A multi-centre longitudinal study analysing multiple sclerosis disease-modifying therapy prescribing patterns during the COVID-19 pandemic

Anoushka P. Lal; Yi Chao Foong; Paul G. Sanfilippo; Tim Spelman; Louise Rath; David Levitz; Marzena Fabis-Pedrini; Matteo Foschi; Mario Habek; Tomas Kalincik; Izanne Roos; Jeannette Lechner-Scott; Nevin John; Aysun Soysal; Emanuele D’Amico; Riadh Gouider; Saloua Mrabet; Katrin Gross-Paju; Simón Cárdenas-Robledo; Abdorreza Naser Moghadasi; Maria Jose Sa; Orla Gray; Jiwon Oh; Stephen Reddel; Sudarshini Ramanathan; Talal Al-Harbi; Ayse Altintas; Todd A. Hardy; Serkan Ozakbas; Raed Alroughani; Allan G. Kermode; Andrea Surcinelli; Guy Laureys; Sara Eichau; Alexandre Prat; Marc Girard; Pierre Duquette; Suzanne Hodgkinson; Cristina Ramo-Tello; Davide Maimone; Pamela McCombe; Daniele Spitaleri; Jose Luis Sanchez-Menoyo; Mehmet Fatih Yetkin; Seyed Mohammad Baghbanian; Rana Karabudak; Abdullah Al-Asmi; Gregor Brecl Jakob; Samia J. Khoury; Masoud Etemadifar; Vincent van Pesch; Katherine Buzzard; Bruce Taylor; Helmut Butzkueven; Anneke Van der Walt

doi:10.1007/s00415-024-12518-7

A multi-centre longitudinal study analysing multiple sclerosis disease-modifying therapy prescribing patterns during the COVID-19 pandemic

Anoushka P. Lal
, Yi Chao Foong
, Paul G. Sanfilippo
, Tim Spelman
, Louise Rath
, David Levitz
, Marzena Fabis-Pedrini
, Matteo Foschi
, Mario Habek
, Tomas Kalincik
, Izanne Roos
, Jeannette Lechner-Scott
, Nevin John
, Aysun Soysal
, Emanuele D’Amico
, Riadh Gouider
, Saloua Mrabet
, Katrin Gross-Paju
, Simón Cárdenas-Robledo
, Abdorreza Naser Moghadasi

Maria Jose Sa, Orla Gray, Jiwon Oh, Stephen Reddel, Sudarshini Ramanathan, Talal Al-Harbi, Ayse Altintas, Todd A. Hardy, Serkan Ozakbas, Raed Alroughani, Allan G. Kermode, Andrea Surcinelli, Guy Laureys, Sara Eichau, Alexandre Prat, Marc Girard, Pierre Duquette, Suzanne Hodgkinson, Cristina Ramo-Tello, Davide Maimone, Pamela McCombe, Daniele Spitaleri, Jose Luis Sanchez-Menoyo, Mehmet Fatih Yetkin, Seyed Mohammad Baghbanian, Rana Karabudak, Abdullah Al-Asmi, Gregor Brecl Jakob, Samia J. Khoury, Masoud Etemadifar, Vincent van Pesch, Katherine Buzzard, Bruce Taylor, Helmut Butzkueven, Anneke Van der Walt

Monash University
Alfred Health
Royal Hobart Hospital
University of Western Australia
Murdoch University
Ospedale S. Maria delle Croci
University of L'Aquila
University of Zagreb
Royal Melbourne Hospital
University of Melbourne, Peter MacCallum Cancer Centre
University of Newcastle
Monash Health
Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases
University of Foggia
Razi University Hospital
Université de Tunis El Manar
Western Tallinn Central Hospital
Universidad Nacional de Colombia
Tehran University of Medical Sciences
Centro Hospitalar Universitário de São João
South Eastern Health and Social Care Trust
University of Toronto
Concord Repatriation General Hospital
The University of Sydney
King Fahad Specialist Hospital, Dammam
Koc University
Izmir Ekonomi University
Multiple Sclerosis Research Association
Al-Amiri Hospital
Ghent University
Hospital Universitario Virgen Macarena
University of Montreal
University of New South Wales
Generalitat de Catalunya
Azienda Ospedaliera per l'Emergenza Cannizzaro
University of Queensland
Royal Brisbane and Women's Hospital
Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati Avellino
Galdakao-Usansolo University Hospital
Erciyes University
Mazandaran University of Medical Sciences
Yeditepe University
Koşuyolu University
Sultan Qaboos University
UMC Ljubljana
University of Ljubljana
American University of Beirut
Isfahan University of Medical Sciences
Université catholique de Louvain
Box Hill Hospital

Research output: Contribution to journal › Article › peer-review

6 Citations (Scopus)

Abstract

Background: The COVID-19 pandemic raised concern amongst clinicians that disease-modifying therapies (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 onset. Methods: A multi-centre longitudinal study with 8,771 participants from MSBase was conducted. Two time periods were defined: pre-pandemic (March 11 2018–March 10 2020) and post-pandemic onset (March 11 2020–11 March 2022). The association between time and prescribing trends was analysed using multivariable mixed-effects logistic regression. DMT initiation refers to first initiation of any DMT, whilst DMT switches indicate changing regimen within 6 months of last use. Results: Post-pandemic onset, 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-CD20mAb initiation/switching decreased in the year of the pandemic, but recovered in the second year, such that overall odds increased slightly post-pandemic (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-gamma-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)]. Conclusions: Post-pandemic onset, clinicians preferentially prescribed natalizumab and cladribine over anti-CD20 mAbs and fingolimod, likely to preserve efficacy but reduce perceived immunosuppressive risks. This could have implications for disease progression in pwMS. Our findings highlight the significance of equitable DMT access globally, and the importance of evidence-based decision-making in global health challenges.

Original language	English
Pages (from-to)	5813-5824
Number of pages	12
Journal	Journal of Neurology
Volume	271
Issue number	9
DOIs	https://doi.org/10.1007/s00415-024-12518-7
Publication status	Published - Sept 2024
Externally published	Yes

Keywords

Anti-CD20 monoclonal antibodies
COVID-19
Cladribine
Disease-modifying therapy
Multiple sclerosis
Natalizumab

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10.1007/s00415-024-12518-7

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Lal, A. P., Foong, Y. C., Sanfilippo, P. G., Spelman, T., Rath, L., Levitz, D., Fabis-Pedrini, M., Foschi, M., Habek, M., Kalincik, T., Roos, I., Lechner-Scott, J., John, N., Soysal, A., D’Amico, E., Gouider, R., Mrabet, S., Gross-Paju, K., Cárdenas-Robledo, S., ... Van der Walt, A. (2024). A multi-centre longitudinal study analysing multiple sclerosis disease-modifying therapy prescribing patterns during the COVID-19 pandemic. Journal of Neurology, 271(9), 5813-5824. https://doi.org/10.1007/s00415-024-12518-7

@article{5e73ef12ce1d40c895d523d3c6f4c574,

title = "A multi-centre longitudinal study analysing multiple sclerosis disease-modifying therapy prescribing patterns during the COVID-19 pandemic",

abstract = "Background: The COVID-19 pandemic raised concern amongst clinicians that disease-modifying therapies (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 onset. Methods: A multi-centre longitudinal study with 8,771 participants from MSBase was conducted. Two time periods were defined: pre-pandemic (March 11 2018–March 10 2020) and post-pandemic onset (March 11 2020–11 March 2022). The association between time and prescribing trends was analysed using multivariable mixed-effects logistic regression. DMT initiation refers to first initiation of any DMT, whilst DMT switches indicate changing regimen within 6 months of last use. Results: Post-pandemic onset, 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-CD20mAb initiation/switching decreased in the year of the pandemic, but recovered in the second year, such that overall odds increased slightly post-pandemic (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-gamma-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)]. Conclusions: Post-pandemic onset, clinicians preferentially prescribed natalizumab and cladribine over anti-CD20 mAbs and fingolimod, likely to preserve efficacy but reduce perceived immunosuppressive risks. This could have implications for disease progression in pwMS. Our findings highlight the significance of equitable DMT access globally, and the importance of evidence-based decision-making in global health challenges.",

keywords = "Anti-CD20 monoclonal antibodies, COVID-19, Cladribine, Disease-modifying therapy, Multiple sclerosis, Natalizumab",

author = "Lal, \{Anoushka P.\} and Foong, \{Yi Chao\} and Sanfilippo, \{Paul G.\} and Tim Spelman and Louise Rath and David Levitz and Marzena Fabis-Pedrini and Matteo Foschi and Mario Habek and Tomas Kalincik and Izanne Roos and Jeannette Lechner-Scott and Nevin John and Aysun Soysal and Emanuele D{\textquoteright}Amico and Riadh Gouider and Saloua Mrabet and Katrin Gross-Paju and Sim{\'o}n C{\'a}rdenas-Robledo and Moghadasi, \{Abdorreza Naser\} and Sa, \{Maria Jose\} and Orla Gray and Jiwon Oh and Stephen Reddel and Sudarshini Ramanathan and Talal Al-Harbi and Ayse Altintas and Hardy, \{Todd A.\} and Serkan Ozakbas and Raed Alroughani and Kermode, \{Allan G.\} and Andrea Surcinelli and Guy Laureys and Sara Eichau and Alexandre Prat and Marc Girard and Pierre Duquette and Suzanne Hodgkinson and Cristina Ramo-Tello and Davide Maimone and Pamela McCombe and Daniele Spitaleri and Sanchez-Menoyo, \{Jose Luis\} and Yetkin, \{Mehmet Fatih\} and Baghbanian, \{Seyed Mohammad\} and Rana Karabudak and Abdullah Al-Asmi and Jakob, \{Gregor Brecl\} and Khoury, \{Samia J.\} and Masoud Etemadifar and \{van Pesch\}, Vincent and Katherine Buzzard and Bruce Taylor and Helmut Butzkueven and \{Van der Walt\}, Anneke",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2024.",

year = "2024",

month = sep,

doi = "10.1007/s00415-024-12518-7",

language = "English",

volume = "271",

pages = "5813--5824",

journal = "Journal of Neurology",

issn = "0340-5354",

publisher = "Springer Science and Business Media Deutschland GmbH",

number = "9",

}

Lal, AP, Foong, YC, Sanfilippo, PG, Spelman, T, Rath, L, Levitz, D, Fabis-Pedrini, M, Foschi, M, Habek, M, Kalincik, T, Roos, I, Lechner-Scott, J, John, N, Soysal, A, D’Amico, E, Gouider, R, Mrabet, S, Gross-Paju, K, Cárdenas-Robledo, S, Moghadasi, AN, Sa, MJ, Gray, O, Oh, J, Reddel, S, Ramanathan, S, Al-Harbi, T, Altintas, A, Hardy, TA, Ozakbas, S, Alroughani, R, Kermode, AG, Surcinelli, A, Laureys, G, Eichau, S, Prat, A, Girard, M, Duquette, P, Hodgkinson, S, Ramo-Tello, C, Maimone, D, McCombe, P, Spitaleri, D, Sanchez-Menoyo, JL, Yetkin, MF, Baghbanian, SM, Karabudak, R, Al-Asmi, A, Jakob, GB, Khoury, SJ, Etemadifar, M, van Pesch, V, Buzzard, K, Taylor, B, Butzkueven, H & Van der Walt, A 2024, 'A multi-centre longitudinal study analysing multiple sclerosis disease-modifying therapy prescribing patterns during the COVID-19 pandemic', Journal of Neurology, vol. 271, no. 9, pp. 5813-5824. https://doi.org/10.1007/s00415-024-12518-7

TY - JOUR

T1 - A multi-centre longitudinal study analysing multiple sclerosis disease-modifying therapy prescribing patterns during the COVID-19 pandemic

AU - Lal, Anoushka P.

AU - Foong, Yi Chao

AU - Sanfilippo, Paul G.

AU - Spelman, Tim

AU - Rath, Louise

AU - Levitz, David

AU - Fabis-Pedrini, Marzena

AU - Foschi, Matteo

AU - Habek, Mario

AU - Kalincik, Tomas

AU - Roos, Izanne

AU - Lechner-Scott, Jeannette

AU - John, Nevin

AU - Soysal, Aysun

AU - D’Amico, Emanuele

AU - Gouider, Riadh

AU - Mrabet, Saloua

AU - Gross-Paju, Katrin

AU - Cárdenas-Robledo, Simón

AU - Moghadasi, Abdorreza Naser

AU - Sa, Maria Jose

AU - Gray, Orla

AU - Oh, Jiwon

AU - Reddel, Stephen

AU - Ramanathan, Sudarshini

AU - Al-Harbi, Talal

AU - Altintas, Ayse

AU - Hardy, Todd A.

AU - Ozakbas, Serkan

AU - Alroughani, Raed

AU - Kermode, Allan G.

AU - Surcinelli, Andrea

AU - Laureys, Guy

AU - Eichau, Sara

AU - Prat, Alexandre

AU - Girard, Marc

AU - Duquette, Pierre

AU - Hodgkinson, Suzanne

AU - Ramo-Tello, Cristina

AU - Maimone, Davide

AU - McCombe, Pamela

AU - Spitaleri, Daniele

AU - Sanchez-Menoyo, Jose Luis

AU - Yetkin, Mehmet Fatih

AU - Baghbanian, Seyed Mohammad

AU - Karabudak, Rana

AU - Al-Asmi, Abdullah

AU - Jakob, Gregor Brecl

AU - Khoury, Samia J.

AU - Etemadifar, Masoud

AU - van Pesch, Vincent

AU - Buzzard, Katherine

AU - Taylor, Bruce

AU - Butzkueven, Helmut

AU - Van der Walt, Anneke

PY - 2024/9

Y1 - 2024/9

N2 - Background: The COVID-19 pandemic raised concern amongst clinicians that disease-modifying therapies (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 onset. Methods: A multi-centre longitudinal study with 8,771 participants from MSBase was conducted. Two time periods were defined: pre-pandemic (March 11 2018–March 10 2020) and post-pandemic onset (March 11 2020–11 March 2022). The association between time and prescribing trends was analysed using multivariable mixed-effects logistic regression. DMT initiation refers to first initiation of any DMT, whilst DMT switches indicate changing regimen within 6 months of last use. Results: Post-pandemic onset, 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-CD20mAb initiation/switching decreased in the year of the pandemic, but recovered in the second year, such that overall odds increased slightly post-pandemic (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-gamma-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)]. Conclusions: Post-pandemic onset, clinicians preferentially prescribed natalizumab and cladribine over anti-CD20 mAbs and fingolimod, likely to preserve efficacy but reduce perceived immunosuppressive risks. This could have implications for disease progression in pwMS. Our findings highlight the significance of equitable DMT access globally, and the importance of evidence-based decision-making in global health challenges.

AB - Background: The COVID-19 pandemic raised concern amongst clinicians that disease-modifying therapies (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 onset. Methods: A multi-centre longitudinal study with 8,771 participants from MSBase was conducted. Two time periods were defined: pre-pandemic (March 11 2018–March 10 2020) and post-pandemic onset (March 11 2020–11 March 2022). The association between time and prescribing trends was analysed using multivariable mixed-effects logistic regression. DMT initiation refers to first initiation of any DMT, whilst DMT switches indicate changing regimen within 6 months of last use. Results: Post-pandemic onset, 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-CD20mAb initiation/switching decreased in the year of the pandemic, but recovered in the second year, such that overall odds increased slightly post-pandemic (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-gamma-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)]. Conclusions: Post-pandemic onset, clinicians preferentially prescribed natalizumab and cladribine over anti-CD20 mAbs and fingolimod, likely to preserve efficacy but reduce perceived immunosuppressive risks. This could have implications for disease progression in pwMS. Our findings highlight the significance of equitable DMT access globally, and the importance of evidence-based decision-making in global health challenges.

KW - Anti-CD20 monoclonal antibodies

KW - COVID-19

KW - Cladribine

KW - Disease-modifying therapy

KW - Multiple sclerosis

KW - Natalizumab

UR - https://www.scopus.com/pages/publications/85197450686

U2 - 10.1007/s00415-024-12518-7

DO - 10.1007/s00415-024-12518-7

M3 - Article

C2 - 38935148

AN - SCOPUS:85197450686

SN - 0340-5354

VL - 271

SP - 5813

EP - 5824

JO - Journal of Neurology

JF - Journal of Neurology

IS - 9

ER -

A multi-centre longitudinal study analysing multiple sclerosis disease-modifying therapy prescribing patterns during the COVID-19 pandemic

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