Research by Olivia Moswela

All of our attendees carry out a piece of research in an area of MS clinical practice or treatment that interests them.

This snapshot, which won the MS Academy MasterClass 6 Project Award 2019, gives you a quick idea of what they found and why. If you want to learn more, just click through to the full research report, or follow the links within the snapshot.

If you would like to contact the alumni who did the research, drop us a line and we’ll put you in touch where possible.

 

Aim

To examine baseline infection screening for the five high-efficacy disease-modifying treatments available for MS locally and determine their compliance to newly implemented local standards when compared to previously implemented SPC (summary of product characteristics) recommendations.

Headlines

  • There is no gold standard for infection screening or risk mitigation prior to starting a DMT
  • SPC recommendations are based on clinical trial results, which exclude those with known risk factors and often exclude those with known class effects experienced in other disease areas, alongside post-marketing pharmacovigilence reports
  • This study combined:
    • development of new local standards based on an analysis of real world practice and literature review
    • an audit of 83 records examining baseline infection screening prior to starting Alemtuzumab, Cladribine, fingolimod, Natalizumab and Ocrelizumab Compared compliance to SPC recommendations (data from Jan 2015-Nov 2018) to compliance with new local standards (data from Dec 2019 to April 2019).

Key findings

  • Relevant screening tests were undertaken in circa 60% of cases under SPC recommendations versus 100% of tests undertaken under new local standards
    • (with the exception of TB Elispot IGRA which was carried out in 49% of cases under SPC recommendations versus 88% of cases under new standards).
  • Screening found the following:
    • Measles IgG, Mumps IgG and Rubella IgG screening on 2 as immunisation records were unavailable
    • Latent TB x 2 (pre-alemtuzumab / natalizumab ) treated with isoniazid
    • HSV positive x 6
    • CMV IgG positive x 4
    • Multiple +ve viral screening tests (n=1) antibody/Immunoglobulin acquired from prior IVIg infusion?
    • Vaccine status check lists were not available to audit from clinical electronic records.

Core recommendations

  • Collaboration with other specialties to better manage risk e.g. infectious diseases
  • Develop toolkit for managing infection risks associated with MS DMTs
  • Consensus statement on managing infection risks associated with MS DMTs

More information