A pilot randomized crossover study has found that there was no difference in the safety and efficacy between clinical and home infusions of natalizumab in patients with multiple sclerosis (MS), according to a study published in the Medical Journal of Australia.
Natalizumab is an intravenous infusion commonly administered under physician supervision in patients with relapsing-remitting multiple sclerosis. Although generally tolerated, a few adverse drug reactions have been reported, such as hypersensitivity, infections, and fatigue. The main adverse reaction of concern is opportunistic infection by the John Cunningham Virus (JCV), which is characterized by progressive multifocal leukoencephalopathy (PML).
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There is a global trend towards delivering health care in the community when possible. This is because this approach confers benefits such as reduced nosocomial infections, greater patient choice and flexibility, and reduced out-of-pocket expenditure. Recently, the home infusion of infliximab in patients with Crohn’s disease suggests that home infusions of monoclonal antibodies might be safe and effective. It is on this basis that the home infusion of natalizumab in MS patients was being investigated.
Researchers recruited MS patients (who were JCV-negative) from the Royal Adelaide Hospital Ambulatory Care Day Unit in Australia from November 2016 to January 2017. A total of 37 patients were recruited and randomized to clinical care (n=19) and home care (n=18). To reduce the risk of PML, every patient treated in both the clinical and home setting was asked to fill in a questionnaire prior to treatment to assess new symptoms that might be suggestive of PML.
Of the 37 patients recruited, 2 were lost to follow-up. The remaining 35 patients did not report any adverse side effects, regardless of where they were treated. Between the two methods of treatment, there were no differences in infection rates (P =.84) and adherence (P =.71). Patients who received home treatment reported greater satisfaction with the convenience of the treatment (P =.008). Home treatment was also significantly cheaper than clinical treatment (A$74 vs A$16).
Schultz TJ, Thomas A, Georgiou P, et al. Home infusions of natalizumab for people with multiple sclerosis: a pilot randomised crossover trial. Ann Clin Transl Neurol. Published online July 21, 2021. doi:10.1002/acn3.51410