A multi-centre longitudinal study analysing multiple sclerosis disease-modifying therapy prescribing patterns during the COVID-19 pandemic

Anoushka P. Lal, Yi Chao Foong, Paul G. Sanfilippo, Tim Spelman, Louise Rath, David Levitz, Marzena Fabis-Pedrini, Matteo Foschi, Mario Habek, Tomas Kalincik, Izanne Roos, Jeannette Lechner-Scott, Nevin John, Aysun Soysal, Emanuele D’Amico, Riadh Gouider, Saloua Mrabet, Katrin Gross-Paju, Simón Cárdenas-Robledo, Abdorreza Naser MoghadasiMaria Jose Sa, Orla Gray, Jiwon Oh, Stephen Reddel, Sudarshini Ramanathan, Talal Al-Harbi, Ayse Altintas, Todd A. Hardy, Serkan Ozakbas, Raed Alroughani, Allan G. Kermode, Andrea Surcinelli, Guy Laureys, Sara Eichau, Alexandre Prat, Marc Girard, Pierre Duquette, Suzanne Hodgkinson, Cristina Ramo-Tello, Davide Maimone, Pamela McCombe, Daniele Spitaleri, Jose Luis Sanchez-Menoyo, Mehmet Fatih Yetkin, Seyed Mohammad Baghbanian, Rana Karabudak, Abdullah Al-Asmi, Gregor Brecl Jakob, Samia J. Khoury, Masoud Etemadifar, Vincent van Pesch, Katherine Buzzard, Bruce Taylor, Helmut Butzkueven, Anneke Van der Walt*

*المؤلف المقابل لهذا العمل

نتاج البحث: المساهمة في مجلةمقالمراجعة النظراء

ملخص

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.

اللغة الأصليةEnglish
الصفحات (من إلى)5813-5824
عدد الصفحات12
دوريةJournal of Neurology
مستوى الصوت271
رقم الإصدار9
المعرِّفات الرقمية للأشياء
حالة النشرPublished - سبتمبر 2024

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