The Problem of Therapeutic Inertia in MS Patients

There is never a good time to be diagnosed with a chronic illness like multiple sclerosis. That said, due to the ever-growing number of treatment options, we are in a much better time right now than we’ve ever been before. Newer treatments are much more effective than those in the past, and we now have numerous options to try when we either can’t tolerate one or have one stop working. Despite having more options than ever before, there is a growing problem of what is known as therapeutic inertia in the MS community.

What is therapeutic inertia?

Therapeutic or clinical inertia is the measurement of resistance to treatment for an existing medical condition. With regards to those with MS, therapeutic inertia occurs when someone fails to make changes to improve upon their treatment, despite there being evidence that what they are doing isn’t really working or something exists that could be more effective. Studies have found that doctors, patients, and even insurance companies can all share some blame when a patient doesn’t upgrade their treatment.

Finding your treatment

Finding the right treatment for multiple sclerosis can be a difficult experience. With such an individualized disease, there isn’t a one-size-fits-all treatment option out there. Finding what works for you can take a significant amount of trial and error. It’s an exhausting affair that requires a real commitment. You can’t simply take a disease-modifying drug and then take a test the following week to see if it’s working.

Monitoring how a person does on a DMT over time

A patient must be on a drug for a lengthy period of time, with MRIs taken at regular intervals, in order to determine if it is actually effective. In some cases, a person will take a treatment that works great until it doesn’t, and they relapse or new lesions are found. Unfortunately, not only determining, but also deciding to act, when it’s time to switch treatments can be problematic.

When to switch to a new DMT

Switching treatments is a tough decision, particularly if your body has been able to tolerate the one you’ve been taking. Switching can mean allergic reactions or new side effects. It can mean adjusting to a new method for administering it (moving from a pill to an injection or IV infusion can be scary). There is also no guarantee that a new treatment will work as well as the one you are switching from or that it will work at all. That’s a hard proposition to consider if you believe your current treatment has been somewhat beneficial. Many people will see lesions and wrongly think that because they have had no disability associated with them, that they aren’t an issue.

New lesions

If new lesions are appearing on your MRI, your disease is active, and you probably need to take action. One of the biggest reasons people don’t change their treatment, even when there is evidence that they need to, is that most people are just averse to change, any change, in any part of their life. Many people have a tendency to stick with what they do and coast. That’s why we use the word inertia here, it’s the tendency of people to not change their therapy because they are comfortable.

The doctor should play an active role

Patients are not the only people responsible for not switching up their treatments when the time may be right. Many physicians aren’t active enough with their patients and won’t really ask enough questions to determine if the patient is having any new issues. MRIs are not the only way to determine disease activity, sometimes a doctor needs to be more of a detective and ask the right questions. There is also a tendency for many doctors to simply go along with whatever their patient’s previous doctor set forth. There are many physicians out there that are very passive and do not like going against a colleague’s decision. Sadly, there are also many physicians out there, even specialists, who simply aren’t knowledgeable enough about the up-to-date treatments that are available.

The insurance company

When the patient and doctor both agree that a change in treatment is warranted, oftentimes everyone’s big bad guy, the insurance company, will throw a wrench in the works. Insurance companies are slow to cover new treatment methods. So if a patient and doctor decide to try something that is newer, many times the insurance company won’t cover it, making the treatment nearly impossible to use because of cost. This is a factor, not only for disease-modifying drugs, but also many of the treatments used for symptom management. Bottom line, insurance companies are slow-moving and stingy when it comes to covering treatments that haven’t been in use for a while. This is very problematic when it comes to a disease like MS, for which breakthroughs are happening constantly.

Don't be afraid to ask questions

With all of these factors conspiring against us, it’s even more important to recognize when a change in treatment is necessary. It’s important to talk to your doctor when new symptoms or lesions arise. Don’t be afraid to ask questions and challenge them, you have to advocate for yourself. Knowing when to switch treatments is very difficult. I know I’ve found myself in a “don’t want to rock the boat” situation numerous times, and I’m left wondering if I could have improved my life had I been more willing to try something new. None of this is to say go change your treatment. It’s simply to help make you aware that many people who could benefit from a change, don’t make that change. It helps to hear that and look in the mirror at your own actions to make sure you don’t fall into that category.

Thanks for reading!

Devin

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