title: Management of multiple sclerosis and the integration of related specialty pharmacy programs within health systems.
abstract: OBJECTIVE
  The management of multiple sclerosis (MS) and the integration of related specialty pharmacy programs within health systems are discussed.
  
  
  CONCLUSIONS
  MS is a progressive immune-mediated inflammatory disease of the central nervous system. Current treatment strategies include the use of disease-modifying therapies (DMTs) that have various degrees of efficacy and tolerability. These DMTs also differ with respect to frequency and route of administration, which can significantly impact patient compliance and ultimately their response to therapy. The introduction of oral and injectable DMTs requiring less-frequent injections and having better adverse-effect profiles may help patients improve adherence to therapy; however, access to these therapies is often restricted due to both their high cost and limited distribution. These DMTs include fingolimod, teriflunomide, dimethyl fumarate, and pegylated interferon beta-1a. All others, with the exception of fingolimod, have limited distribution. Pharmacists in health-system pharmacy programs can play a significant role in assisting patients with MS manage their disease efficiently and safely by educating them about their therapies, ensuring compliance with the associated risk evaluation and mitigation strategy (REMS) program, and helping them access these therapies in a timely manner.
  
  
  CONCLUSIONS
  MS is a progressive neurologic disorder that requires lifelong treatment with DMTs. Good compliance, compliance with the associated REMS program, and timely access to these drugs may positively influence patient care and outcomes and provide an opportunity for the health-system pharmacists to have a active role in caring for these patients.
authors.affiliation: Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, IL mhabib1@uic.edu.
authors.forename: Mitra
authors.initials: M
authors.lastname: Habibi
authors.affiliation: Rush University Medical Center, Chicago, IL.
authors.forename: Huda-Marie
authors.initials: HM
authors.lastname: Kuttab
mesh_terms: D000046:Academic Medical Centers / Q000379:methods / Q000639:trends; D003437:Crotonates / Q000008:administration & dosage; D019468:Disease Management; D000068876:Fingolimod Hydrochloride / Q000008:administration & dosage; D006308:Health Systems Plans / Q000639:trends; D006801:Humans; D006885:Hydroxybutyrates; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D009103:Multiple Sclerosis / Q000175:diagnosis / Q000188:drug therapy*; D009570:Nitriles; D010607:Pharmacy Service, Hospital / Q000379:methods* / Q000639:trends; D014052:Toluidines / Q000008:administration & dosage
chemical_list: D003437:Crotonates; D006885:Hydroxybutyrates; D007166:Immunosuppressive Agents; D009570:Nitriles; D014052:Toluidines; C527525:teriflunomide; D000068876:Fingolimod Hydrochloride