Has the pandemic changed treatment strategy in multiple sclerosis?

Area of Science:

• Neurology
• Immunology
• Epidemiology

Background:

• The Covid-19 pandemic imposed social distancing, limiting healthcare access and raising safety concerns for immunosuppressive disease-modifying treatments (DMTs) in multiple sclerosis (MS).
• Real-world data on DMT prescription patterns during the pandemic were needed to assess treatment trends in MS patients.

Purpose of the Study:

• To analyze changes in DMT prescription rates for multiple sclerosis patients before and during the Covid-19 pandemic.
• To evaluate the impact of the pandemic on the initiation of new DMTs in a large MS cohort.

Main Methods:

• Retrospective analysis of the Vienna MS database (VMSD) from January 2017 to December 2021.
• Comparison of annualized DMT prescription rates between the pre-pandemic period (until March 15, 2020) and the Covid-19 era (from March 16, 2020).
• Stratification of DMTs by efficacy and mechanism of action.

Main Results:

• Overall DMT prescriptions decreased by 17.2% during the Covid-19 era compared to the pre-pandemic period.
• A sharp decline of 54% was observed in the first nine months of the pandemic, with a partial recovery in 2021.
• Prescriptions for high-efficacy DMTs like alemtuzumab (-64%), anti-CD20 (-49%), and cladribine (-46%) significantly reduced, while natalizumab increased by 24%.

Conclusions:

• The Covid-19 pandemic was associated with a substantial drop in DMT prescriptions for MS, especially for potent immunosuppressive agents.
• These changes suggest the pandemic significantly influenced treatment decisions for multiple sclerosis.
• The long-term clinical impact of these altered DMT prescription patterns requires further investigation.