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

Journal: Journal of neurology

Volume: 

Issue: 

Year of Publication: 

Affiliated Institutions:  Department of Neuroscience, Central Clinical School, The Alfred, Melbourne, VIC, Australia. Perron Institute for Neurological and Translational Science, The University of Western Australia, Perth, Australia. Department of Neuroscience, MS Center, Neurology Unit, S. Maria Delle Croci Hospital, AUSL Romagna, Ravenna, Italy. Department of Neurology, University Hospital Center Zagreb, Zagreb, Croatia. Department of Neurology, Neuroimmunology Centre, Royal Melbourne Hospital, Melbourne, Australia. Hunter Medical Research Institute, University Newcastle, Newcastle, Australia. Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Australia. Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey. Medical and Surgical Sciences, Universita Di Foggia, Foggia, Italy. Department of Neurology, LR SP, Clinical Investigation Centre Neurosciences and Mental Health, Razi University Hospital, Tunis, Tunisia. Multiple Sclerosis Centre, West-Tallinn Central Hospital, Tallinn, Estonia. Department of Neurology, Centro de Esclerosis Múltiple (CEMHUN), Hospital Universitario Nacional de Colombia Bogota, Bogota, Colombia. Multiple Research Centre, Neuroscience Institute, Tehran University of Medical Science, Tehran, Iran. Department of Neurology, Centro Hospitalar Universitario de Sao Joao, Porto, Portugal. South Eastern HSC Trust, Belfast, UK. St. Michael's Hospital, Toronto, Canada. Department of Neurology, Concord Repatriation General Hospital, Sydney, Australia. Translational Neuroimmunology Group, Kids Neuroscience Centre and Brain and Mind Centre, Concord Hospital, Sydney, Australia. Neurology Department, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia. Department of Neurology, School of Medicine and Koc University Research Center for Translational Medicine (KUTTAM), İstanbul, Turkey. Izmir University of Economics, Medical Point Hospital, Izmir, Turkey. Division of Neurology, Department of Medicine, Amiri Hospital, Sharq, Kuwait. Department of Neurology, University Hospital Ghent, Ghent, Belgium. Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain. CHUM and Universite de Montreal, Montreal, Canada. Immune Tolerance Laboratory Ingham Institute and Department of Medicine, UNSW, Sydney, Australia. Department of Neuroscience, Hospital Germans Trias I Pujol, Badalona, Spain. Centro Sclerosi Multipla, UOC Neurologia, Azienda Ospedaliera Per L'Emergenza Cannizzaro, Catania, Italy. University of Queensland, Brisbane, Australia. Azienda Ospedaliera Di Rilievo Nazionale San Giuseppe Moscati Avellino, Avellino, Italy. Department of Neurology, Galdakao-Usansolo University Hospital, Osakidetza-Basque Health Service, Galdakao, Spain. Department of Neurology, Erciyes University, Kayseri, Turkey. Neurology Department, Booalisina Hospital, Mazandaran University of Medical Sciences, Sari, Iran. Department of Neurological Sciences, Faculty of Medicine, Yeditepe University, Istanbul, Turkey. College of Medicine & Health Sciences and Sultan Qaboos University Hospital, Sultan Qaboos University, Al-Khodh, Oman. Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia. Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon. Neurology, Dr. Etemadifar MS Institute, Isfahan University of Medical Sciences, Isfahan, Iran. Department of Neurology, Cliniques Universitaires Saint-Luc, Brussels, Belgium. Department of Neurosciences, Box Hill Hospital, Box Hill, Australia. Royal Hobart Hospital, Hobart, Australia. Department of Neuroscience, Central Clinical School, The Alfred, Melbourne, VIC, Australia. anneke.vanderwalt@monash.edu.

Abstract summary 

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.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.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)].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.

Authors & Co-authors:  Lal Anoushka P AP Foong Yi Chao YC Sanfilippo Paul G PG Spelman Tim T Rath Louise L Levitz David D Fabis-Pedrini Marzena M Foschi Matteo M Habek Mario M Kalincik Tomas T Roos Izanne I Lechner-Scott Jeannette J John Nevin N Soysal Aysun A D'Amico Emanuele E Gouider Riadh R Mrabet Saloua S Gross-Paju Katrin K Cárdenas-Robledo Simón S Moghadasi Abdorreza Naser AN Sa Maria Jose MJ Gray Orla O Oh Jiwon J Reddel Stephen S Ramanathan Sudarshini S Al-Harbi Talal T Altintas Ayse A Hardy Todd A TA Ozakbas Serkan S Alroughani Raed R Kermode Allan G AG Surcinelli Andrea A Laureys Guy G Eichau Sara S Prat Alexandre A Girard Marc M Duquette Pierre P Hodgkinson Suzanne S Ramo-Tello Cristina C Maimone Davide D McCombe Pamela P Spitaleri Daniele D Sanchez-Menoyo Jose Luis JL Yetkin Mehmet Fatih MF Baghbanian Seyed Mohammad SM Karabudak Rana R Al-Asmi Abdullah A Jakob Gregor Brecl GB Khoury Samia J SJ Etemadifar Masoud M van Pesch Vincent V Buzzard Katherine K Taylor Bruce B Butzkueven Helmut H Van der Walt Anneke A

Study Outcome 

Source Link: Visit source

Statistics
Citations :  Barzegar M et al (2021) COVID-19 among patients with multiple sclerosis: a systematic review. Neurol Neuroimmunol Neuroinflamm 8:4
Authors :  55
Identifiers
Doi : 10.1007/s00415-024-12518-7
SSN : 1432-1459
Study Population
Male,Female
Mesh Terms
Other Terms
Anti-CD20 monoclonal antibodies;COVID-19;Cladribine;Disease-modifying therapy;Multiple sclerosis;Natalizumab
Study Design
Longitudinal Study
Study Approach
Mixed Methods
Country of Study
Publication Country
Germany