Time Requirements of Healthcare Professionals for Managing Disease-Modifying Therapies for Multiple Sclerosis in Qatar, Kuwait and Bahrain

The application of high-efficacy disease-modifying therapies (DMTs) for the management of multiple sclerosis (MS) requires input from the MS clinic (diagnosis, clinic visits, follow-up), the clinical laboratory (monitoring of lymphocytes and other biomarkers), the pharmacy (managing, handling, and dispensing DMTs) and for administration (oral treatment, injections, or infusions). The time needed to fulfil these resource requirements varies between individual DMTs. Pharmacists and MS specialists at each centre provided estimates of the time needed within each specialist area to manage prescriptions of a range of DMTs (natalizumab, alemtuzumab, ocrelizumab, ofatumumab, fingolimod, dimethyl fumarate [DMF], cladribine tablets (CladT]). The overall times needed for 4 years of treatment were calculated. Oral treatments without need for immediate post- first-dose monitoring (CladT and DMF) were given an administration time of 0 h. Average times from each resource are shown as follows: for individual DMTs, average clinic times varied between 2.5 h (DMF) and 4.3 h (alemtuzumab), average lab times varied between 1.8 h (CladT) and 10.7 h (alemtuzumab), average pharmacy times varied between 1.0 h (alemtuzumab) and 21.7 h (natalizumab), and average administration times varied between 0 h (CladT and DMF) and 73.3 h (natalizumab). Administration times were longest for DMTs given by infusion. Average total times were lowest for CladT (5.9 h) and highest for natalizumab (101.3 h). CladT was associated with the lowest total time in all 3 countries (5.7–6.3 h); the DMTs with highest total times were natalizumab (Qatar [96.0 h], Kuwait [135.7 h]) and alemtuzumab (Bahrain [78.0 h]). There is considerable variation between countries in the Arabian Gulf with regard to the time resource needed to manage high-efficacy DMT therapy from the clinic, laboratory and pharmacy, and for administration. Times for administration are especially long variable for infusion agents. The administration of CladT for MS required the least time resource on average overall and in all three countries studied, while natalizumab and alemtuzumab required the most time.