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. 2019 Oct;9(5):424-432.
doi: 10.1212/CPJ.0000000000000718.

A multidisciplinary approach to dosing nusinersen for spinal muscular atrophy

Carla D Zingariello  1 , John Brandsema  1 , Elizabeth Drum  1 , Alicia A Henderson  1 , Scott Dubow  1 , Allan M Glanzman  1 , Oscar Mayer  1 , Sabrina W Yum  1 , Elizabeth A Kichula  1
Affiliations

A multidisciplinary approach to dosing nusinersen for spinal muscular atrophy

Carla D Zingariello et al. Neurol Clin Pract. 2019 Oct.

Abstract

Background: In December 2016, nusinersen gained FDA approval as the first pharmacologic treatment for spinal muscular atrophy (SMA), a disorder of motor neurons and the leading genetic cause of infant mortality. Nusinersen's intrathecal delivery requirement, strict dosage protocol, and accelerated FDA approval presented a challenge to health care centers hoping to implement treatment of patients with SMA. Scheduling logistics, combined with the specific ventilatory, anesthetic, and spinal access needs of this patient population, requires extensive coordination of care. This complexity, in addition to the high cost of treatment, may lead to overburdening of an institution's dosing resources, causing delays in treatment initiation and limiting patients' access to therapy and may result in barriers to coverage.

Methods: We initiated a comprehensive stepwise protocol to maximize patient inclusion, as well as safety and efficiency outcome measures. This retrospective cohort study reviews the dosing process.

Results: As a result of immense collaborative efforts involving care coordination of patients and families, in addition to health providers in the divisions of neurology, anesthesiology, pulmonology, orthopedics, interventional radiology, physical therapy, and neurosurgery, we have successfully dosed 62 SMA patients. Throughout this process, we have improved anesthetic techniques, as well as minimized procedural complications and missed scheduled doses.

Conclusion: We present here recommendations for safe and effective implementation of nusinersen utilizing a multidisciplinary approach, based on our 1 and a half year experience at a tertiary care children's hospital.

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Figures

Figure
Figure. Flowchart for dosing location and anesthesia requirement
IR = interventional radiology; OR = operating room; PACU = post-anesthesia care unit.
See this image and copyright information in PMC

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