Research by Dr Jessica Vaz

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

This project was runner up for the MS Academy MasterClass Project Award for 2018, and this snapshot 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 optimise treatment for MS patients on disease-modifying treatments (DMTs) by testing for the JC virus (JCV) antibody to help reduce the risk of PML developing.

Headlines

  • Jersey Hospital has around 200 people with MS, mostly relapsing-remitting.
  • relapsing category.
  • The most common DMT for Jersey’s relapsing-remitting MS (RRMS) patients is TYSABRI with 65 patients currently on monthly TYSABRI infusions.
  • PML is a rare and potentially fatal virus in the brain caused by JCV. One of three factors known to increase the risk of PML in TYSABRI-treated patients is the presence of anti-JCV antibodies.
  • 300 samples taken from 2012-2018 were tested for JCV antibodies
  • Several changes to the DMT service were made, including patient education, risk assessment, increased monitoring and movement from TYSABRI to other DMTs

Key findings

As part of this research, the MS team on Jersey:

  • Created a dedicated high titre clinic for RRMS on TYSABRI with high index values
    • 15 patients used this
    • newly created PML risk calculator was used
  • Introduced PML education for patients to help them detect symptoms early and understand the severity of the risk
  • Discussed with patients a move from TYSABRI to more effective or lower risk DMTs
    • 13 patients chose to move to Gilenya, 2 of whom had relapses and fully recovered after oral steroids.
    • 2 decided to remain with TYSABRI despite risks, and signed written consent forms.
  • Started imaging and lumbar puncture testing
    • Set up fast track MRI scans by liaising with the Radiology department
    • Liaised with the Virology lab / Unilabs to set up CSF JCV DNA testing
  • Specific monitoring for risks associated with the DMT Gilenya were set up:
    • early appointments for OCT (optical coherence tomography) scans in liaison with Ophthalmology
    • liaison with clinical investigations for early cardiac monitoring

Core recommendations

  • Advise patients starting on TYSABRI of the risk of PML and take baseline MRI (within 3 months), and anti-JCV antibody test, before starting treatment.
  • Make sure patients on DMTs are monitored regularly:
    • TYSABRI patients monitored to be given a neurological examination regularly and a full brain MRI once a year
    • Patients at higher risk of PML to have MRIs every 3-6 months using an abbreviated protocol (full report, scroll to Recommendation 3)
    • If PML is suspected, the MRI should include contrast-enhanced T1-weighted and CSF for the presence of JC virus DNA.
    • If PML is suspected at any time, treatment with TYSABRI must be stopped until PML has been excluded.
  • Test / re-test for anti-JC virus antibodies:
    • every 6 months in antibody-negative patients
    • every 6 months in low-index patients once they reach the 2-year treatment point
  • Re-discuss PML risk with TYSABRI patients after 2 years of treatment
  • Continue to be vigilant about the risk of PML for up to 6 months after treatment with TYSABRI stops.

 

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