1
|
Debus JL, Bachmann P, Frahm N, Mashhadiakbar P, Langhorst SE, Streckenbach B, Baldt J, Heidler F, Hecker M, Zettl UK. Associated factors of potential drug-drug interactions and drug-food interactions in patients with multiple sclerosis. Ther Adv Chronic Dis 2022; 13:20406223221108391. [PMID: 35959503 PMCID: PMC9358348 DOI: 10.1177/20406223221108391] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 06/01/2022] [Indexed: 12/15/2022] Open
Abstract
Background: Multiple sclerosis (MS) is the most common immune-mediated demyelinating
disease in younger adults. Patients with MS (PwMS) are vulnerable to the
presence of potential drug–drug interactions (pDDIs) and potential drug–food
interactions (pDFIs) as they take numerous medications to treat MS,
associated symptoms and comorbidities. Knowledge about pDDIs and pDFIs can
increase treatment success and reduce side effects. Objective: We aimed at determining the frequency and severity of pDDIs and pDFIs in
PwMS, with regard to polypharmacy. Methods: In the cross-sectional study, we analysed pDDIs and pDFIs of 627 PwMS aged
⩾18 years. Data collection was performed through patient record reviews,
clinical examinations and structured patient interviews. pDDIs and pDFIs
were identified using two DDI databases: Drugs.com Interactions Checker and
Stockley’s Interactions Checker. Results: We identified 2587 pDDIs (counted with repetitions). Of 627 PwMS, 408 (65.1%)
had ⩾ 1 pDDI. Polypharmacy (concomitant use of ⩾ 5 drugs) was found for 334
patients (53.3%). Patients with polypharmacy (Pw/P) were found to have a
15-fold higher likelihood of having ⩾ 1 severe pDDI compared with patients
without polypharmacy (Pw/oP) (OR: 14.920, p < 0.001).
The most frequently recorded severe pDDI was between citalopram and
fingolimod. Regarding pDFIs, ibuprofen and alcohol was the most frequent
severe pDFI. Conclusion: Pw/P were particularly at risk of severe pDDIs. Age and educational level
were found to be factors associated with the occurrence of pDDIs,
independent of the number of medications taken. Screening for pDDIs/pDFIs
should be routinely done by the clinical physician to increase drug safety
and reduce side effects.
Collapse
Affiliation(s)
- Jane Louisa Debus
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Centre, Gehlsheimer Str. 20, 18147 Rostock, Germany
| | - Paula Bachmann
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Centre, Rostock, Germany
| | - Niklas Frahm
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Centre, Rostock, Germany
| | - Pegah Mashhadiakbar
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Centre, Rostock, Germany
| | - Silvan Elias Langhorst
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Centre, Rostock, Germany
| | - Barbara Streckenbach
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Centre, Rostock, Germany; Department for Neurology, Ecumenic Hainich Hospital gGmbH, Mühlhausen, Germany
| | - Julia Baldt
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Centre, Rostock, Germany; Department for Neurology, Ecumenic Hainich Hospital gGmbH, Mühlhausen, Germany
| | - Felicita Heidler
- Department for Neurology, Ecumenic Hainich Hospital gGmbH, Mühlhausen, Germany
| | - Michael Hecker
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Centre, Rostock, Germany
| | - Uwe Klaus Zettl
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Centre, Rostock, Germany
| |
Collapse
|
2
|
Alonso RN, Chertcoff A, Eizaguirre MB, Bauer J, Leguizamón F, Curbello MC, Cassará FP, Garcea O, Carrá A, Silva BA. Decision Making Process in Multiple Sclerosis: an Argentine pilot study. Mult Scler Relat Disord 2022; 61:103751. [DOI: 10.1016/j.msard.2022.103751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/18/2022] [Accepted: 03/18/2022] [Indexed: 10/18/2022]
|
3
|
Neter E, Glass-Marmor L, Haiien L, Miller A. Concordance Between Persons with Multiple Sclerosis and Treating Physician on Medication Effects and Health Status. Patient Prefer Adherence 2021; 15:939-943. [PMID: 33994780 PMCID: PMC8114576 DOI: 10.2147/ppa.s291485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/12/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND As the number of treatment options for multiple sclerosis (MS) has expanded, alignment between physician and patient on effects of medication has emerged as important for medication persistence/discontinuation. OBJECTIVE To evaluate physician-patient agreement levels on medication effect and health status. METHODS Persons with MS (PwMS) (n=71) participated in a cross-sectional study collecting their satisfaction (using the Treatment Satisfaction Questionnaire for Medication), intention to dis/continue treatment and global health perception; physicians assessed response to medication and global health status. RESULTS Concordance between PwMS' assessment of medication effectiveness and physician's assessment on response to medication, health status and EDSS were r s= 0.50, r s= 0.57 and r s= -0.58, respectively. CONCLUSION The significant concordance attests to physician-patient effective communication and may contribute to improved medication adherence.
Collapse
Affiliation(s)
- Efrat Neter
- Department of Behavioral Sciences, Ruppin Academic Center, Emeq Hefer, Israel
- Correspondence: Efrat Neter Department of Behavioral Sciences, Ruppin Academic Center, 3 Bait, Emeq Hefer, 4025000, IsraelTel +972-54-6462677Fax +972-9-8983043 Email
| | - Lea Glass-Marmor
- Multiple Sclerosis Center & Department of Neurology, Carmel Medical Center, Haifa, Israel
| | - Loren Haiien
- Multiple Sclerosis Center & Department of Neurology, Carmel Medical Center, Haifa, Israel
| | - Ariel Miller
- Multiple Sclerosis Center & Department of Neurology, Carmel Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
| |
Collapse
|
4
|
Lapides DA. Shared Decision-making in Autoimmune Neurology: Making Decisions in the Face of Uncertainty. Neurol Clin Pract 2019; 11:141-146. [PMID: 33842067 DOI: 10.1212/cpj.0000000000000796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 11/18/2019] [Indexed: 11/15/2022]
Abstract
Purpose of review In this article, the author explores the use of shared decision making (SDM) in the management of the preference-sensitive condition, neural autoantibody-mediated syndromes. Recent findings The field of autoimmune neurology lacks trials and often data to support therapeutic decisions. Treatment choices need to be made acutely, lacking crucial laboratory information and with uncertainty regarding treatment response and prognosis. This lack of data does not necessitate indecision in a population where delayed treatment may lead to poor outcomes. Over the past several decades, SDM has emerged as a model of communication enabling clinicians and their patients to explore current knowledge in the context of a patient's values and goals to arrive at joint decision, even when data are lacking. Summary SDM is a tool autoimmune neurologists should use to develop individualized treatment plans based on the patient's clinical presentation contextualized within specific values and preferences.
Collapse
Affiliation(s)
- David A Lapides
- Department of Neurology, University of Virginia, Charlottesville, VA
| |
Collapse
|
5
|
Oreja-Guevara C, Potra S, Bauer B, Centonze D, Giambastiani MP, Giovannoni G, Kesselring J, Langdon D, Morrow SA, Nouvet-Gire J, Pontaga M, Rieckmann P, Schippling S, Alexandri N, Shanahan J, Thompson H, Van Galen P, Vermersch P, Yeandle D. Joint Healthcare Professional and Patient Development of Communication Tools to Improve the Standard of MS Care. Adv Ther 2019; 36:3238-3252. [PMID: 31487006 PMCID: PMC6822792 DOI: 10.1007/s12325-019-01071-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Indexed: 12/27/2022]
Abstract
Introduction Effective communication between patients and healthcare professionals (HCPs) is important to enhance outcomes in multiple sclerosis (MS). However, in practice, patients often report a disconnect in communication. Communication tools to aid patient–HCP communication have a long history of use in many chronic conditions. For example, symptom diaries have been shown to enhance outcomes in cancer, headache and sleep disorder management. MS in the 21st Century, a Steering Group of HCP specialists and patients with MS (PwMS), has created two communication tools designed for use by both patients and their HCPs. Methods The Steering Group first identified prominent issues in patient–HCP communication through group discussions and survey data. Following this, a series of workshops led to the development of two communication tools as potential solutions to these identified issues in communication. Results The two most prominent issues identified were HCP time constraints during appointments and the misalignment of patient and HCP priorities—the communication tools developed through the workshops were created to address these. The “myMS priorities” tool [see supplementary materials] is designed to maximize the use of consultation time while the “myMS commitments” tool [see supplementary materials] aims to improve patient–HCP shared decision-making. Conclusions The MS in the 21st Century Steering Group adopted a broad, iterative and collaborative approach in the development of these tools to help ensure they would be as useful as possible to both HCPs and PwMS. These tools have been developed through shared patient–HCP expertise and are based on existing tools in other therapy areas as well as a review of the existing literature and data from MS in the 21st Century Steering Group surveys. The next steps will focus on the validation of these tools through testing them in real-world environments and clinical trials. Funding Merck KGaA, Darmstadt, Germany. Electronic Supplementary Material The online version of this article (10.1007/s12325-019-01071-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Celia Oreja-Guevara
- Servicio de Neurología, Hospital Clínico San Carlos, IdISSC, Departamento de Medicina, Universidad Complutense, Madrid, Spain.
| | - Stanca Potra
- Member of the MS in the 21st Century Steering Group, Bucharest, Romania
| | - Birgit Bauer
- Member of the MS in the 21st Century Steering Group, Berlin, Germany
| | | | | | - Gavin Giovannoni
- Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK
| | | | - Dawn Langdon
- Royal Holloway, University of London, London, UK
| | | | | | - Maija Pontaga
- Member of the MS in the 21st Century Steering Group, Riga, Latvia
| | | | | | - Nektaria Alexandri
- Global Medical Affairs, Neurology and Immunology, Merck KGaA, Darmstadt, Germany
| | - Jane Shanahan
- Member of the MS in the 21st Century Steering Group, Ascot, UK
| | | | - Pieter Van Galen
- Member of the MS in the 21st Century Steering Group, Brussels, Belgium
| | | | - David Yeandle
- Member of the MS in the 21st Century Steering Group, Southampton, UK
| |
Collapse
|
6
|
Zettl UK, Schreiber H, Bauer-Steinhusen U, Glaser T, Hechenbichler K, Hecker M. Baseline predictors of persistence to first disease-modifying treatment in multiple sclerosis. Acta Neurol Scand 2017; 136:116-121. [PMID: 27796033 DOI: 10.1111/ane.12705] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Patients with multiple sclerosis (MS) require lifelong therapy. However, success of disease-modifying therapies is dependent on patients' persistence and adherence to treatment schedules. In the setting of a large multicenter observational study, we aimed at assessing multiple parameters for their predictive power with respect to discontinuation of therapy. MATERIALS AND METHODS We analyzed 13 parameters to predict discontinuation of interferon beta-1b treatment during a 2-year follow-up period based on data from 395 patients with MS who were treatment-naïve at study onset. Besides clinical characteristics, patient-related psychosocial outcomes were assessed as well. RESULTS Among patients without clinically relevant fatigue, males showed a higher persistence rate than females (80.3% vs 64.7%). Clinically relevant fatigue scores decreased the persistence rate in men and especially in women (71.4% and 51.2%). Besides gender and fatigue, univariable and multivariable analyses revealed further factors associated with interferon beta-1b therapy discontinuation, namely lower quality of life, depressiveness, and higher relapse rate before therapy initiation, while higher education, living without a partner, and higher age improved persistence. CONCLUSIONS Patients with higher grades of fatigue and depressiveness are at higher risk to prematurely discontinue MS treatment; especially, women suffering from fatigue have an increased discontinuation rate.
Collapse
Affiliation(s)
- U. K. Zettl
- Department of Neurology; Neuroimmunology Section; University of Rostock; Rostock Germany
| | | | - U. Bauer-Steinhusen
- Neurology, Immunology, and Ophthalmology; Bayer Vital GmbH; Leverkusen Germany
| | - T. Glaser
- Neurology, Immunology, and Ophthalmology; Bayer Vital GmbH; Leverkusen Germany
| | | | - M. Hecker
- Department of Neurology; Neuroimmunology Section; University of Rostock; Rostock Germany
| | | |
Collapse
|