AttackMS is a trial by ProfK that offers the individual the chance to get on natalizumab rapidly after entry into the health care system with the opportunity to receive natalizumab whilst the diagnostic work-up occurs and then to either stop treatment – if the diagnosis of CIS or MS is not confirmed – or continue taking natalizumab as a first line treatment, or switch to an alternative, knowing that natalizumab is active very quickly and the second attack is more likely to be controlled. However, getting on treatment within 2 weeks is a tall order based on standard time to appointment and time to treatment.
Is this possible? Well, that is a question of the trial, but I can say this. It is not the norm…
From http://www.myplannedcare.nhs.uk, you can get the:
(a) Average waiting time for first outpatient appointment at this hospital for this specialty
(b) Average waiting time for treatment at this hospital for this specialty
This is available by regions in England, (a) North West, (b) North East & Yorkshire (c) Midlands (d) East of England (e) South East, (f) SouthWest and (g) London.
I extracted information for all NHS Trusts (NHSTs) or NHS Foundation Trusts (NHSFTs), and then looked specifically searched for Neurology. First thing to say is that many regional hospitals have no details for Neurology at all, which already shows there are marked differences in availability of neurology across England (paediatric neurology was excluded from the analysis). The search was done on 31 July 2023.
For (i) the median waiting time was 19 weeks (range 6-35 weeks).
For (ii) the median waiting time was 20 weeks (range 5-33 weeks)
Now, there are three main sites for recruitment for AttackMS in London (though you can be referred to one of them rapidly from anywhere in the UK – just tell the HCPs you are dealing with to get in touch via email@example.com), so what are their current routine waiting times?
Barts Health NHST (i) 17 weeks (ii) 20 weeks
St George`s University Hospitals NHSFT (i) 13 (ii) 14 weeks
Chelsea & Westminster Hospital NHSFT (i) 17 weeks (ii) 17 weeks
I predict we can do it, and it is one aim of the trial, that is can we recruit and treat within 2 weeks, and another question is: Is there repair by switching off the immune attack?
If you know anyone with a neurological event suggestive of MS get them referred to one of these three centres, or simply email firstname.lastname@example.org for an inquiry. It may be a chance to get on a highly effective treatment very, very quickly, or the team may say hey we don’t think you have CIS/MS, but you get seen within a day or two, not 13 or 17, or indeed 35 weeks later (by which time *all* participants who fulfil the criteria for AttackMS will already be on treatment since from week 12, *all* participants receive natalizumab!
Here are the waiting times of all NHSTs with Neurology specifically mentioned as an available speciality across England; make of them what you will:
It is there for all to see. Remember, this *all* Neurology appointments, not just MS. It would be nice to get a feel of the prescribing habits of different places as it speaks to equality of services and points at the odd ones out… maybe in a good way, maybe not. Transparency is what you should get. Nottingham at one end and Hampshire at the other.
CoI: I am a member of the trial management team of AttackMS. ProfK is chief investigator of the trial.
Acknowledgement: AttackMS is sponsored by Queen Mary University of London, and funded by Biogen.
Disclaimer: My views only.