The following is a summary of “A multi-centre longitudinal study analyzing multiple sclerosis disease-modifying therapy prescribing patterns during the COVID-19 pandemic,” published in the June 2024 issue of Neurology by Lal et al.

The COVID-19 pandemic caused doctors to worry that specific disease-modifying therapies (DMT), especially anti-CD20 monoclonal antibodies (mAb) and fingolimod, might increase COVID-19 severity in patients with multiple sclerosis (pwMS).

They involved 8,771 MSBase participants spanning two periods: pre-pandemic (March 11, 2018, to March 10, 2020) and post-pandemic onset (March 11, 2020, to March 11, 2022). Multivariable mixed-effects logistic regression was utilized to analyze the association between time and prescribing trends. The DMT initiation referred to the first initiation of any DMT, while DMT switches indicated a change in regimen within six months of the last use.

The results showed a notable increase in natalizumab and cladribine initiation and switching post-pandemic [(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-CD20mAb initiation and switching decreased during the pandemic year but rebounded in the subsequent year, resulting in a slight overall increase post-pandemic (initiation: OR 1.26, 95% CI 1.06–1.49; switching: OR 1.15, 95% CI 1.02–1.29). Fingolimod, interferon-beta, and alemtuzumab initiation and switching significantly decreased [(Fingolimod-initiation: OR 0.55, 95% CI 0.41–0.73; switching: OR 0.49, 95% CI 0.41–0.58), (Interferon-beta-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)].

Investigators concluded that after the pandemic, doctors favored natalizumab and cladribine over anti-CD20 mAbs and fingolimod. This likely aimed to balance treatment effectiveness with reduced perceived immune system suppression, which could impact the disease course in pwMS.

Source: link.springer.com/article/10.1007/s00415-024-12518-7