This document outlines the process for setting up and managing an alemtuzumab service for treating multiple sclerosis. It discusses selecting appropriate patients, monitoring treatment and side effects, and establishing protocols. It also describes challenges such as ensuring long-term follow up and managing side effects like autoimmune diseases. Case studies demonstrate both successful outcomes and complications from alemtuzumab treatment.
1. Managing an
Alemtuzumab Service
Gail Clayton
Lead MS Clinical Nurse Specialist
&
Jacki Smee
MS Clinical Nurse Specialist
Cardiff and Vale University Health Board
2. Aims
Background on setting up Alemtuzumab
service
Patient selection
Infusion related and long-term side-effects
Ongoing monitoring requirements
Potential challenges
Case studies
3. Historical perspective
Consultant with special interest
appointed
A number of patients with highly
active / aggressive MS
2001 – Helen Durham
Cambridge trial
2002 – 1st patient treated in
Cardiff
Risk Sharing Scheme –
negotiated funding with WAG to
include all disease modifying
therapies
4. Setting up the service
Ad hoc
Limited staff knowledge
No patient information
MS nurse working 12 hour
days - competence?
No follow up and
monitoring
Keen to learn and develop
a protocol
10. So what do we do?
1.
2.
3.
4.
5.
6.
7.
Identify patients
Discuss at MDT
Admit to Neurology Day Unit
Patient information folder
Buddy system
In-patient prescription
Take home medications
In-patient prescription
23. Getting it right
Diagnosed Aug 2006
2007 x2
2008 Apr Oct
Rebif Nov 2008
2009 x2
2010 x4
Scanned 2010 new and
enhancing lesions
Treated Oct 2010 & 2011
Currently building houses
in Nepal for a charity
24. When all else fails
Diagnosed Nov 2008
Relapses 2009 x2
Rebif Oct 2009
2010 x3
2011 x1
Natalizumab Dec 2011
2012 x4
NABs +
Liaison with Cambridge
6 month washout
Alemtuzumab Nov 2012
Re-scan next week
26. Patient comments!
After my MS Campath treatment it felt like i had hit rock bottom, feeling useless,
drained and fatigued in a big way. Then a few months later i felt like Superman, felt
like i had been cloned. NOTHING CAN STOP ME, NOT EVEN MS !
Campath has given me my life back. Before my first infusion, life was steadily closing
in. I had no room to breathe between relapses, each one leaving me weaker than
before. Campath stopped MS in its tracks. I may still have the same symptoms as
pre-Campath, but there has been absolutely no disease progression since last
summer. A miracle? It certainly feels that way. I still get bad days, but they are more
than outweighed by the good. My son is no longer frightened at the decline in my
health. I am able to be fully-engaged in his life once more, a precious, priceless gift.
I received my first dose of Campath in November 2012. At this time I was confined to
a wheelchair because I was having relapse after relapse and was unable to walk.
Before recovering from one relapse I was going into another. I now work 4 days a
week in a school. I am so grateful to have been able to have this treatment, it has
made such a difference giving me back quality of life. I feel myself again!
27. Conclusions
Alemtuzumab is highly effective
at reducing relapses
Significant side-effect profile
Restrict use to
more aggressive disease
conventional treatments failures
Absolute need to ensure robust
long-term monitoring and
follow-up
Preceptorship
Graph showing relapses pre and post Campath treatment
20
19
18
Relapses
17
Patient 1
16
Patient 2
Patient 3
15
Patient 4
14
Patient (Number 1-19)
Patient 5
13
Patient 6
12
Patient 7
11
Patient 8
10
Patient 9
9
Patient 10
Patient 11
8
Patient 12
7
Patient 13
6
Patient 14
5
Patient 15
4
Patient 16
3
Patient 17
2
Patient 18
Patient 19
1
0
-1
-4000 -3500 -3000 -2500 -2000 -1500 -1000 -500
0
500
Time (Days Pre and Post Campath)
1000