In Multiple Sclerosis, Fewer Injections Are Better
05 May 2002
Sir William Osler, one of Canada’s great physicians, counselled, “The way to longevity is to develop a chronic disease early in life and learn to live with it.” But this is easier said than done especially if fate hands you Multiple Sclerosis (MS). Fortunately, medicine is available to slow down the progression of this difficult disease. So why do many patients fail to follow their doctor’s advice when it ‘s so important to do so?
We don’t know why Canada has one of the highest rates of MS in the world. Nor why this disease afflicts twice as many women as men. Or why it’s the most common central nervous system disease to strike young adults. Or why its severity varies from one person to another.
But we do know what happens to sufferers. Multiple sclerosis means “multiple scars” which slowly but insidiously damage nerve fibers.
Trees die if you strip away their bark. The same holds true for human nerves. Multiple scars damage the myelin sheath that surrounds the nerve and also injure the nerve itself. This assault disrupts the conduction of nerve impulses resulting in a variety of symptoms.
Twenty percent of patients are fortunate. They suffer only a few attacks at intervals of several years resulting in hardly any physical impairment.
But for the rest, nerve scarring causes a variety of symptoms. Some complain of numbness, weakness, and problems with vision. Others notice loss of balance, problems with movement and an inability to control either their bladder or bowel functions.
These patients usually experience recurring attacks lasting for days or weeks along with increasing disability. And the more the nerve covering is damaged the greater the disability.
There is no cure for MS. But there are several drugs that delay the progression of the disease. Therapy involves the use of interferons which are normally produced in the body and play a role in the immune system. They were first discovered by their ability to interfere with the reproduction of viruses.
Currently there are several interferon products available. All are effective in decreasing recurring attacks of MS. But as happens in many pharmaceutical developments much debate has ensued about which is the better product. Last year at an international neurological meeting in London, England, I heard heated exchange on this matter.
But no medication is effective if you don’t take it. And today this is what often happens. For instance, many people stop taking antibiotics once they start feeling better. Or they discontinue blood pressure or asthmatic drugs with serious consequences. And of course these patients rarely tell their doctor they failed to follow instructions. So what researchers report on what occurs with medication is not what actually happens in the real world.
But one would think that MS patients would invariably follow a prescription schedule. After all, most know it’s vitally important to prevent serious recurrences of nerve damage. But even interferon drugs are not exempt from patients failing to take their medication. One reason, interferon sometimes results in flu-like symptoms and reactions at the injection site. It appears in practice that the fewer injections needed the greater the chance that patients will follow their doctors’ advice.
To prove this case researchers studied 253 patients with MS. One group took Avonex which required just one injection a week. Three non-Avonex drugs used by the remainder needed more frequent injections.
Only 18 percent of Avonex patients forgot or deliberately skipped an injection. On the other hand 45 percent of non-Avonex patients failed to take their medication as directed.
But it was not just the once-a-week injection that improved patient adherence to therapy. Avonex is the only drug given by intramuscular injection. This resulted in fewer injection site reactions and they were also 3 times less likely to experience flu-like symptoms.
I’m sure there will be continuing debate as to whether weekly or more frequent injections are best. But Dr. Jean-Pierre H. Cote’, a Montreal neurologist specializing in MS treatment says, “This study suggests that more frequent treatments per week are not necessarily better. The higher tolerability of Avonex, combined with once-a-week convenience improves patient compliance which is essential if patients are to obtain the full benefits of treatment.”
Let’s hope that it won’t be too many years before we’re talking about curing this disease rather than preventing recurrences. For more information go to www.msalliance.com
