Saturday, 28 March 2015

How do like your pills?

Wicks P, Brandes D, Park J, Liakhovitski D, Koudinova T, Sasane R.Preferred features of oral treatments and predictors of non-adherence: two web-based choice experiments in multiple sclerosis patients. Interact J Med Res. 2015;4(1):e6. doi: 10.2196/ijmr.3776.

BACKGROUND:Oral disease modifying therapies (DMTs) for multiple sclerosis (MS) differ in efficacy, tolerability, and safety.
OBJECTIVE: We sought to understand how these attributes impact patient preference and predicted DMT non-adherence among oral-naïve MS patients.
METHODS:Adult MS patients from the "PatientsLikeMe" Web-based health data-sharing platform completed a discrete choice exercise where they were asked to express their preference for one of three hypothetical oral DMTs, each with a certain combination of levels of tested attributes. Another Web-based exercise tested a number of possible drivers of non-adherence, mainly side effects. Data from an MS clinic were used to adjust for sample bias. Respondents' preferences were analyzed using Hierarchical Bayesian estimation.
RESULTS:A total of 319 patients completed all questions. Most respondents were female (77.7%, 248/319) with mean age 48 years (SD 10). Liver toxicity was the attribute that emerged as the most important driver of patient preference (25.8%, relative importance out of 100%), followed by severe side effects (15.3%), delay to disability progression (10.7%), and common side effects (10.4%). The most important drivers of predicted non-adherence were frequency of daily dosing (17.4% out of 100%), hair thinning (14.8%), use during pregnancy (14.1%), severe side effects (13.8%), and diarrhea (13.0%).
CONCLUSIONS:Understanding the important concerns expressed by patients may help health care providers to understand and educate their patients more completely about these concerns. This knowledge may therefore improve both choices of appropriate therapy and adherence to therapy over time.
This is a survey on what you want from your pills. So if you look at which pills you prefer obviously you want them to work and then there is a side effect. It they have nasty side effects you won't want them, So if its hair thinning we know which pill you are worried about (Aubagio), pregnancy you will not want aubagio because of birth defect potential, gut problems (Tecfidera)  don't want to take it too often (Tecfidera). I guess its rocket science but Pharma do spend alot on Marketing so your choice is their profit. 

ClinicSpeak: psychiatric comorbidity

Do you suffer from anxiety, depression or substance misuse? #ClinicSpeak #MSBlog #MSResearch

"The meta-analysis below confirms what we know; MSers are likely to have a high rate of psychiatric co-morbidity. This includes depression, anxiety and alcohol and substance abuse. Psychiatric comorbidity is the hidden, often ignored, underbelly of MS. Anxiety and fatigue are so common that they are virtually ubiquitous foes of the MSer. It is very important that anxiety is recognised and managed early. I suspect that alcohol and substance misuse is due to MSers self-medicating. Alcohol is anxiolytic and is almost certainly the most widely used anxiolytic on the planet."

"MSers have reason to be anxious and depressed. The uncertainty that goes with being diagnosed with MS cannot be underestimated. I have recently discovered mindfulness, through the recommendations of some of my patients. Mindfulness is a technique of self-meditation that teaches you to focus on the here and now and not the future; you can't control the future so why worry about it. The NHS and NICE recommends mindfulness training as part of a holistic approach to the management of anxiety. Mindfulness is a useful adjunct to CBT (cognitive behavioural therapy) and exercise to help anxiety. Finally, if anxiety cannot be managed using these, and other, techniques there is also the option of medication, for example the SSRIs. I typically try to avoid SSRIs because of weight gain as a side effect and the increasing recognition of a withdrawal syndrome on stopping them.The latter is called the anti-depressant withdrawal syndrome and occurs in ~30-40% of people who stop SSRIs."

"If you suffer from anxiety, depression, fatigue, alcohol and substance misuse don't ignore the problem please raise it with your GP, neurologist or MS specialist nurse."

Marrie et al. The incidence and prevalence of psychiatric disorders in multiple sclerosis: A systematic review. Mult Scler. 2015 Mar;21(3):305-317.

BACKGROUND: Psychiatric comorbidity is associated with lower quality of life, more fatigue, and reduced adherence to disease-modifying therapy MS.

OBJECTIVES: The objectives of this review are to estimate the incidence and prevalence of selected comorbid psychiatric disorders in MS and evaluate the quality of included studies.

METHODS: We searched the PubMed, PsychInfo, SCOPUS, and Web of Knowledge databases and reference lists of retrieved articles. Abstracts were screened for relevance by two independent reviewers, followed by full-text review. Data were abstracted by one reviewer, and verified by a second reviewer. Study quality was evaluated using a standardized tool. For population-based studies we assessed heterogeneity quantitatively using the I 2 statistic, and conducted meta-analyses.

RESULTS: We included 118 studies in this review. Among population-based studies, the prevalence of anxiety was 21.9% (95% CI: 8.76%-35.0%), while it was 14.8% for alcohol abuse, 5.83% for bipolar disorder, 23.7% (95% CI: 17.4%-30.0%) for depression, 2.5% for substance abuse, and 4.3% (95% CI: 0%-10.3%) for psychosis.

CONCLUSION: This review confirms that psychiatric comorbidity, particularly depression and anxiety, is common in MS. However, the incidence of psychiatric comorbidity remains understudied. Future comparisons across studies would be enhanced by developing a consistent approach to measuring psychiatric comorbidity, and reporting of age-, sex-, and ethnicity-specific estimates.

Treatment inhibits the formation of cortical lesions

Rinaldi F, Perini P, Atzori M, Favaretto A, Seppi D, Gallo P. Disease-modifying drugs reduce cortical lesion accumulation and atrophy progression in relapsing-remitting multiple sclerosis: results from a 48-month extension study. Mult Scler Int. 2015;2015:369348. doi: 10.1155/2015/369348. Epub 2015 Feb 23.
Cortical lesions (CLs) and atrophy are pivotal in multiple sclerosis (MS) pathology. This study determined the effect of disease modifying drugs (DMDs) on CL development and cortical atrophy progression in patients with relapsing-remitting MS (RRMS) over 48 months. Patients (n = 165) were randomized to sc IFN β-1a 44 μg (rebif), im IFN β-1a 30 μg (Avonex) , or glatiramer acetate 20 mg. The reference population comprised 50 DMD-untreated patients with RRMS. After 24 months, 43 of the untreated patients switched to DMDs. The four groups of patients were followed up for an additional 24 months. At 48 months the mean standard deviation number of new CLs was significantly lower in patients treated with sc IFN β-1a (1.4 ± 1.0, range 0-5) compared with im IFN β-1a (2.3 ± 1.3, range 0-6, P = 0.004) and glatiramer acetate (2.2 ± 1.5, range 0-7, P = 0.03). Significant reductions in CL accumulation and new white matter and gadolinium-enhancing lesions were also observed in the 43 patients who switched to DMDs after 24 months, compared with the 24 months of no treatment. Concluding, this study confirms that DMDs significantly reduce CL development and cortical atrophy progression compared with no treatment.

Cortical lesions (grey matter) lesions are difficult to spot and yet this study again shows that it is better to be treated than not treated to be treated. In this study rebif came up trumps but in other things it doesn't so it is swings and roundabouts, but it would also suggest that with a more active DMD the chance for improvement is even better because no cortical lesions are going to be better than .