• Disease-modifying therapies (DMTs) are effective for treating multiple sclerosis (MS), but many people with MS stop taking them or have doses left over when they switch medications.
• Some people may switch DMTs because they don’t want to inject themselves with medication or because they perceive the medications as ineffective.
• A new study found more than $5 million in wasted doses of expensive DMTs in one year at a single MS care center.

A recent study looking at medicine waste found that unused disease-modifying therapies are thrown away at alarming rates. These medications are one of the most significant cost burdens to people with multiple sclerosis, and their prices have only continued to increase over the past decade. In fact, inflation for DMT prices was found to be five to seven times higher than for other types of prescription drugs.

DMTs are approved by the U.S. Food and Drug Administration (FDA) based on evidence that they can reduce the rate of MS relapses and slow the progression of disability. Many people with MS often switch DMTs for another medication, especially in cases of relapsing-remitting MS. Doctors may recommend switching in cases of continuing relapses, worsening lesions, or increased disease activity.

As people switch medications, they may have unused doses that go to waste. However, no study has looked into exactly why people switch DMTs nor how much unused medication expires or is returned to outpatient clinics.

“The magnitude of unused DMTs from people with MS has never been quantified and the impact of such therapies in the context of the overall economic burden of care in MS remains poorly understood,” said Dr. Darin T. Okuda, professor of neurology at the University of Texas Southwestern Medical Center and lead author of the study, in an interview with Neurology Live. “Despite widespread concern about the costs of DMTs in MS, the true prevalence of the problem of wasted medication remains.”

With this, Dr. Okuda and colleagues created a medicine waste project to determine why people with MS switch DMTs and how many unused drugs were being thrown away as a result.

What Drives Switches in DMTs?

This study included 422 participants diagnosed with MS who had switched DMTs at least once. Among participants who switched DMTs:

• 59.3 percent did so for nonmedical reasons, including health insurance changes, high out-of-pocket costs, desire to switch to a new medication, desire to switch to oral treatment, and family planning
• 54 percent cited medical reasons, such as medication not working, abnormal lab results, clinical relapses, progression of disability, and development or enlargement of lesions
• 41 percent switched due to side effects, including reactions at the injection site, hair thinning, stomach problems, headache, or other effects

Are you considering switching MS treatments? Here are five things you should know.

What Happens to Unused Doses?

The researchers also took a survey of what happened to already-prescribed DMTs once a participant switched medications. They found that:

• Around 29 percent of people reported using up their old DMT before beginning the new one
• 22.7 percent of them discarded unused doses
• 22.4 percent kept unused doses at home
• 15.4 percent returned their unused doses to the prescribing health care provider
• 7.8 percent gave them back to their pharmacist
• Around 3 percent gave them directly to another person with MS

Researchers found that in 2018, participants returned $5,152,632.02 worth of unused DMTs to a single provider. Both oral and injected medications were returned at about equal rates.

Overall, this study highlights the need to better understand why people with MS switch treatments and how this impacts medical waste and expenses to the health care system.

What Should You Do With Unused Medications?

If you and your doctor agree that it’s time to switch MS treatments, you have options as to what you can do with whatever doses you have left of your original prescription.

Use a Drug Take-Back Program

According to the FDA, the best way to dispose of most types of unused or expired medications is through a drug take-back site or program. Some communities have permanent collection sites. Others have periodic take-back events. The U.S. Drug Enforcement Administration’s (DEA’s) next National Prescription Drug Take Back Day takes place on Oct. 29 from 10 a.m. to 2 p.m. Your local law enforcement agency may be able to help you find a location. The DEA also can point you to an authorized collector in your area.

Dispose of Them at Home — Safely

If you are unable to access a drug take-back service quickly, you may be able to flush your unused medications down the toilet or sink, according to the FDA. To do so, your medication needs to be on the FDA’s flush list.

Drugs that aren’t on the FDA’s flush list may be discarded in the trash. If you use this approach, the FDA recommends the following:

1. Mix the medications with an unappealing substance, such as cat litter or coffee grounds.
2. Place the mixture in a container, such as a sealed plastic bag.
3. Toss the container in your trash.
4. Remove personal information from your empty medicine bottles and packaging and put them in the trash or recycling bin, as appropriate.

Donate Them

Finally, some states have passed laws allowing people to donate their unused drugs. The laws vary from state to state, including where drugs can be donated and whether the drug packaging needs to be unopened or sealed. A nonprofit called Sirum offers a program through which individuals and organizations can donate unused medications.

Your pharmacist or health care provider may be able to provide additional guidance as to what to do with your unused medications. You can also reach out to the FDA at 888-463-6332.

Talk With Others Who Understand

On MyMSTeam, the social network for people with multiple sclerosis and their loved ones, more than 189,000 members come together to ask questions, give advice, and share their stories with those who understand life with MS.

Have you switched MS treatments? What did you do with any leftover doses of your old DMT? Share in the comments below, or start a conversation with others on MyMSTeam.