Interventions to Increase Leukocyte Testing during Treatment with Dimethyl Fumarate

Area of Science:

• Pharmacovigilance
• Clinical Quality Improvement
• Multiple Sclerosis Therapeutics

Background:

• Dimethyl fumarate (DMF) is a multiple sclerosis (MS) treatment associated with potential leukopenia and infection risks.
• Periodic white blood cell (WBC) monitoring is crucial for patients on DMF therapy.
• The US Department of Veteran Affairs (VA) implemented a safety program to identify patients on DMF lacking documented WBC counts.

Purpose of the Study:

• To evaluate the effectiveness of interventions aimed at improving WBC monitoring in patients prescribed DMF within the VA system.
• To identify specific interventions associated with higher WBC monitoring rates.
• To assess the impact of multiple interventions on monitoring adherence.

Main Methods:

• A survey was distributed to 118 VA sites treating patients with DMF between January 1, 2016, and September 30, 2016.
• Sites were queried on the use of seven specific interventions to enhance WBC monitoring.
• A multivariate analysis was conducted on data from 92 responding sites (78% response rate) involving 1115 patients.

Main Results:

• The mean WBC monitoring rate across responding sites was 54%.
• Academic detailing was associated with a 17% increase in WBC monitoring rates (p=0.011).
• Provider education increased monitoring rates by 9% (p=0.037), and each additional intervention increased rates by 3.8% (p=0.005).

Conclusions:

• Physician-centered interventions, particularly academic detailing, are effective in improving WBC monitoring for DMF-treated patients.
• Implementing multiple interventions can further enhance monitoring adherence.
• These findings support targeted quality improvement strategies to mitigate risks associated with DMF therapy.