Improving adherence to injectable disease-modifying drugs in multiple sclerosis.

Multiple sclerosis (MS) is the most common neurological disorder leading to permanent disability in early adulthood and premature pension. Prophylactic treatment should be initiated early in the disease process to prevent permanent disability at best. Injectable drugs, i.e., interferon beta preparations and glatiramer acetate, belong to the first-line therapeutics in MS. Autoinjection devices, available for all disease-modifying drugs, can improve injection tolerability and patient's satisfaction compared with manual injection. In one study, the use of an autoinjector has been found to be the strongest predictor of adherence at 24 months. Nevertheless, long-term adherence to injectable MS therapies is generally suboptimal for various barriers with an impact on efficacy of these treatments. Improvements concerning drug delivery by innovative features could be achieved by the first electronic autoinjector RebiSmart(™) and may help to increase adherence. Patients' rating of the new electronic device and short-term adherence data convey some evidence that patients' treatment satisfaction and adherence may increase by its use. Long-term studies, already under way, are awaited to show, if long-term adherence will be positively influenced. A further achievement of the new electronic device is the possibility to monitor adherence objectively allowing a discussion between the patient and health care provider about nonadherence reasons. The necessity of improving adherence to injectable disease-modifying drugs within the growing field of oral MS therapeutics will also be discussed.