Home care..Natalizumab style

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During the pandemic, avoiding hospitals has been advantageous. Natalizumab is usualy infused in hospital. In this study they looked at infusing at home and they concluded it was safe and cheaper to infuse at home. However, I would start to ask why bother?

Subcutaneous natalizumab has been approved and whilst this will be intially administered in the hosptial environment…I can easily see that it will be administered at home and then you can get rid of the infusion costs. In the UK this would not matter to the Doctors and it would save on 20% Value Added Tax. Because drugs administered in hospitals are taxed.

I guess you know on take-Aways you don’t pay tax on food………it’s also the case with drugs also.

However the subcutaneous natalizumab was not yet approved in the USA. This suits the neuros because they can charge for infusions.

So home subcutanous injection may be the way to go, this is being offered with ofatumumab…I suspect it is a matter of time before natalizumab goes that way. Let’ s see

COI mutiple but none considered relevant

Schultz TJ, Thomas A, Georgiou P, Juaton MS, Cusack L, Simon L, Naidoo K, Webb K, Karnon J, Ravindran J. Home infusions of natalizumab for people with multiple sclerosis: a pilot randomised crossover trial. Ann Clin Transl Neurol. 2021 Jul 21. doi: 10.1002/acn3.51410. Epub ahead of print. PMID: 34288591.

Objective: The delivery of healthcare at home has expanded to intravenous infusions of monoclonal antibodies. A recently developed model of care for home infusions of natalizumab for people with relapsing-remitting multiple sclerosis was evaluated. This pilot study of home infusions of natalizumab and usual care (attendance in a hospital out-patients’ clinic) compared safety, feasibility, patient satisfaction, effectiveness and costs.

Methods: In this randomised AB/BA crossover trial, 37 adults were randomised to usual care (n = 19) or home infusions (n = 18). After three infusions, patients crossed over to the alternate treatment for another three infusions. Patient safety outcomes and adherence, satisfaction, quality of life, disability and costs were compared.

Results: No adverse events were recorded from 207 infusions from 35 patients across both home and clinic infusions. There was no difference in adherence (p = 0.71) and infection rates (p = 0.84) between home and clinic settings. Satisfaction with “convenience” of home infusions was significantly greater (p = 0.008) but there were no differences in quality of life measures. Excluding pharmacy, costs were A$74 lower per infusion at home, including A$16 of patients” out-of-pocket costs.

Interpretation: There were no differences in safety and effectiveness between clinic and home infusions of natalizumab. The home infusions were shown to be feasible, more convenient and less expensive than usual care. Larger scale studies are required to verify these preliminary findings, particularly around safety and management of hypersensitivity adverse events in the home setting and for equivalence of clinical outcomes.

Disclaimer: Please note that the opinions expressed here are those of the author and do not reflect the positions of the Barts and The London School of Medicine and Dentistry nor Barts Health NHS Trust or Queen Mary Univeristy of London.

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MouseDoctor

4 comments

  • I’ve been having natalizumab infusions at home for 15 months now via my hospital’s hospital in the home service. It takes about 45 mins to an hour all up on the fast protocol – a few mins for set up, paperwork and obs, 30 minute infusion, 3 minute flush and then packing up. I then discharge myself AMA and the nurse heads off to their next patient. To my knowledge, there are two hospitals in my region offering this service (the one in the study is in another city).

    I love it. I almost would rather have the infusion than have to do an injection myself! It’s much easier than a hospital-based service. I’ve had nurses hide off screen while I’ve been in video calls, have had the opportunity to talk to someone outside my family or work face to face, even when we’ve been under very tight restrictions.

    Anecdotally, the nurses have all said how they’ve enjoyed the introduction of the infusions to their rounds, and learning more about MS. I guess it’s a change from dressings and wound care.

  • I drove 60 miles for Tysabri every 28 days for the infusion x 6 years (then Lemtrada x 2 rd’s), I would obviously prefer home vs the infusion site at Dr’s office. Not sure about tolerating long term self injectioning (the IV stick is frustrating as well). If the Interval is every 28 days or longer dI might reconsider. If we had access to aHSCT, we wouldn’t need maintenance MS DMT’s regularly, forever, they are bandaids, repeat.

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