxiety over the treatment process, and not fear and anxiety about the disease. These observations are according to Patricia Kennedy, a nurse practitioner and consultant at Can Do Multiple Sclerosis, formerly The Heuga Center for MS, US, who presented at the 2nd Vetter Drug Management Leadership Conference in Germany.

“If the injectable therapies that we have available today are good for MS, good for patients, and good for the future, why aren’t patients taking them?” questioned Kennedy. “It is important for industry to be aware of MS patients’ reasons for avoiding treatment and what they go through when facing the disease,” she added. She then urged delivery-device manufacturers to consider patient behavior and feelings when developing new devices in order to increase a patient’s chances of initiating therapy and complying with long-term treatment.

According to Kennedy, healthcare professionals face a number of challenges when dealing with MS patients, with those who are eligible for therapy opting out of treatment for a number of reasons, including: lack of belief that it is needed; fear of needles; the constant reminder of the disease each time they need to inject; lack of family support; and the financial burden of treatment.

“Even in those patients that do begin treatment, it’s another challenge to keep them on it,” admitted Kennedy. She also advised of the problems that US healthcare systems currently face with disposal of syringes and sharp objects; this is a particular problem in more populated regions in the US.

Education of patients and their support networks is incredibly important to help with patient compliance and disease management. However, Kennedy also provided advice to industry on how new device development might help MS patients to manage and control their disease since injection-related issues are still a primary cause for patient’s fear of starting therapy and is the main reason for lack of compliance.

What can industry do?
“The easier we can make it for a patient to administer treatment, the more likely it is that the medication is going to be used,” explained Kennedy. “In most cases, the smaller the needle, the better. Although a 29-gauge needle might be easier to use than a 30-gauge needle, and although both are small, the patient will opt for the slimmer 30-gauge every time. Psychologically, that’s what they want,” she added.

According to Kennedy, patients want titrated, prefilled syringes that are marked clearly. Not only does this avoid any issues of efficient mixing and incorrect dosing, but MS patients often have vision problems. Kennedy also emphasized the importance of travel devices, such as pens. “Patients want devices that are easy to travel with because we live in a mobile society, and if we provide the option of transporting less bulky injections devices whilst they’re away from home, patients are more likely to comply with their medication,” she advised.

In general, Kennedy also believes that injection devices could help patients immensely. “Most patients like injectors; even if the needle is a 30-gauge needle, patient’s don’t want to see it. So if you can hide the injector, then that’s good. It’s psychological,” she said. Injection devices not only help overcome the psychological barrier to injections, but they are also easier to use than syringes, which is especially beneficial for those patients that suffer from tremors. In addition, they help patients to obtain a consistent depth of injection and thus reduce the number of injection-related side effects.

“I also believe that needless devices would help improve patient compliance with drug therapy,” added Kenney.

The bottom-line for patients, according to Kennedy, is to provide them with delivery devices that are easy to use, offer choice and flexibility, with increased comfort.

“What patients really want, first of all, is control over their MS — easily-injectable systems can help with that. They want to be self-effective, they want a medication that’s easy to use because then they’re not reminded about their MS, and if they’re reminded less often then life goes on and they’re able to pursue other things.

“So in the future, I would urge industry to continue to make injectable devices that are more patient-friendly. We need to work together to decrease the number of non-users; let’s raise that 50% to 75%,” she insisted. “I doubt we’ll ever make 100%, but we can lessen the impact of MS on a person’s life by giving them maximum control and letting them get on with their life. If we treat people early with the medications, we already have available to us today, and treatment is consistent and easy to administer, it gives them hope for the future,” she concluded.