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Has the pandemic changed treatment strategy in multiple sclerosis?
Gabriel Bsteh1, Katharina Riedl1, Nik Krajnc1
1Department of Neurology, Medical University of Vienna, Währinger Guertel 18-20, Vienna 1090, Austria.
Background:
Social distancing measures during the Covid-19 pandemic reduced access to health care and concerns were raised over the safety of immunosuppressive disease modifying treatments (DMT) for multiple sclerosis (MS).
Objective:
To investigate changes in DMT prescription before and during the pandemic in a large and well-characterized real-world cohort of MS patients.
Methods:
From the Vienna MS database (VMSD) we extracted MS patients who were initiated on a new DMT (both treatment-naïve and switching) between January 1st 2017 and December 31st 2021. Two time periods were defined: 1) the preCovid-19 era (January 1st 2017 to March 15th 2020, i.e. the day of the first lockdown in Austria) and the Covid-19 era (March 16th 2020 to December 31st 2021). Average annualized DMT prescription rates were descriptively compared between the two periods.
Results:
The average annualized number of prescriptions in the preCovid-19 era was 90.3/year and dropped to 74.8/year (-17.2%) in the Covid-19 era, driven by a marked reduction to 41.7/year (-54%) in the first nine months of the Covid-19 era, partly offset by a rise to 101 in 2021. Use of alemtuzumab (-64%), antiCD20 (-49%), cladribine (-46%), and S1PM (-38%) was reduced, while natalizumab increased by 24%. Lower efficacy treatments remained stable.
Conclusions:
The pandemic coincides with a drop in DMT prescription, most markedly for immunosuppressive high-efficacy treatments, strongly suggesting the pandemic as the causal factor. If and how much this affects long-term outcome is yet to be determined.
Insights
The Covid-19 pandemic led to a significant decrease in disease-modifying treatment (DMT) prescriptions for multiple sclerosis (MS) patients, particularly for high-efficacy immunosuppressive therapies. Long-term outcomes remain to be determined.
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.
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