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Systematic multidimensional clinical point-of-care monitoring of people with multiple sclerosis using 3test
Author(s): ,
K. Allen-Philbey
Affiliations:
The Royal London Hospital, Barts Health NHS Trust, Clinical Board Medicine (Neuroscience)
,
O. Yildiz
Affiliations:
The Royal London Hospital, Barts Health NHS Trust, Clinical Board Medicine (Neuroscience); Barts and The London School of Medicine & Dentistry, Queen Mary University of London, Blizard Institute (Neuroscience)
,
D. Raciborska
Affiliations:
The Royal London Hospital, Barts Health NHS Trust, Clinical Board Medicine (Neuroscience)
,
A. Stennett
Affiliations:
The Royal London Hospital, Barts Health NHS Trust, Clinical Board Medicine (Neuroscience)
,
J. Mathews
Affiliations:
The Royal London Hospital, Barts Health NHS Trust, Pharmacy, London, United Kingdom
,
B. Turner
Affiliations:
The Royal London Hospital, Barts Health NHS Trust, Clinical Board Medicine (Neuroscience); Barts and The London School of Medicine & Dentistry, Queen Mary University of London, Blizard Institute (Neuroscience)
,
G. Giovannoni
Affiliations:
The Royal London Hospital, Barts Health NHS Trust, Clinical Board Medicine (Neuroscience); Barts and The London School of Medicine & Dentistry, Queen Mary University of London, Blizard Institute (Neuroscience)
K. Schmierer
Affiliations:
The Royal London Hospital, Barts Health NHS Trust, Clinical Board Medicine (Neuroscience); Barts and The London School of Medicine & Dentistry, Queen Mary University of London, Blizard Institute (Neuroscience)
ECTRIMS Online Library. Allen-Philbey K. Oct 12, 2018; 228873; P1031
Kimberley Allen-Philbey
Kimberley Allen-Philbey
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Abstract: P1031

Type: Poster Sessions

Abstract Category: Clinical aspects of MS - Clinical assessment tools

Introduction: Disease modifying treatment (DMT) of people with advanced MS (EDSS ≥6.5) is an unmet need. The (non-parametric) EDSS is labour-intensive and relatively insensitive to changes not affecting ambulation, particularly at scores >4. Both the neuroanatomical observation that >50% of cortico-spinal tracts terminate at the cervical level as well as trial data suggesting length-dependency of axonal damage indicate that DMT in advanced MS may preserve function in shorter tract systems. However, due to the regulatory environment of drug development, people with advanced MS (pwAMS) are largely excluded from DMT trials.
Objective: To establish regular parametric data collection in order to (i) inform DMT decisions and (ii) improve characterisation for recruitment of pwMS in clinical trials.
Methods: pwMS underwent a clinical test battery (3test) at the Royal London Hospital, consisting of the symbol digit modality test (SDMT; cognition), 9-hole-peg-test (9HPT; upper limb), and 25ft walking test (25ftTW; lower limb), recorded in the BartsMS database. pwMS consented to the National MS Register to record patient reported outcomes (PROs) including the “webEDSS”. Standardised data from the BartsMS database and UK MS Register was electronically linked and visualised in a clinical portal for interpretation by the clinical team and pwMS.
Results: 334 pwMS (EDSS 0 - 8.5; mean age 44.5 years, 206 female) were assessed annually. 64% had a relapsing and 36% a progressive disease course. 82/334 pwMS were not on DMT. Follow-up at one and two time points was obtained in subsets of 82 and eight pwMS, respectively. On-site assessments were technically and logistically feasible within 15 minutes. Mean time for 9HPT was 34.5±69.7 and 36.1±83.9 seconds for dominant and non-dominant hands respectively. Mean 25ftTW was 8±5 seconds. Mean SDMT score was 49.7±16.1. PROs provided insights into quality of life (QoL). The clinical portal contained clinically meaningful data displayed in an engaging format.
Conclusion: 3test is a simple clinical monitoring battery to benefit (i) patient management and (ii) trial recruitment, including pwMS with EDSS ≥ 6.5. Longitudinal data collection may unravel natural history, disease evolution and treatment responses. Standardisation of a simple, yet regularly collected dataset may improve performance assessment between centres and consolidate clinically meaningful benchmarks.
Disclosure: Kimberley Allen-Philbey: nothing to disclose. Ozlem Yildiz: nothing to disclose. Dominika Raciborska: nothing to disclose. Andrea Stennett: nothing to disclose. Joela Mathews has received advisory board fees from Novartis and Merck. Ben Turner has received travel bursaries, grants and advisory boards fees from Biogen, Roche, Sanofi-Aventis, Novartis and Merck. Gavin Giovannoni has received research support from Takeda and compensation for participating on Advisory Boards from Abbvie, Almirall, Atara Bio, Biogen, Sanofi-Genzyme, Genentech, GSK, Merck, Novartis, Roche and Teva. Klaus Schmierer has been a PI of trials sponsored by Medday, Roche and Teva and involved in trials sponsored by Biogen, Sanofi-Genzyme, Novartis and Canbex.

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