#ECTRIMS2016 – Poor Medication Adherence in Pediatric MS Patients Linked to Fatigue, Lack of Routine

Children with multiple sclerosis (MS) in North America identified a number of challenges in adhering to disease-modifying therapies — a potential first step to devising  therapeutic approaches that might improve adherence to MS medications among young patients and, subsequently, disease outcomes in these children.

The results were presented in the talk, “Medication adherence in paediatric MS: barriers and facilitators,” given at the 32nd Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) held in London (Sept. 14-17).

Disease modifying therapies (DMT) are widely used in pediatric multiple sclerosis (POMS). However, up to half of children with MS show poor adherence to this type of medication, and as a consequence, often experience increased relapse rates that affect their social life (such as missing school). Currently, the underlying reasons for such poor adherence in pediatric patients are not well understood.

Researchers enrolled children with MS from nine North American centers and performed a randomized and controlled trial of medication adherence, which included electronic monitoring paired with motivational interviewing, versus attention control. Children with a diagnosis of MS on DMTs for at least six months were included in the study.

Analyses of 28 baseline interviews with participants, randomized to the motivational interviewing arm of the study (19 female), captured these emergent themes:

• Importance of medication adherence: participants referred to relapse prevention and improved energy levels as motivators

• Strategies for remembering to take medication: parental reminders, alarms, and routines

• Obstacles to adherence: side effects of medication, distractions from daily routine, and fatigue

• Facilitators to adherence: support from family, school staff, and the medical team.

Through motivational interviewing, children with MS identified specific barriers and facilitators to medication adherence. Facilitators included use of a tracking device, the identification of specific strategies related to medication and routines, and recall of neurological symptoms. Barriers included the difficulties in handling medication-induced side effects, fatigue, and all the changes impacting a daily routine.

“Future studies will evaluate whether thematic changes occurred through the course of the study, and whether changes in adherence accompanied thematic changes,” the team concluded.