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 2 months 2 2 (n=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