Tuesday, 14 May 2013

Are you taking your meds for spasticity?

Epub: Halpern et al. Adherence Associated with Oral Medications in the Treatment of Spasticity. PM R. 2013 May 3. doi:pii: S1934-1482(13)00245-1.

OBJECTIVE: Lack of adherence to medications for chronic conditions is a pervasive problem. This study examined adherence to baclofen, tizanidine, and dantrolene (FDA-approved oral spasticity medications) and identified determinants of adherence.


DESIGN: Retrospective administrative claims data analysis, employing medical and pharmacy claims data and enrollment information from a large, national US health plan.

SUBJECTS & Methods: Subjects were commercial health plan members who: initiated treatment on baclofen, tizanidine, or dantrolene from January 1, 2004 through September 30, 2009; and had stroke, spinal cord injury (SCI), traumatic brain injury (TBI), cerebral palsy (CP), or multiple sclerosis (MS). Descriptive and logistic regression statistical analyses were performed.

MAIN OUTCOME MEASUREMENTS: Outcomes were: adherence, measured as continuous medication possession ratio (MPR) and as a binary indicator (MPR ≥ 0.80 = adherent; MPR < 0.80 = non-adherent); change in oral spasticity medication; and use of non-oral spasticity therapy.
RESULTS:The study population included 2,840 subjects. Adherence overall was poor: the range of mean unadjusted MPR values was 0.10 to 0.50, indicating that at best, subjects were adherent to their index spasticity medications for 50% of their treatment periods. Unadjusted overall MPRs for baclofen and tizanidine were 20.4% and 9.1%, respectively. Less than 5% of subjects changed oral spasticity medications. Results of logistic regression to identify determinants of adherence showed that subjects treated with tizanidine versus baclofen had 37.4% lower odds of adherence and those with TBI versus stroke had 77.5% lower odds of adherence. The odds of adherence increased with age and with pre-index contracture or decubitus ulcer.

CONCLUSIONS: Adherence to oral spasticity medication adherence was poor irrespective of index spasticity medication or condition. Results from this study indicate that physicians cannot assume that patients are adherent to prescribed oral spasticity medications. A more complete understanding of the reasons behind non-adherence is required.



People do not like there meds because of side-effects and this is a problem. This is especially the case in trials when the Msers are not taking the drugs...so not surprising that they fail

CoI: Members of Team G are trying to develop drugs for spasticity that do not have the side effect profile

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