The Importance of Pharmacist Involvement in Laboratory Adherence for Patients on Disease Modifying Therapy for Multiple Sclerosis, Utilizing a Clinical Dashboard

Background: Within Geisinger, clinical pharmacists working in Medication Therapy Disease Management (MTDM) have developed a laboratory (lab) monitoring protocol for disease modifying therapies (DMTs) with neurology. The protocol was developed to help safely monitor patients on DMTs and to prevent serious adverse events such as prolonged lymphopenia, liver damage, and progressive multifocal leukoencephalopathy (PML). Therefore, a clinical dashboard was developed to track and evaluate outcomes of lab adherence while on DMTs.

Objectives: To develop an improved, effective clinic process for safe monitoring and tracking of lab adherence outcomes while on DMTs. To show an improvement in the percentage of patients meeting lab adherence to DMTs based on an implemented protocol while utilizing a clinical dashboard.

Methods: This is a prospective cohort study comparing lab adherence between those followed by MTDM and those not followed by MTDM pharmacists using a clinical dashboard, capturing lab adherence data from the electronic health records (EHR) in a large integrated health system. Patients were included in the dashboard if identified with a diagnosis of multiple sclerosis (MS), seen at least once in neurology clinic, and prescribed a DMT.

Results: A total of 1,057 patients who were prescribed a DMT were identified on the dashboard, 836 patients were identified as followed by MTDM pharmacists while 221 patients were not followed by MTDM pharmacists. Patients on oral DMTs who were followed by MTDM versus non-MTDM had a higher percentage of patients meeting lab adherence for dimethyl fumarate (adherence to CBC/D and CMP are 91.7% and 92.7% for MTDM and 24.4% and 24.4% for non-MTDM, respectively), fingolimod (adherence to CBC/D and CMP are 94.7% and 93.2% for MTDM and 21.4% and 28.6% for non-MTDM, respectively), and teriflunomide (adherence to CBC/D and CMP are 93.1% and 94.6% for MTDM and 33.3% and 50% for non-MTDM, respectively). Patients on natalizumab who were followed by MTDM also had better lab adherence (adherence to CBC/D, CMP, and John Cunningham Virus (JCV) testing are 85.7%, 89.3%, and 87.5% for MTDM and 10%, 20%, and 20% for non-MTDM, respectively).

Conclusions: An MS clinic patient population on different DMTs at Geisinger showed that patients followed by MTDM had better lab adherence to protocol. Those followed by MTDM on injectable, oral, and infusion DMTs had significantly improved lab adherence.