TY - JOUR
T1 - A multi-centre longitudinal study analysing multiple sclerosis disease-modifying therapy prescribing patterns during the COVID-19 pandemic
AU - Lal, Anoushka P.
AU - Foong, Yi Chao
AU - Sanfilippo, Paul G.
AU - Spelman, Tim
AU - Rath, Louise
AU - Levitz, David
AU - Fabis-Pedrini, Marzena
AU - Foschi, Matteo
AU - Habek, Mario
AU - Kalincik, Tomas
AU - Roos, Izanne
AU - Lechner-Scott, Jeannette
AU - John, Nevin
AU - Soysal, Aysun
AU - D’Amico, Emanuele
AU - Gouider, Riadh
AU - Mrabet, Saloua
AU - Gross-Paju, Katrin
AU - Cárdenas-Robledo, Simón
AU - Moghadasi, Abdorreza Naser
AU - Sa, Maria Jose
AU - Gray, Orla
AU - Oh, Jiwon
AU - Reddel, Stephen
AU - Ramanathan, Sudarshini
AU - Al-Harbi, Talal
AU - Altintas, Ayse
AU - Hardy, Todd A.
AU - Ozakbas, Serkan
AU - Alroughani, Raed
AU - Kermode, Allan G.
AU - Surcinelli, Andrea
AU - Laureys, Guy
AU - Eichau, Sara
AU - Prat, Alexandre
AU - Girard, Marc
AU - Duquette, Pierre
AU - Hodgkinson, Suzanne
AU - Ramo-Tello, Cristina
AU - Maimone, Davide
AU - McCombe, Pamela
AU - Spitaleri, Daniele
AU - Sanchez-Menoyo, Jose Luis
AU - Yetkin, Mehmet Fatih
AU - Baghbanian, Seyed Mohammad
AU - Karabudak, Rana
AU - Al-Asmi, Abdullah
AU - Jakob, Gregor Brecl
AU - Khoury, Samia J.
AU - Etemadifar, Masoud
AU - van Pesch, Vincent
AU - Buzzard, Katherine
AU - Taylor, Bruce
AU - Butzkueven, Helmut
AU - Van der Walt, Anneke
PY - 2024/9
Y1 - 2024/9
N2 - 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.
AB - 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.
KW - Anti-CD20 monoclonal antibodies
KW - Cladribine
KW - COVID-19
KW - Disease-modifying therapy
KW - Multiple sclerosis
KW - Natalizumab
UR - http://www.scopus.com/inward/record.url?scp=85197450686&partnerID=8YFLogxK
U2 - 10.1007/s00415-024-12518-7
DO - 10.1007/s00415-024-12518-7
M3 - Article
C2 - 38935148
AN - SCOPUS:85197450686
SN - 0340-5354
VL - 271
SP - 5813
EP - 5824
JO - Journal of Neurology
JF - Journal of Neurology
IS - 9
ER -