BackgroundInjectable disease-modifying drugs (DMDs) reduce the number of relapses and delay disability progression in patients with relapsing–remitting multiple sclerosis (RRMS). Regular self-injection can be stressful and impeded by MS symptoms. Auto-injection devices can simplify self-injection, overcome injection-related issues, and increase treatment satisfaction. This study investigated patient responses to an electronic auto-injection device.MethodsPatients with RRMS (n = 63), aged 18–65 years, naïve to subcutaneous (sc) interferon (IFN) β-1a therapy, were recruited to a Phase IV, observational, open-label, multicenter study (NCT01195870). Patients self-injected sc IFN β-1a using the RebiSmart™ (Merck Serono S.A. – Geneva, Switzerland) electronic auto-injector for 12 weeks, including an initial titration period if recommended by the prescribing physician. In week 12, patients completed a questionnaire comprising of a visual analog scale (VAS) to rate how much they liked using the device, a four-point response question on ease of use (‘very difficult’, ‘difficult’, ‘easy’, or ‘very easy’), and a list of ten device functions to rank, based upon their experiences.ResultsSix patients (9.5%) discontinued the study: one switched to manual injection; two discontinued all treatment; three changed therapy. In total, 59 out of 63 patients (93.7%) completed the VAS; 54 out of 59 (91.5%; 95% confidence interval: 81.3%–97.2%) ‘liked’ using the electronic auto-injector (score ≥6), whereas 57 out of 59 (96.6%) rated the device overall as ‘easy’ or ‘very easy’ to use. Device features rated as most useful were the hidden needle (mean [standard deviation] score: 3.3 [3.01]; n = 56), confirmation sound (3.9 [2.45]), and multidose cartridge (4.6 [2.32]). The least useful functions were the dose history list (8.0 [2.57]) and dose history calendar (7.5 [2.30]).ConclusionsThese findings suggest that the electronic auto-injector may be suitable for patients who are new to injectable DMD therapy. Devices that simplify the injection process may help to ensure that patients receive the full benefits of treatment.

This action research study was conducted over an 18 month period within a district general hospital. The study has improved the quality of the service provided to people experiencing a relapse of multiple sclerosis. The authors now identify and treat a three-fold increase in relapse patients. At least 85% of these patients are treated within 10 days of reporting symptoms to a specialist nurse. Before the study, only 12% of patients received treatment within this time. The authors' data identify what patients valued about this service and also inform debate around distress associated with relapse and how services should develop to respond to this. The study is of particular importance to the UK because the National Institute for Clinical Excellence (NICE) has published guidance to the NHS about the management of this specific patient group (NICE, 2003). This study also clearly demonstrates how specialist nursing services can combine a substantial clinical role with instigating and managing change in service delivery that results in improvements in patient care.

The role of the multiple sclerosis (MS) nurse is constantly evolving, owing to the introduction of new MS therapies and new patient treatment KeywordsMultiple sclerosis (MS) specialist nurse, MS nurse role, patient communication, MS nurse-patient relationships, MS therapies Disclosure: Chrysa Chrysovitsanou has no conflicts of interest to declare. Del Thomas has received honoraria and consultation fees from Merck Serono, Teva and Novartis.Martin Duddy has received honoraria for lectures and consultancy, expenses and hospitality for educational meetings from Bayer, Biogen Idec, Merck Serono, Novartis and Teva. He has also participated as an investigator in collaborative trials funded by Bayer, Biogen Idec, GSK, Novartis, Merck Serono, Roche and Sanofi Aventis. Acknowledgement: Editorial assistance was provided by James Gilbart at Touch Briefings.

Nurses specializing in the care of patients with multiple sclerosis (MS) are uniquely positioned to provide personalized care. Patients prescribed cladribine tablets (taken for ≤10 days per year for 2 years), indicated for adults with highly active relapsing MS in the EU and Australia, can benefit from an active partnership with their healthcare professionals, including MS nurses, who can promote an understanding of and the adherence to treatment. In clinical studies, patients treated with cladribine tablets had lower annual relapse rates, greater odds of being relapse free, a longer time to sustained progression of disability and a significant reduction in radiological disease activity compared with patients receiving placebo. Patients should be advised that, although everyone will have a different experience, the safety of cladribine tablets is supported by 16 years of clinical trial and post-approval data. Furthermore, there is no indication of a more serious disease course or more severe outcomes for patients with MS treated with cladribine tablets who acquire coronavirus disease 2019 compared with the general population or other patients with MS. This article presents practical considerations that may help achieve a greater understanding of the potential benefits and drawbacks of MS treatment, build the patient–nurse relationship, encourage shared decision-making and ultimately may improve care.

Multiple sclerosis (MS), a progressive inflammatory and neurodegenerative disease of the central nervous system, is one of the most common causes of neurological disability in adults. The efficacy of disease-modifying therapies is improving and more oral medications are becoming available. These treatments have effects that include limiting chronic inflammatory damage, reducing the frequency of relapses, delaying disease progression and controlling symptoms. Most of these medications, however, can only delay disease progression and some have side effects that increase the burden of disease. The need for close monitoring varies between drugs and in the treatment-decision process, it is important to discuss the benefit–risk profile with the patient and to take account of the long-term nature of this disease. MS nurses have a pivotal role in the patient management and are important in ensuring compliance with treatment. The 2012 ‘MS International Clinic’ at Barcelona gathered MS nursing professionals from 26 countries and offered a singular opportunity to review the pathophysiology of the disease and discuss the benefits and limitations of current treatment options. The MS International Clinic also aimed to strengthen the role of the MS nurse in symptom management and patient support and to share best nursing practices.