[Natalizumab (Tysabri) prescription practices of neurologists in southern France]

Abstract

Introduction: Tysabri is indicated as single-drug disease-modifying therapy in patients with highly active relapsing remitting multiple sclerosis (RRMS). Potential risk for opportunistic infection and especially for progressive multifocal leucoencephalopathy has implied specific guidelines for use. The purpose of this study was to ascertain the prescription practices of neurologists in southern France and to learn more about how the drug is used in clinical practice compared with management guidelines stated in the product's characteristics and national recommendations.

Methods: We developed a questionnaire which was sent to all neurologists practicing in our region, whether they had multiple sclerosis patients or not. Questions regarded demographic data (geography, practice in hospital or private office), current knowledge on natalizumab (mechanism of action, indications), monitoring of treated patients (pre-therapeutic and therapeutic check-up), rescue decisions and overall experience with using natalizumab.

Results: Two hundred fifty neurologists, practicing in eight administrative districts in our region, were contacted. Demographic data showed that most of them were prescribing Tysabri. Patients treated with Tysabri were mostly followed in teaching hospitals (79%). Concerning knowledge about natalizumab, neurologists applied the recommended check-up (73%) but most of them preferred prescribing Tysabri as a second line of treatment after IFN failure (66%). Inefficacy was mainly evaluated on clinical parameters (one or two relapses under treatment with sequels or EDSS progression in each answer); MRI was only useful to confirm clinical conclusions, but for the neurologists, gadolinium enhancement was required to confirm lack of efficacy.

Discussion: Results tended to show that, in clinical practice, despite some deviation from national guidelines, the recommended precautions are applied for the use of Tysabri. Neurologists considered that Tysabri is other immunosuppressant drugs used in RRMS. Further medical information might be useful to improve compliance with all of the recommended indications and standard practices for patient follow-up.

Conclusion: This survey enabled an assessment of current knowledge about Tysabri as a treatment for RRMS patients and to learn more about how it was used in real life practice during its first year of marketing in France.