I recently advised a young patient – she just turned 18, it was her first presentation in adult neurology. Her MS had already started at the age of 15. At that time, she was cared for by a children’s clinic. She had been prescribed interferon-beta 1a (Rebif) for immunotherapy, certainly also because this substance is approved for the treatment of children. This is always a significant argument in the selection of therapy for underage patients and the legal situation is indeed an important point for doctors.
Now, this is not about the approval of drugs in childhood, but rather that the 3x weekly application of an interferon is not comfortable – especially for teenagers, who certainly have other things on their minds than the therapy of a chronic disease. The interferon therapy did not show optimal effect in my young patient, the follow-up MRIs kept showing new lesions and clinically there were signs of (mild) sensory relapses.
During the consultation, I asked her, knowing full well how challenging injections can be, if she takes the drug regularly at all. After some hesitation (her mother was present), she admitted that she occasionally skips the medication, or even takes “breaks” – she does a lot of sports, has changed her diet and takes vitamins.
From my point of view, this is a cautious way of saying that she possibly takes every opportunity not to take the drug – and accordingly, it cannot work as it should. My patient is not an isolated case, but rather the rule, because from clinical surveys we know that adherence with many MS drugs is not particularly good.
So, how should one deal with this situation? Of course, one could leave everything as it is, wag the finger and demand that the medication must be taken regularly. But that would probably not help, and might even lead in the long run to my young patient turning away from conventional MS therapy. Such a situation would not be fair to anyone.
Accordingly, it is much more sensible to actually search out the drug from the large selection of current MS therapies that is most tolerable for the individual patient. A drug that is “convenient,” that can easily be integrated into daily life and does not constantly evoke memories of a chronic disease.
And that’s why the answer to the initial question is a clear “yes”. Convenience is indeed an adequate argument for or against therapy. Patients with MS, no matter how young or old, may, indeed must, demand that the convenience of a therapy is taken into account when choosing – with everyone being able to define “convenience” individually. An important task of the doctor is to pave the way to an individually “suitable” drug (of course, weighing up the risk-benefit ratio). Because nobody benefits if a lot of money is spent on drugs that end up in some drawer – and certainly not patients who develop disabilities due to inadequate treatment.
In conclusion: The “convenience”, or as it is called in modern terms, the “convenience” of a drug, is for me equally important in the selection of therapy alongside effect and safety
