The proposed new NHS England MS Prescribing Guidelines will stop the - - PowerPoint PPT Presentation

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The proposed new NHS England MS Prescribing Guidelines will stop the - - PowerPoint PPT Presentation

Apr 19, 2023 264 likes •709 views

The proposed new NHS England MS Prescribing Guidelines will stop the current wide variation in DMT prescribing across England. Yes! Dr David Paling Royal Hallamshire Hospital, Sheffield NIHR Sheffield Biomedical Research Centre Translational

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The proposed new NHS England MS Prescribing Guidelines will stop the current wide variation in DMT prescribing across England. Yes!

Dr David Paling Royal Hallamshire Hospital, Sheffield NIHR Sheffield Biomedical Research Centre Translational Neuroscience

#MSdebate

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Disclosures pt 1

  • I have been offered travel support and honoraria

for educational activites from Sanofi Genzyme, Biogen, Teva, Celgene, Merrk, MedDay

  • Our unit has been provided with research support

from Genzyme and Biogen.

#MSdebate

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Disclosures Pt 2

  • Over the weekend I realised that we were both

preparing the same side of the debate.

  • Gavin Giovannoni immediately changed sides
  • You are not voting for the nicest person

#MSdebate

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Pubmed – accessed 13/03/2018

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`

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When you stand on the shoulders of gods, it is difficult to comprehend the banality

  • f the common man

How hard this is for the new neurologist

#MSdebate

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Evidence

20 40 60 80 100 120 140 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Number of papers in PubMed per year for multiple sclerosis with drug name in the title

Glatiramer Acetate and Beta Interferon Natalizumab Fingolimod Di Methly Fumarate Alemtuzumab Cladribine

#MSdebate

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Evidence

50 100 150 200 250 300 350 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Number of papers in PubMed per year for multiple sclerosis with Beta Interferon, Glatiramer, Natalizumab, Fingolimod, Fumarate, or Cladribine in the title

Total

Does not include Ocrelizumab, Siponimod, Posenimod, Ofatunumab #MSdebate

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no

yes

Oh Dear

PHEW

#MSdebate

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NO YES YES - BUT

#MSdebate

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What about Glatiramer? NO YES

#MSdebate

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NO####

NO YES - but

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Yes - BUT

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YES YES YES

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YES Yes but be carefulNO

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YES - but

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2016/17 NHS England Spend on MS DMTs

Courtesy of Prof Coles, Cambridge

£249,417,164

15 new schools 5000 physiotherapists 150 per MS centre #MSdebate

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2016 MS Society Report

#MSdebate

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NHS England spend on MS drugs, 2016-2017: Ten highest spending Trusts

Courtesy of Prof Coles, Cambridge

5 10 15

INTERFERON BETA TERIFLUNOMIDE DIMETHYL FUMARATE FINGOLIMOD NATALIZUMAB ALEMTUZUMAB #MSdebate

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NHS England spend on MS drugs, 2016-2017: Ten middling spending Trusts

Courtesy of Prof Coles, Cambridge

£ Million

0.5 1 1.5 2 2.5 3 3.5 4 4.5

INTERFERON BETA TERIFLUNOMIDE DIMETHYL FUMARATE FINGOLIMOD NATALIZUMAB ALEMTUZUMAB #MSdebate

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NHS England spend on MS drugs, 2016-2017: Ten lowest spending Trusts

Courtesy of Prof Coles, Cambridge

0.001 0.002 0.003 0.004 0.005 0.006 0.007

INTERFERON BETA TERIFLUNOMIDE DIMETHYL FUMARATE FINGOLIMOD NATALIZUMAB ALEMTUZUMAB

£ Million

#MSdebate

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DMT decisions

  • Existing guidance is complex and contradictory
  • Amount of evidence is overwhelming
  • Stick to what you know

#MSdebate

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MS All Stars

  • Alasdair Coles, Cambridge (Chair)
  • Neil Robertson, Cardiff (Vice chair)
  • Adnan Dr Adnan Al-Araji, North Midlands
  • Belinda Waller, Edinburgh
  • Bob Brenner, London
  • Brendan Mclean, Cornwall
  • Bruno Gran, Nottingham
  • Gavin Giovannoni, London
  • Sian Price, Sheffield
  • Waqar Rashid, Sussex

896 papers in MS 1 paper a day 2.5 years

MS Advisory Committee

#MSdebate

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#MSdebate

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What does the algorithm do

  • Shows you all the rules and will inform Blueteq
  • Tells all regions to make all disease modifying

therapies available

  • Tells you what you need for your service
  • MS specialist consultant neurologist
  • MS specialist nurse
  • Specialist MS centre and its multi-disciplinary team.

#MSdebate

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Blueteq

#MSdebate

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MDT meetings

  • Complex cases or those where higher-risk disease-

modifying therapies (currently cladribine and the monoclonal antibody therapies) are proposed, should be discussed at a multi-disciplinary team meeting (MDT),

  • two MS specialist consultant neurologists
  • one specialist MS nurse,
  • access to neuro-radiology expertise.

#MSdebate

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MDT meetings

  • Set up in 2000 in cancer

services to address inequalities of care

  • Improve survival for

endometrial1,2 and ovarian cancers3

  • Get better with time4

1. Br J Cancer. 2013;109:2295–2300 2. Diseases of the Esophagus, vol. 19, no. 3, pp. 164–171, 2006 3. British Journal of Cancer, vol. 70, no. 2, pp. 363–370, 1994 4. MDT development. Available at https://www.england.nhs.uk/wp-content/uploads/2015/01/mdt-dev-guid-flat-fin.pdf

#MSdebate

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Will MDT meetings affect practise

#MSdebate

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Why will all this reduce disparities

  • Principle of obedience to authority
  • What those in power who you respect do
  • 10 of the finest minds in MS created the

algorithm

  • Principle of social proof
  • What those around you do.
  • MDT enables this

#MSdebate

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The proposed new NHS England MS Prescribing Guidelines will stop the current wide variation in DMT prescribing across England. Yes!

Dr David Paling Royal Hallamshire Hospital, Sheffield NIHR Sheffield Biomedical Research Centre Translational Neuroscience

#MSdebate

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It’s only the start

#MSdebate

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MS Academy

#MSdebate

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The proposed new NHS England MS Prescribing Guidelines will stop the current wide variation in DMT prescribing across England. Yes!

Dr David Paling Royal Hallamshire Hospital, Sheffield NIHR Sheffield Biomedical Research Centre Translational Neuroscience

#MSdebate