By Dr Adrienn Petreczky, James Cook University Hospital, Middlesbrough
This audit was conducted to assess the prescribing practices at JCUH. The data was provided by MS nurses who run their own database and from Blueteq provided by regional Senior Neuropharmacist.
I was looking into which DMTs are prescribed at JCUH, the number of patients receiving treatment, the most frequently prescribed DMTs, the ration of first versus second line treatments and the trend in prescribing practices over the last 4 years using data from previous audits where they were available.
I have also compared the prescribing practices of JCUH with other regional Neurosciences centres, including DMTs prescribed and costs per patient.
The conclusion was that we had over 400 patients currently receiving DMTs. All 11 DMTs were available and prescribed. First line treatments (interferons, glatiramer acetate, teriflunomide and tecifedera) were prescribed for 78% of patients, second line treatment (cladribine, Fingolimod, natalizumab and alemtuzumab) were prescribed for 22% of patients.
Out of 1st line DMTs, interferons, in particular Rebif was most commonly prescribed
Out of 2nd line DMTs, Fingolimod and Natalizumab were the most commonly prescribed DMTs 36 patients in each group).
In terms of comparison between the Trusts, JCUH had similar number of patients receiving DMT as York, and slightly less patients than Leeds. The 2 outliers in the region were Newcastle with over 1,000 patients receiving DMT and Sunderland with 157patients. In terms of spent per patient JCUH was similar to Leeds. York Hospital NHS Trust spend the least amount per patient and Sunderland had spent the most per patient reflecting the fact that York hospital had a high proportion of patients receiving tecfidera compared to Sunderland who had high proportion of patients receiving Alemtuzumab.
In terms of trend in prescribing over the last 4 years, it appears that the number of patients receiving certain DMTs had grown exponentially (the data available for Fingolimod, tecfidera, teriflunomide and natalizumab between 2014 and 2018 shows increase in patient numbers between 40-90%). This will have implication for future cost and workforce planning for the department.