Files and links (1)
Published (Version of Record)CC BY-NC V4.0, Open Access
Journal article
3018 A multi-centre longitudinal study analysing disease modifying therapy prescribing patterns during the COVID-19 pandemic
BMJ neurology open, Vol.6(Suppl 1), p.A17
2024
Abstract
Background/Objectives
The COVID-19 pandemic raised concern amongst clinicians that disease-modifying therapy (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.
Methods
A multi-centre longitudinal study with 8,771 participants was conducted using data from the MSBase COVID-19 sub-study. Trends in DMT prescribing between 2018–2022 were analysed using multivariable mixed-effects logistic regression. DMT-initiation referred to the first prescription of any DMT in that timeframe, DMT-switches denoted a change in DMT regimen within 6 months of last DMT use.
Results
Post-pandemic, 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-CD20 mABs initiation decreased during-pandemic but recovered post-pandemic. Overall, anti-CD20 mABs initiation/switching increased, however less than other high-efficacy DMTs(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-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]). Dimethyl fumarate initiation increased, while switching decreased(Initiation: OR 1.76, 95% CI 1.49–2.09;Switching:OR 0.85, 95% CI 0.69–1.05).
Conclusion
Post-pandemic, clinicians preferentially prescribed natalizumab and cladribine over anti-CD20 mABs and fingolimod, likely to preserve efficacy but reduce perceived risk of immunosuppression. This has clinical implications for disease progression and highlights the importance of equitable access to DMTs and COVID-19 treatment in a pandemic to ensure continued use of high-efficacy DMTs.
Details
- Title
- 3018 A multi-centre longitudinal study analysing disease modifying therapy prescribing patterns during the COVID-19 pandemic
- Authors/Creators
- Nevin John - National Hospital for Neurology and NeurosurgerySteve Vucic - The University of SydneyRiadh Gouider - 52 Department of Neurology, University of Tunis El Manar, Tunis, TunisiaTomas Kalincik - The University of MelbourneGuillermo Izquierdo - Hospital Universitario Virgen MacarenaAlexandre Prat - National MS Center MelsbroekMarc Girard - National MS Center MelsbroekPierre Duquette - Université de MontréalPierre Grammond - 10 Hotel-Dieu de Levis, Levis, Quebec, CanadaSerkan Ozakbas - Dokuz Eylül UniversityJeannette Lechner-Scott - Hunter Medical Research InstituteCavit Boz - Karadeniz Technical UniversityJulie Prevost - Centre Intégré de Santé et de Services Sociaux des LaurentidesRecai Turkoglu - 31Haydarpasa Numune Training and Research Hospital, TurkeyVincent Van Pesch - UCLouvainCristina Ramo-Tello - TriasMark Slee - 9Liverpool Hospital, Sydney, NSW, AustraliaRaed Alroughani - Amiri HospitalVahid Shaygannejad - Isfahan University of Medical SciencesDaniele Spitaleri - ALTAJosé Luis Sánchez-Menoyo - 48 Department of Neurology, Galdakao-Usansolo Hospital, Galdakao, SpainSuzanne Hodgkinson - 9Liverpool Hospital, Liverpool, NSW, AustraliaRana Karabudak - Hacettepe UniversityTim Spelman - Peter MacCallum Cancer CentreHelmut Butzkueven - Alfred HealthNoriko Isobe - Kyushu UniversityPaul G Sanfilippo - Monash UniversityMichael Barnett - The Alfred HospitalOrla Gray - 54 South and East Belfast Health and Social Services Trust, Belfast, UKMaria José Sá - Hospital de São JoãoAllan Kermode - 3Western Australian Neuroscience Research Institute, The University of Western Australia, Nedlands, WA, AustraliaGuy Laureys - 50 Universitair Ziekenhuis Gent, Gent, BelgiumRichard Macdonell - Austin HealthAnneke Van Der Walt - Monash UniversityAyse Altintas - 23 Department of Neurology, Koc Universitesi, Istanbul, TurkeyMario Habek - University of ZagrebPamela McCombe - 18Royal Brisbane and Women’s Hospital, Herston, QLD, AustraliaSeyed Mohammad Baghbanian - Mazandaran University of Medical SciencesYi Chao Foong - Monash UniversityRiki Matsumoto - Kyoto UniversityAbdullah Al-Asmi - Sultan Qaboos University HospitalBruce Taylor - 1Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, AustraliaSamia J Khoury - Harvard Medical SchoolTodd Hardy - MindKatherine Buzzard - 4 Eastern Health, Box Hill, Victoria, AustraliaMarzena Fabis-Pedrini - 3The Perron Institute for Neurological and Translational Science, The University of Western Australia, QEII Medical Centre, Nedlands, WA, AustraliaLouise Rath - Alfred HealthOlga Skibina - Alfred HealthJiwon Oh - Unity Health TorontoWilliam M Carroll - 1Centre for Neuromuscular and Neurological Disorders, Western Australian Neuroscience Research Institute, The University of Western Australia, Sir Charles Gairdner Hospital, QEII Medical Centre, Nedlands, AustraliaKatrin Gross-Paju - Centre for Neurological Diseases, West Tallinn Central Hospital, Tallinn, EstoniaJan Schepel - Waikato District Health BoardSara Eichau - Hospital Universitario Virgen MacarenaElisabetta Cartechini - 26Ospedale Generale Provinciale Macerata, ItalyAysun Soysal - 28Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, TurkeyDavide Maimone - University of CalgaryAnoushka Lal - Monash UniversityMasoud Etemadifar - Isfahan University of Medical SciencesOliver Gerlach - 25 Department of Neurology, Zuyderland Medical Centre Sittard-Geleen, Sittard-Geleen, The NetherlandsSaloua Mrabet - Razi UniversityEmanuele D'Amico - University of CataniaYolanda Blanco - Hospital Clínic de BarcelonaMatteo Foschi - Department of Biotechnological and Applied Clinical Sciences, University of L`Aquila, L`Aquila, ItalyMelissa Cambron - 56Az Sint-Jan Brugge, Bruges, BelgiumAndrea Surcinelli - National MS Center MelsbroekDavid Levitz - 1Department of Neuroscience, Central Clinical School, The Alfred, Melbourne, VIC, AustraliaLiesbeth Van Hijfte - 16Department of Neurology, Universitary Hospital Ghent, Ghent, BelgiumMehmet Fatih Yetkin - Erciyes UniversitySimón Cárdenas-Robledo - Hospital Universitario Nacional de ColombiaEmmanuelle Lapointe - Centre Hospitalier Universitaire de SherbrookeAbdorreza Naser Moghadasi - University of TehranGregor Brecl Jakob - 43University Medical Centre Ljubljana, Ljubljana, SloveniaTalal Al-Harbi - King Fahad Specialist Hospital
- Publication Details
- BMJ neurology open, Vol.6(Suppl 1), p.A17
- Publisher
- BMJ Publishing Group
- Identifiers
- 991005696265007891
- Copyright
- © Author(s) (or their employer(s)) 2024.
- Murdoch Affiliation
- Institute for Immunology and Infectious Diseases
- Language
- English
- Resource Type
- Journal article
UN Sustainable Development Goals (SDGs)
This output has contributed to the advancement of the following goals:
Metrics
53 File views/ downloads
61 Record Views