Safe monitoring of natalizumab therapy in multiple sclerosis

Abstract

Natalizumab is one of the most effective therapies for relapsing-remitting multiple sclerosis. One complication is progressive multifocal leucoencephalopathy, a viral brain infection caused by John Cunningham virus (JCV). Monitoring of neurological symptoms, JCV serology and regular brain imaging are required to ensure safe use of this therapy. Local audit data from 2015 indicated poor compliance with safety monitoring: under 25% of investigations were within recommended timeframes. Subsequently, a protocol was implemented to improve monitoring, with specialist nurses coordinating requests for MRI scans and arranging JCV serology, with frequency determined according to JCV index. A re-audit assessed the impact of this protocol (n=155). Some 97.4% of patients were appropriately tested for JCV and 88.4% were imaged within the recommended interval. Additional work with the informatics and virology team ensured serology results became more easily accessible. The use of a standardised, nurse-led operating procedure has resulted in marked improvement in the safety monitoring of natalizumab.