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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

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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