Adherence with Treatment Recommendations

Treatment adherence is not the same as treatment compliance “adherence is an active choice of patients to follow through with the prescribed treatment while taking responsibility for their own well-being while compliance is a passive behavior in which a patient is following a list of instructions from the doctor (Mir T. H. 2023).”

Adherence with disease-modifying therapies (DMT) has been found to be a problem for many persons with MS. 


Hartung D., Bourdette D., Ahmed S., Whitham R. (2015) examine the pricing trajectories in the United States of 9 disease-modifying therapies (DMT) for multiple sclerosis (MS) over the last 20 years and assess the influences on rising prices. They found first-generation DMTs, originally costing $8,000 to $11,000, now cost about $60,000 per year. Costs for these agents have increased annually at rates 5 to 7 times higher than prescription drug inflation. DMT costs in the United States currently are 2 to 3 times higher than in other comparable countries.

Callaghan B., Reynolds E., et al. (2019) analysed claims from a large commercial health insurance database to identify out-of-pocket medication costs for patients with multiple sclerosis (n=105,355).  MS medication monthly out-of-pocket expenses (mean $15 in 2004, $309 in 2016) with minimal differences between medications.

Bebo et al. (2022) estimate that the average excess per-person annual medical costs for per person with MS was $65,612; at $35,154 per person, disease-modifying therapies (DMTs) accounted for the largest proportion of this cost.


Lee and McPherson, et al.(2019), retrospectively evaluated the correlation between medication adherence and clinical outcomes to identify barriers to adherence in the MS patients filling DMT prescriptions at Yale New Haven Health Outpatient Pharmacy Services (OPS). A statistically significant correlation was identified between patients with a diagnosis of depression and patients with an MPR <80%, suggesting a correlation between worsening adherence and increasing depressive symptoms.


Duquette and Yeung, et al. (2019) tracked DMT compliance and discontinuation rates for privately insured Canadians with RRMS MS at 6, 12, and 24 months. Claims data were collected for each DMT (oral: Gilenya (fingolimod), Tecfidera (DMF), and Aubagio (teriflunomide); infusible: Tysabri (natalizumab); and injectables: BRACE therapies include Betaseron (interferon beta-1b), Rebif (interferon beta-1a), Avonex (interferon beta-1a), Copaxone (Glatiramer acetate, GA), and Extavia (interferon beta-1b). Compliance for a specific DMT was measured using medication possession ratio (MPR), which is defined as the number of doses dispensed in relation to the dispensing period.  Fig.1


It is known that disease-modifying agents are known to be only partially effective – i.e., they may slow disease progression, but don’t halt disease progression or cure the disease. It is important for healthcare professionals to support the patient’s optimism and hope for a benign disease course while continuing to emphasize the potential benefit of early treatment for a chronic and unpredictable disease.

Patients who are receiving treatment for MS associated depression – either with antidepressants or with psychotherapy – are significantly more likely to continue to take disease-modifying drugs. Health care professionals can help increase patient compliance by promoting realistic expectations about the results of treatment, taking time to listen to patient concerns, clarifying misconceptions about therapy, and helping patients manage drug side effects.

Approximately a third of patients with MS may be using complementary and alternative medicine therapies, such as St. John’s Wort for depression. Because of potential drug interactions with complementary and alternative therapies, patients should be encouraged to speak to their physicians before starting additional prescribed or over-the-counter medications or substances purchased at health food stores.

Instant Feedback:
A large number of people stop taking disease-modifying drugs because their symptoms don’t improve or even increase.



Bebo, B., Cintina, I., LaRocca, N., Ritter, L., Talente, B., Hartung, D., Ngorsuraches, S., Wallin, M., & Yang, G. (2022). The Economic Burden of Multiple Sclerosis in the United States: Estimate of Direct and Indirect Costs. Neurology98(18), e1810–e1817.

Callaghan B.C., Reynolds E., Banerjee M., Kerber K.A., Skolarus L.E., Magliocco B., Esper G.E., Burke J.F. (2019) Out-of-pocket costs are on the rise for commonly prescribed neurologic medications. Neurology. 2019; 92 (22)

Duquette P, Yeung M, Mouallif S, Nakhaipour HR, Haddad P, Schecter R (2019) A retrospective claims analysis: Compliance and discontinuation rates among Canadian patients with multiple sclerosis treated with disease-modifying therapies. PLoS ONE 14(1)

Hartung D., Bourdette D., Ahmed S., Whitham R. (2015). The cost of multiple sclerosis drugs in the US and the pharmaceutical industry; Too big to fail? Neurology. 2015; 84 (21)

Lee J., McPherson D., D’Ambrosi M., Stutsky, M. (2019). Correlates and barriers to medication adherence in multiple sclerosis patients and their impact on clinical outcomes. Journal of Drug Assessment. Vol. 8, 2019

Mir T. H. (2023). Adherence Versus Compliance. HCA healthcare journal of medicine4(2), 219–220.