Real-World, Individualized, Comprehensive Patient Education and Support Procedures to Optimize Treatment Experience with Alemtuzumab

Background: Alemtuzumab is a high-efficacy disease-modifying therapy for RRMS administered as 2 annual infusion courses. Infusion-associated reactions with alemtuzumab are minimized with prophylactic medication, and monthly monitoring for autoimmune adverse events (AEs) is required for 48 months after the last infusion. Patient education, typically provided by advanced practice clinicians (APCs), is key to achieving the best treatment outcomes. 

Objectives: To describe real-world education and support procedures developed at Riverhills Neuroscience (Cincinnati, OH) for alemtuzumab patients, with the aim of optimizing the patient experience, adherence to safety monitoring, and outcomes.

Methods: The introductory visit, conducted by an APC and individualized for each patient, is designed to foster understanding of alemtuzumab’s mechanism of action (MoA), possible AEs and their signs and symptoms, and timing of prophylactic medications, blood draws, and required appointments. Before the visit, the patient receives informational pamphlets, prescribing information, and clinician’s contact information. The patient is encouraged to bring a family member or support person to the initial visit, which begins with a patient history and physical examination, including skin and thyroid; abnormalities trigger specialist referral. An education session explains MS pathophysiology and alemtuzumab MoA, including lymphocyte depletion/repopulation after treatment, and potential AEs; the importance of adhering to monthly blood monitoring for autoimmune AE surveillance is also discussed. Infusion procedures are reviewed, including medications required before, during, and after infusion. Patients receive a schedule of their prophylactic medications and infusion, which is especially important for patients with cognitive impairment, along with pre-infusion reminder telephone calls for medication initiation and blood draws; post-infusion blood draw reminders are provided during one-to-one follow-up visits. 

Results: As of December 2016, our center has treated 5 patients with alemtuzumab; 7 have undergone the patient education program. Compliance with pre-infusion medication was 100%. Patients’ perception of alemtuzumab is more positive after education.

Conclusions: Comprehensive education and support by APCs throughout the alemtuzumab infusion and monitoring period can reassure patients and optimize their overall experience and adherence, which may lead to improved treatment outcomes.