Multidisciplinary Care Linked to Increased Survival, Spanish Study Shows
Multidisciplinary care with timely use of respiratory and feeding support contributes to increased survival for people with amyotrophic lateral sclerosis (ALS), a single-center study in Spain finds.
The study, “Survival benefit of multidisciplinary care in amyotrophic lateral sclerosis in Spain: association with noninvasive mechanical ventilation,” was published in the Journal of Multidisciplinary Healthcare.
To date, only Rilutek (riluzole), Tiglutik (riluzole oral suspension), and Radicava (edaravone) have been approved in the U.S. for the treatment of ALS. Still, these therapies can only delay disease progression and extend patients’ survival — meaning that most treatments available are aimed at relieving symptoms and improving quality of life.
Guidelines recommend that people with ALS should be followed and treated by multidisciplinary teams. A broader care approach has been shown to improve patients’ outcomes, according to reports from Italy, England, and Ireland. But the positive results of a multidisciplinary care approach are still debatable, with some studies failing to demonstrate a beneficial effect.
To learn more, a team of Spanish researchers reviewed the clinical records of 334 people with the disorder who were followed at the ALS Multidisciplinary Care Clinic of the Hospital Universitari de Bellvitge.
All patients were evaluated by a team of specialists, which included a neurologist, a pulmonologist, a nutritionist, an endocrinologist, a rehabilitation specialist, a physical therapist, a psychologist, a social worker, a nurse manager, a speech therapist, and an administrative worker.
Every three months, these patients would undergo detailed clinical evaluation that included analysis of their pulmonary function and nutritional status. Following the guidelines of the American Academy of Neurology and the European Federation of Neurological Societies, the patients were advised to initiate early noninvasive mechanical ventilation (NIMV) to improve breathing, and to place a gastrostomy tube (or G-tube, connected directly to the stomach) to help in feeding.
The team compared the outcome of these patients with the records of 54 ALS patients who were seen only by a neuromuscular neurologist.
The analysis found that patients who were monitored by the multidisciplinary team were more likely to take Rilutek (88.7% vs 30.6%), as well as to initiate NIMV (47.8% vs 14.5%). They were also more likely to place a G-tube (32.9% vs 3.2%).
A total 276 patients (30.7%) died during follow-up. Overall, median survival time of those treated under the multidisciplinary care model was 40 months, compared with 34 months in the group treated by a single neurologist.
The increase in survival was found to be greater in people with bulbar onset disease, in which the muscles involved in speaking, swallowing, and breathing are generally the first to be affected. These patients’ survival increased by 10 months, from 24 to 34 months.
Overall, multidisciplinary care with associated reduced time to NIMV and gastrostomy — meaning the therapies were started early — showed a beneficial effect on extending survival among patients.
“Our study provides further evidence for increased survival in the multidisciplinary care clinic compared with a general neurology practice,” the researchers said.
“Timely use of NIMV and gastrostomy and compliance with [these] interventions are fundamental aspects of this benefit,” they added.