title: Recognizing nonadherence in patients with multiple sclerosis and maintaining treatment adherence in the long term.
abstract: BACKGROUND
  Patients with multiple sclerosis (MS) face many challenges. One significant challenge is long-term adherence to disease-modifying therapy (DMT). Four of the 6 currently available DMTs involve self-injection, and all cause adverse events of varying degrees of severity. Although effective, the benefit of DMTs is difficult to determine on an immediate basis. Healthcare providers must play a major role in recognizing nonadherence and identifying strategies to promote adherence.
  
  
  METHODS
  We conducted a literature search of the MEDLINE database using the search terms "adherence" and "multiple sclerosis" to gather data from relevant studies investigating adherence among patients with MS.
  
  
  RESULTS
  Barriers to maintaining treatment adherence in patients with MS include forgetting the medication, injection anxiety, perceived lack of efficacy, coping with adverse events, and issues with complacency and treatment fatigue. An open and honest healthcare provider-patient relationship is a core element in maintaining motivation and adherence in patients with MS. In addition, continuous education and consistent reinforcement of the value of treatment are essential strategies in the maintenance of treatment adherence. Other strategies to promote adherence include management of treatment expectations and minimization of adverse events.
  
  
  CONCLUSIONS
  The chronic nature of MS makes treatment adherence challenging in patients with long-standing disease. Patients and healthcare providers need to work together to establish open lines of communication and a trust-based therapeutic relationship to ensure that patients have the knowledge and skills they need to adhere to long-term MS therapy.
authors.affiliation: Maryland Center for Multiple Sclerosis, University of Maryland, Baltimore, Maryland, USA. kcostello@som.maryland.edu
authors.forename: Kathleen
authors.initials: K
authors.lastname: Costello
authors.forename: Patricia
authors.initials: P
authors.lastname: Kennedy
authors.forename: Jo
authors.initials: J
authors.lastname: Scanzillo
mesh_terms: D006801:Humans; D008137:Longitudinal Studies; D009103:Multiple Sclerosis / Q000188:drug therapy* / Q000453:epidemiology*; D015995:Prevalence; D012646:Self Administration / Q000706:statistics & numerical data; D016312:Treatment Refusal / Q000706:statistics & numerical data*; D016903:Drug Monitoring