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

Area of Science:

• Neurology
• Immunology
• Epidemiology

Background:

• COVID-19 concerns prompted investigation into disease-modifying therapies (DMTs) for multiple sclerosis (MS).
• Specific concerns focused on anti-CD20 monoclonal antibodies (mAbs) and fingolimod potentially worsening COVID-19 outcomes in people with MS (pwMS).

Purpose of the Study:

• To analyze changes in DMT prescribing trends among pwMS before and after the COVID-19 pandemic onset.
• To understand how clinical concerns influenced treatment choices during a global health crisis.

Main Methods:

• A multi-center, longitudinal study involving 8,771 participants from the MSBase registry.
• Comparison of DMT prescribing data from two periods: pre-pandemic (March 2018-March 2020) and post-pandemic onset (March 2020-March 2022).
• Statistical analysis using multivariable mixed-effects logistic regression to identify trends in DMT initiation and switching.

Main Results:

• Post-pandemic, significant increases in initiation and switching were observed for natalizumab and cladribine.
• Anti-CD20 mAb use saw an initial decrease followed by a slight overall increase post-pandemic.
• Initiation and switching of fingolimod, interferon-beta, and alemtuzumab significantly decreased.

Conclusions:

• Clinicians preferentially prescribed natalizumab and cladribine post-pandemic, likely balancing efficacy with reduced perceived immunosuppressive risks.
• These prescribing shifts may influence long-term disease progression in pwMS.
• Findings underscore the need for equitable DMT access and evidence-based decision-making during global health challenges.