Local MS DMT practice – Time from decision to treatment
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Current guidelines suggest that DMT should be started as soon as possible for eligible patients. However, there is no standardised time specified.
To assess if all the patients were selected and treated as per national guidelines. To assess the time from decision to actual commencement of DMT at Pinderfields Hospital, MYHT.
A retrospective review of notes and database of 21 patients who started or due to start DMT over 6 months (10/2018-03/2019) was conducted at Pinderfields Hospital which is a MS treatment centre.
We noted the duration from ‘treatment decision’ to ‘the prescription of DMT’ was 4 weeks in 43% cases, 4-8 weeks in 19%, 8-12 weeks in 24% and >12 weeks in 14%. This does not include the date of commencement by patient who were prescribed first line injectable or oral drugs. There was one definite spinal cord relapse with MRI symptomatic lesion just after starting Tecifdera.
The existing data lacked the date of order and delivery/receipt by patient particularly for first line drugs. We assume it takes 2 weeks for the prescribed first line drugs to be delivered by Home care. Patients take time to choose after receiving information on DMTs which in turn contributes to the delay. There is no national standard for treatment commencement time which could be due to the variability of service provision in different setups and vice versa.
We recommend establishing a robust database to specify the above lacking data. We propose that a national audit may prove to be propitious in exploring the nationwide practice and could drive the MS centres to standardise the treatment pathway.