Home infusions of natalizumab for relapsing-remitting MS are feasible, more convenient and less expensive than usual administration of the monoclonal antibody in the clinic, researchers say.
A South Australian pilot study, randomised 37 adults on natalizumab for RRMS to home infusion delivered by nurses or usual clinic-based care for three infusions then crossed them over for the next three infusions.
Patients had been diagnosed for an average of 8–9 years, and been receiving natalizumab for nearly 5 years.
The study, published in Annals of Clinical and Translational Neurology, found no adverse events in either the home infusion or usual care groups. There was also no difference between infection rates in the home infusion and usual care groups.
Participants who had recently had home infusions were significantly more satisfied with the convenience of their treatment than those who most recently had infusions in the clinic.
“Convenience provided patients with autonomy and control over their medical appointments and lifestyle, and freed up time and capacity for family and work. Participants were able to flexibly change the timing of their medical appointment by contacting the infusion nurse; one participant even elected to have an infusion in their workplace,” the study said.
Quality of life as measured by SP-36 improved slightly between treatment periods for both groups of patients. Other quality of life measures also indicated fewer problems over time with no statistically significant interactions between group and treatment period.
Rates of treatment adherence were similar in both groups.
The study found the mean costs for an infusion at the clinic (nursing, consumables ward and non-clinical costs) was $538 versus $480 to deliver a home infusion (nursing time, travel costs, medical courier and insurance).
The mean “out of pocket” costs to patients were $16.70 at the clinic versus $0.30 at home while the mean time spent per infusion was 146 min in the clinic compared to 53.9 min at home.
“Time savings for home infusion patients (~90 min) have not been included in costings but likely contribute to the greater convenience of home infusions, which also includes greater accompaniment by a friend or relative,” the study said.
Despite study limitations such as a short-time frame and the small number of participants, the researchers led by Dr Tim Schultz from the Adelaide Nursing School, said home infusions of natalizumab were feasible.
The pilot study said large-scale studies were required to further test the findings, particularly around the safety and management of hypersensitivity adverse events in the home setting and for equivalence of clinical outcomes.
The study was funded by Biogen.
Image from Post-op Care at Home supplied by lead author.