Background: Multiple Sclerosis (MS) has no cure and causes irreversible damage to the brain and spinal cord leading to physical and cognitive disability. Disease modifying therapy, such as fingolimod, must be initiated as soon as possible to slow the progression of disability in patients with MS. Prior to initiating therapy with fingolimod, patients are required to complete an electrocardiogram, eye exam, and blood tests (VZV antibody, CBC with differential, ALT, AST, and total bilirubin). These baseline tests are required within 6 months prior to fingolimod treatment initiation to ensure that the medication is appropriate and safe for the patient.
Objectives: The primary objective is to compare the difference in time to fingolimod treatment initiation prior to and after integration of a clinical pharmacy specialist in the outpatient MS clinic at Emory Healthcare. The secondary objective is to compare the percentage of patients prior to and after integration of a clinical pharmacy specialist who completed all baseline assessments within six months prior to treatment initiation.
Methods: A single-center, retrospective chart review was completed between 10/4/2010 and 9/16/2020. Data collection was performed on patients who were diagnosed with relapsing MS and prescribed fingolimod by an Emory Neurologist. Clinical Pharmacy Services (CPS) were implemented in the MS clinic in August of 2016. Clinical pharmacy services were defined as documentation by the pharmacist of involvement in therapy initiation. Encounters for fingolimod initiation that included pharmacist intervention were compared to encounters that did not include pharmacist intervention.
Results: Incorporation of a clinical pharmacy specialist to assist in fingolimod treatment initiation contributed to a 49% decrease in time to initiation. Time to treatment initiation with CPS intervention was 42.9 days, compared to 83.9 days without CPS intervention. Additionally, a significantly higher percentage of patients completed the required baseline assessments six months prior to fingolimod initiation with CPS intervention.
Conclusions: Integration of a clinical pharmacy specialist in the therapeutic management of MS patients is crucial to early intervention with disease modifying therapy. An additional analysis could be performed to compare clinical outcomes for the patients based on time to initiate fingolimod treatment. Furthermore, the significant increase in the percentage of patients who completed their baseline assessments prior to starting treatment increases the safe and effective use of fingolimod. As demonstrated in this project, utilization of pharmacists practicing within a multidisciplinary setting to optimize MS patient care is extremely beneficial.