Electronic Pill Bottle Improves DMT Adherence, Subcutaneous Cladribine Personalized Dosing Well-Tolerated, MS Fatigue Unchanged Long-Term

Neurology News Network for the week ending March 6, 2021.

This week Neurology News Network covered a trio of abstracts from the ACTRIMS Forum 2021, which included the use of electronic smart pill bottle caps to improve disease-modifying therapy adherence, a study using subcutaneous cladribine personalized dosing, and the effects of MS fatigue in a long-term program.

Welcome to this special edition of Neurology News Network. I’m Marco Meglio. Please excuse our appearance this week as a majority of the US workforce, including the NeurologyLive team, moves to working remote as we come together to help reduce the spread of the novel coronavirus. This episode was dedicated to the recent cover of the ACTRIMS Forum.

A reminder system using electronic smart caps from a pill bottle paired with remote smartphone app technology produced greater rates of adherence for people with multiple sclerosis, but still suggested that developing strategies to improve adherence to oral disease-modifying therapies (DMTs) remains a need within MS care. Overall, the average perfect adherence over the 90-day study period for all participants was 65%. Average perfect adherence was statistically significantly higher in the reminders arm (68%) compared to the monitoring only arm (61.4%). Notably, there was no difference observed in perfect adherence by once versus twice daily dosing. Of 5959 total scheduled doses in the monitoring only arm, 4% were taken early, 61.4% on time, 5.6% late, 4.7% in excess, and 24.4% not at all. Of 7135 doses in the reminders arm, 3.4% were taken early, 68% on time, 3.7% late, 12.2% in excess, and 12.8% not at all.

Data from a recent study suggest that subcutaneous cladribine personalized dosing (CPD) was well-tolerated in patients with relapsing multiple sclerosis, with efficacy in line with oral cladribine trial data. The researchers offered CPD to people with MS regardless of disease course. Treatment schedule consisted of 10 mg on 3 consecutive days in week 1 (4 days in people over 90 kg), another 0-3 doses in week 5 based on total lymphocyte count in week 4. A second cycle of CPD was administered 11 months later. CPD was generally well-tolerated. Over the follow-up period, 1 myocardial infarction, 1 breast cancer, 1 pulmonary embolism, and 3 severe allergic skin reactions without long-term sequelae occurred. Death occurred in 2 severely disabled patients with MS, 1 from influenza and 1 from encephalitis. Lymphopenia of at least grade 3 occurred in 7%.

An abstract presented at the ACTRIMS Forum 2021, showed that patients with multiple sclerosis (MS) who entered a long-term fatigue program remained unchanged after a 5- to 6-year period, raising questions about whether fatigue is progressive within this patient population.Senior author Cinda L. Hugos, MS, PT, associate professor of neurology, Oregon Health & Science University, and colleagues compared 38 participants who completed either the Fatigue: Take Control or the MS: Take Control fatigue self-management programs. Upon completion, t-tests revealed no significant differences in Modified Fatigue Impact Scale (MFIS) scores within or between groups at the 5- to 6-year follow-up compared with any other time point. Additionally, chi-square tests showed that regardless of group, there was no significant difference in the proportion of those who completed any of the potential behavior changes.

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