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A Multi-Centre Longitudinal Study Analysing Multiple Sclerosis Disease-Modifying Therapy Prescribing Patterns During the Covid-19 Pandemic Publisher Pubmed



Lal AP1, 2 ; Foong YC1, 2, 55 ; Sanfilippo PG1 ; Spelman T1 ; Rath L1 ; Levitz D1 ; Fabispedrini M3, 4 ; Foschi M5, 6 ; Habek M7, 8 ; Kalincik T9, 10 ; Roos I9 ; Lechnerscott J11 ; John N12, 13 ; Soysal A14 Show All Authors
Authors
  1. Lal AP1, 2
  2. Foong YC1, 2, 55
  3. Sanfilippo PG1
  4. Spelman T1
  5. Rath L1
  6. Levitz D1
  7. Fabispedrini M3, 4
  8. Foschi M5, 6
  9. Habek M7, 8
  10. Kalincik T9, 10
  11. Roos I9
  12. Lechnerscott J11
  13. John N12, 13
  14. Soysal A14
  15. Damico E15
  16. Gouider R16, 17
  17. Mrabet S16, 17
  18. Grosspaju K18
  19. Cardenasrobledo S19, 20
  20. Moghadasi AN21
  21. Sa MJ22
  22. Gray O23
  23. Oh J24
  24. Reddel S25
  25. Ramanathan S26
  26. Alharbi T27
  27. Altintas A28
  28. Hardy TA25
  29. Ozakbas S29, 30
  30. Alroughani R31
  31. Kermode AG3, 4
  32. Surcinelli A5
  33. Laureys G32
  34. Eichau S33
  35. Prat A34
  36. Girard M34
  37. Duquette P34
  38. Hodgkinson S35
  39. Ramotello C36
  40. Maimone D37
  41. Mccombe P38, 39
  42. Spitaleri D40
  43. Sanchezmenoyo JL41
  44. Yetkin MF42
  45. Baghbanian SM43, 44
  46. Karabudak R45, 46
  47. Alasmi A47
  48. Jakob GB49, 50
  49. Khoury SJ51
  50. Etemadifar M52
  51. Van Pesch V53
  52. Buzzard K54
  53. Taylor B55
  54. Butzkueven H1, 2
  55. Van Der Walt A1, 2
Show Affiliations
Authors Affiliations
  1. 1. Department of Neuroscience, Central Clinical School, The Alfred, Melbourne, VIC, Australia
  2. 2. Department of Neurology, The Alfred Hospital, 55 Commercial Road, Melbourne, 3004, Australia
  3. 3. Perron Institute for Neurological and Translational Science, The University of Western Australia, Perth, Australia
  4. 4. Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, Perth, Australia
  5. 5. Department of Neuroscience, MS Center, Neurology Unit, S. Maria Delle Croci Hospital, AUSL Romagna, Ravenna, Italy
  6. 6. Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L’Aquila, L’Aquila, Italy
  7. 7. Department of Neurology, University Hospital Center Zagreb, Zagreb, Croatia
  8. 8. School of Medicine, University of Zagreb, Zagreb, Croatia
  9. 9. Department of Neurology, Neuroimmunology Centre, Royal Melbourne Hospital, Melbourne, Australia
  10. 10. CORe, Department of Medicine, University of Melbourne, Melbourne, Australia
  11. 11. Hunter Medical Research Institute, University Newcastle, Newcastle, Australia
  12. 12. Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Australia
  13. 13. Department of Neurology, Monash Health, Clayton, Australia
  14. 14. Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey
  15. 15. Medical and Surgical Sciences, Universita Di Foggia, Foggia, Italy
  16. 16. Department of Neurology, LR 18SP03, Clinical Investigation Centre Neurosciences and Mental Health, Razi University Hospital, Tunis, Tunisia
  17. 17. Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
  18. 18. Multiple Sclerosis Centre, West-Tallinn Central Hospital, Tallinn, Estonia
  19. 19. Department of Neurology, Centro de Esclerosis Multiple (CEMHUN), Hospital Universitario Nacional de Colombia Bogota, Bogota, Colombia
  20. 20. Departamento de Medicina InternaFacultad de Medicina, Universidad Nacional de Colombia, Bogota, Colombia
  21. 21. Multiple Research Centre, Neuroscience Institute, Tehran University of Medical Science, Tehran, Iran
  22. 22. Department of Neurology, Centro Hospitalar Universitario de Sao Joao, Porto, Portugal
  23. 23. South Eastern HSC Trust, Belfast, United Kingdom
  24. 24. St. Michael’s Hospital, Toronto, Canada
  25. 25. Department of Neurology, Concord Repatriation General Hospital, Sydney, Australia
  26. 26. Translational Neuroimmunology Group, Kids Neuroscience Centre and Brain and Mind Centre, Concord Hospital, Sydney, Australia
  27. 27. Neurology Department, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
  28. 28. Department of Neurology, School of Medicine and Koc University Research Center for Translational Medicine (KUTTAM), Istanbul, Turkey
  29. 29. Izmir University of Economics, Medical Point Hospital, Izmir, Turkey
  30. 30. Multiple Sclerosis Research Association, Izmir, Turkey
  31. 31. Division of Neurology, Department of Medicine, Amiri Hospital, Sharq, Kuwait
  32. 32. Department of Neurology, University Hospital Ghent, Ghent, Belgium
  33. 33. Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain
  34. 34. CHUM and Universite de Montreal, Montreal, Canada
  35. 35. Immune Tolerance Laboratory Ingham Institute and Department of Medicine, UNSW, Sydney, Australia
  36. 36. Department of Neuroscience, Hospital Germans Trias I Pujol, Badalona, Spain
  37. 37. Centro Sclerosi Multipla, UOC Neurologia, Azienda Ospedaliera Per L’Emergenza Cannizzaro, Catania, Italy
  38. 38. University of Queensland, Brisbane, Australia
  39. 39. Royal Brisbane and Women’s Hospital, Brisbane, Australia
  40. 40. Azienda Ospedaliera Di Rilievo Nazionale San Giuseppe Moscati Avellino, Avellino, Italy
  41. 41. Department of Neurology, Galdakao-Usansolo University Hospital, Osakidetza-Basque Health Service, Galdakao, Spain
  42. 42. Department of Neurology, Erciyes University, Kayseri, Turkey
  43. 43. Neurology Department, Booalisina Hospital, Mazandaran University of Medical Sciences, Sari, Iran
  44. 44. Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
  45. 45. Department of Neurological Sciences, Faculty of Medicine, Yeditepe University, Istanbul, Turkey
  46. 46. Neuroimmunology Unit, Kosuyolu Hospitals, Istanbul, Turkey
  47. 47. College of Medicine & amp
  48. 48. Health Sciences and Sultan Qaboos University Hospital, Sultan Qaboos University, Al-Khodh, Oman
  49. 49. Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
  50. 50. Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
  51. 51. Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
  52. 52. Neurology, Dr. Etemadifar MS Institute, Isfahan University of Medical Sciences, Isfahan, Iran
  53. 53. Department of Neurology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
  54. 54. Department of Neurosciences, Box Hill Hospital, Box Hill, Australia
  55. 55. Royal Hobart Hospital, Hobart, Australia

Source: Journal of Neurology Published:2024


Abstract

Background: The COVID-19 pandemic raised concern amongst clinicians that disease-modifying therapies (DMT), particularly anti-CD20 monoclonal antibodies (mAb) and fingolimod, could worsen COVID-19 in people with multiple sclerosis (pwMS). This study aimed to examine DMT prescribing trends pre- and post-pandemic onset. Methods: A multi-centre longitudinal study with 8,771 participants from MSBase was conducted. Two time periods were defined: pre-pandemic (March 11 2018–March 10 2020) and post-pandemic onset (March 11 2020–11 March 2022). The association between time and prescribing trends was analysed using multivariable mixed-effects logistic regression. DMT initiation refers to first initiation of any DMT, whilst DMT switches indicate changing regimen within 6 months of last use. Results: Post-pandemic onset, there was a significant increase in DMT initiation/switching to natalizumab and cladribine [(Natalizumab-initiation: OR 1.72, 95% CI 1.39–2.13; switching: OR 1.66, 95% CI 1.40–1.98), (Cladribine-initiation: OR 1.43, 95% CI 1.09–1.87; switching: OR 1.67, 95% CI 1.41–1.98)]. Anti-CD20mAb initiation/switching decreased in the year of the pandemic, but recovered in the second year, such that overall odds increased slightly post-pandemic (initiation: OR 1.26, 95% CI 1.06–1.49; Switching: OR 1.15, 95% CI 1.02–1.29. Initiation/switching of fingolimod, interferon-beta, and alemtuzumab significantly decreased [(Fingolimod-initiation: OR 0.55, 95% CI 0.41–0.73; switching: OR 0.49, 95% CI 0.41–0.58), (Interferon-gamma-initiation: OR 0.48, 95% CI 0.41–0.57; switching: OR 0.78, 95% CI 0.62–0.99), (Alemtuzumab-initiation: OR 0.27, 95% CI 0.15–0.48; switching: OR 0.27, 95% CI 0.17–0.44)]. Conclusions: Post-pandemic onset, clinicians preferentially prescribed natalizumab and cladribine over anti-CD20 mAbs and fingolimod, likely to preserve efficacy but reduce perceived immunosuppressive risks. This could have implications for disease progression in pwMS. Our findings highlight the significance of equitable DMT access globally, and the importance of evidence-based decision-making in global health challenges. © The Author(s) 2024.
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