Home administration of intravenous methylprednisolone for multiple sclerosis relapses: the experience of French multiple sclerosis networks.
BACKGROUND
One single center study has provided support for a home-based approach to the therapeutic management of multiple sclerosis (MS) relapse.


OBJECTIVE
To report a multicenter series of patients with MS who were treated at home for a relapse with a 3-day course of intravenous methylprednisolone.


METHODS
The home administration of intravenous methylprednisolone was coordinated by four MS networks in France; patients with MS with a relapse were referred by their neurologists, and treatment was administered by a local nurse. We analyzed the safety and efficiency of this approach and estimated the related cost savings. Patients completed a patient satisfaction questionnaire.


RESULTS
Eight hundred and seven patients received intravenous methylprednisolone at home. The mean disease duration was 10.3 +/- 7.9 years. Treatment was often prescribed by community-based neurologists. The delay between prescription and treatment was 2.8 +/- 0.5 days if treatment was initiated at home and 1.9 +/- 3.0 days if treatment was initiated in hospital (the subsequent two injections were always administered at home). Home treatment was well tolerated; three serious side effects requiring hospital transfer were observed (anxiety, thoracic oppression, and arrhythmia), which were fully reversible. Overall, 93.8% of patients were satisfied with the treatment approach, and 98% wished to receive future treatment courses at home. The overall cost savings of home-based treatment versus hospital-based treatment were evaluated at EUR1,091,482.


CONCLUSIONS
Safety data, patient satisfaction, and economic considerations support home-based treatment of MS relapses with intravenous methylprednisolone, provided strict patient selection criteria are observed and the process is coordinated and closely monitored by an MS network.
Créange
A
A
Réseau SINDEFI-SEP, Créteil, France. alain.creange@hmn.aphp.fr
Debouverie
M
M
Jaillon-Rivière
V
V
Taithe
F
F
Liban
D
D
Moutereau
A
A
Clavelou
P
P
Defer
G
G
D000328:Adult; D017046:Cost Savings; D016208:Databases, Factual; D005260:Female; D005602:France; D040362:Geographic Information Systems; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D005102:Health Expenditures; D006699:Home Care Services / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy* / Q000191:economics; D009313:National Health Programs / Q000191:economics / Q000458:organization & administration*; D010043:Outcome and Process Assessment, Health Care; D017060:Patient Satisfaction; D055502:Secondary Prevention; D011795:Surveys and Questionnaires
D005938:Glucocorticoids; D008775:Methylprednisolone