PracticeUpdate Conference Series - ANZAN 2018

" We were all very pleasantly surprised … to observe such a robust reduction in risk of progressive multifocal leukoencephalopathy across all three definitions. Since efficacy is not captured by the TOUCH database, the next step will be to evaluate the efficacy of extended interval dosing of natalizumab. "

Dr. Zhovtis Ryerson concluded that in patients with John Cunningham virus antibody-positive MS, natalizumab extended interval dosing was asso- ciated with a clinically and statistically significant reduction in risk of PML vs standard interval dosing. “We were all very pleasantly surprised,” Dr. Zhovtis Ryerson said, “to observe such a robust reduction in risk of progressive multifocal leukoencephalop- athy across all three definitions. Since efficacy is not captured by the TOUCH database, the next step will be to evaluate the efficacy of extended interval dosing of natalizumab.” Tim Schultz, PhD, of the University of Adelaide in South Australia, and colleagues set out to evaluate home infusion of natalizumab. He explained that for peoplewithMS, monthly infusions at specialist clinics are time-consuming, potentially costly, and restrictive. Conversely, increased demand for hospital services drives innovation, including home delivery of care. Dr. Schultz and colleagues developed a rigorous model of care for home infusions of natalizumab and evaluated it in a randomized crossover trial. The pilot study tested the feasibility and safety of home infusions and compared the acceptability and clinical effectiveness vs usual clinic-based care in a hospital outpatient clinic. Thirty-seven stable adult patients were recruited who had received at least 6 prior natalizumab infusions and were assessed as safe by their neurologist. They were randomized to home or clinic-based infusions. After 3 infusions, patients crossed over to the alternate treatment for another 3 infusions. Treatment adherence, patient safety outcomes, quality of life (Multiple Sclerosis Quality of Life Inventory), and patient satisfaction were assessed.

A total of 2 patients moved out of Adelaide and withdrew. No adverse events were reported with either home or clinic infusion. No difference was observed in the adherence rate (86/104, 82.7% at home) and (84/103, 81.6% at clinic) (X 2 = 0.0), nor in the number of infections during home care (n=8) vs the clinic (n=10) (X 2 = 0.04). No difference was observed in any of the nine subscales of the Multiple Sclerosis Quality of Life Inventory. Of the four subscales of the Treatment Satisfaction Questionnaire for Medication (effec- tiveness, side effects, convenience, global satisfaction); patients who had most recently received home care were significantly more satisfied with the convenience of their treatment (P = .0008). Dr. Schultz concluded that the results suggested that delivery of infusions of natalizumab at home was feasible, safe, and as effective as in the hos- pital. Patients reported home infusions to be more convenient than those in the clinic.

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ANZAN 2018 • PRACTICEUPDATE CONFERENCE SERIES