Time from DMT decision to starting therapy Dr. Orla Tuohy Locum - - PowerPoint PPT Presentation

Time from DMT decision to starting therapy

• Dr. Orla Tuohy

Locum consultant neurologist; Queen Alexandra Hospital Portsmouth and Southampton General Hospital

Background

• NICE guidelines (2014) and quality statements (2016) –

don’t comment on DMTs

• ABN 2015 guidelines – ‘The ABN recommend starting

treatment as early as possible in eligible patients’. ‘All individuals with active relapsing–remitting MS should be considered expeditiously for treatment’.

• Increasing complexity of DMT decision-making
• Pre-treatment work-up requirements

Background

• Specialist MS clinic in Wessex neurological centre/UHS
• Referrals from a substantial geographical area
• 5-6 neurologists doing multiple sclerosis clinics; 5 multiple

sclerosis nurse specialists

• MS MDT alternate weeks – for discussion of patients

being considered for higher efficacy treatments

• Monthly DMT information sessions for first-line therapies

Objectives

• To review the time taken, from DMT-, or DMT strategy

selection, to starting treatment

• To identify any trends or variation in timing; e.g between

moderate versus higher efficacy DMTs

• To identify any potential areas for improvement

Methods

• Review the details of new patient attendances in multiple

sclerosis specialist clinics in January and February 2019

• In patients who were eligible for DMTs to collect data on

DMT, time taken from decision on particular DMT to prescription

DMTs and numbers

• n=40 patients; 8 excluded as not DMT eligible [not MS

n=2; progressive MS n=2; already started on DMT elsewhere n=3]

DMT n

IFN/GA 12 DMF 10 Fingolimod 1 Natalizumab 4 Alemtuzumab 2 Cladribine 2 Ocrelizumab 1

Time to start treatment

Mean min max IFN/GA (n=12) 1.5 months 0.25 9 DMF (n=10) 2.1 months 0.5 6 Natalizumab (n=4) 2.8 months 1.5 4 Alemtuzumab (n=2) 2 months 2 2 Cladribine (n=1) 2 months n/a Ocrelizumab (n=1) 3 months n/a

p-value for comparison of IFN/GA vs Natalizumab; p=0.4

Observations

• Time to start treatment longer for higher efficacy versus

moderate efficacy drugs (although not statistically significant)

• Natalizumab – consent, JCV serology and results,
• Alemtuzumab – +/- group information session, pre-

assessment visit, consent

• Ocrelizumab – consent, pre-assessment visit

Proposed improvements

• Nurse-led consenting
• Weekly MDT or virtual MDT
• Increased capacity to allow earlier pre-assessment clinic

appointments

• Electronic DMT information sessions