PO118 An audit of natalizumab initiation, termination and monitoring

Abstract

BackgroundNatalizumab is highly effective in relapsing-remitting multiple sclerosis (RRMS). However, prolonged treatment is associated with increasing risk of progressive multifocal leukoencephalopathy (PML), with treatment-associated risk up to 1:125 in some patients.MethodsWe audited the use of natalizumab at St George’s Hospital against NICE and NHS England criteria, examining documented reasons for initiation, ongoing monitoring and termination of treatment between 2014–2016.Results19 patients (15F) initiated treatment, 5 of whom later stopped/switched treatment (PML risk (1), continued relapses (1), pregnancy (2), progressive disease (1)). 2/3 patients were re-consented at JCV seroconversion. Only 1/19 patient was informed of stopping criteria prior to treatment initiation. 15/19 patients had treatment duration >3 months, of whom 9/15 had regular Consultant reviews. 12/15 had the presence/absence of relapses and 5/15 had EDSS explicitly documented.ConclusionsAlthough natalizumab is being initiated appropriately, there is inadequate discussion of stopping criteria. Improved documentation is required around disability including EDSS. Potential solutions include clear stopping criteria in patient information leaflets and patient self-monitoring of EDSS. The importance of a full multiple sclerosis team with specialist therapies nurses is highlighted.