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.
