A multi-centre longitudinal study analysing multiple sclerosis disease-modifying therapy prescribing patterns during the COVID-19 pandemic
Por:
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, Cardenas-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 and Van der Walt, A
Publicada:
27 jun 2024
Ahead of Print:
1 jun 2024
Resumen:
BackgroundThe 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.MethodsA 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.ResultsPost-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)].ConclusionsPost-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.
Filiaciones:
Lal, AP:
The Alfred, Cent Clin Sch, Dept Neurosci, Melbourne, Vic, Australia
The Alfred Hosp, Dept Neurol, 55 Commercial Rd, Melbourne, Vic 3004, Australia
Foong, YC:
The Alfred, Cent Clin Sch, Dept Neurosci, Melbourne, Vic, Australia
The Alfred Hosp, Dept Neurol, 55 Commercial Rd, Melbourne, Vic 3004, Australia
Royal Hobart Hosp, Hobart, Australia
Sanfilippo, PG:
The Alfred, Cent Clin Sch, Dept Neurosci, Melbourne, Vic, Australia
Spelman, T:
The Alfred, Cent Clin Sch, Dept Neurosci, Melbourne, Vic, Australia
Rath, L:
The Alfred, Cent Clin Sch, Dept Neurosci, Melbourne, Vic, Australia
Levitz, D:
The Alfred, Cent Clin Sch, Dept Neurosci, Melbourne, Vic, Australia
Fabis-Pedrini, M:
Univ Western Australia, Perron Inst Neurol & Translat Sci, Perth, WA, Australia
Murdoch Univ, Ctr Mol Med & Innovat Therapeut, Perth, WA, Australia
Foschi, M:
S Maria Croci Hosp, Dept Neurosci, Neurol Unit, AUSL Romagna,MS Ctr, Ravenna, Italy
Univ Aquila, Dept Biotechnol & Appl Clin Sci DISCAB, Laquila, Italy
Habek, M:
Univ Hosp Ctr Zagreb, Dept Neurol, Zagreb, Croatia
Univ Zagreb, Sch Med, Zagreb, Croatia
Kalincik, T:
Royal Melbourne Hosp, Neuroimmunol Ctr, Dept Neurol, Melbourne, Vic, Australia
Univ Melbourne, Dept Med, CORE, Melbourne, Australia
Roos, I:
Royal Melbourne Hosp, Neuroimmunol Ctr, Dept Neurol, Melbourne, Vic, Australia
Lechner-Scott, J:
Univ Newcastle, Hunter Med Res Inst, Newcastle, NSW, Australia
John, N:
Monash Univ, Sch Clin Sci, Dept Med, Clayton, Vic, Australia
Monash Hlth, Dept Neurol, Clayton, Australia
Soysal, A:
Bakirkoy Educ & Res Hosp Psychiat & Neurol Dis, Istanbul, Turkiye
D'Amico, E:
Univ Foggia, Med & Surg Sci, Foggia, Italy
Gouider, R:
Razi Univ Hosp, Clin Invest Ctr Neurosci & Mental Hlth, Dept Neurol, LR 18SP03, Tunis, Tunisia
Univ Tunis El Manar, Fac Med Tunis, Tunis, Tunisia
Mrabet, S:
Razi Univ Hosp, Clin Invest Ctr Neurosci & Mental Hlth, Dept Neurol, LR 18SP03, Tunis, Tunisia
Univ Tunis El Manar, Fac Med Tunis, Tunis, Tunisia
Gross-Paju, K:
West Tallinn Cent Hosp, Multiple Sclerosis Ctr, Tallinn, Estonia
Cardenas-Robledo, S:
Hosp Univ Nacl Colombia Bogota, Ctr Esclerosis Multiple CEMHUN, Dept Neurol, Bogota, Colombia
Univ Nacl Colombia, Dept Med Interna, Fac Med, Bogota, Colombia
Moghadasi, AN:
Univ Tehran Med Sci, Neurosci Inst, Multiple Res Ctr, Tehran, Iran
Sa, MJ:
Ctr Hosp Univ Sao Joao, Dept Neurol, Porto, Portugal
Gray, O:
South Eastern HSC Trust, Belfast, North Ireland
Oh, J:
St Michaels Hosp, Toronto, ON, Canada
Reddel, S:
Concord Repatriat Gen Hosp, Dept Neurol, Sydney, NSW, Australia
Ramanathan, S:
Concord Hosp, Kids Neurosci Ctr, Translat Neuroimmunol Grp, Sydney, Australia
Concord Hosp, Brain & Mind Ctr, Sydney, Australia
Al-Harbi, T:
King Fahad Specialist Hosp Dammam, Neurol Dept, Dammam, Saudi Arabia
Altintas, A:
Koc Univ Res Ctr Translat Med KUTTAM, Sch Med, Dept Neurol, Istanbul, Turkiye
Hardy, TA:
Concord Repatriat Gen Hosp, Dept Neurol, Sydney, NSW, Australia
Ozakbas, S:
Izmir Univ Econ, Med Point Hosp, Izmir, Turkiye
Multiple Sclerosis Res Assoc, Izmir, Turkiye
Alroughani, R:
Amiri Hosp, Dept Med, Div Neurol, Sharq, Kuwait
Kermode, AG:
Univ Western Australia, Perron Inst Neurol & Translat Sci, Perth, WA, Australia
Murdoch Univ, Ctr Mol Med & Innovat Therapeut, Perth, WA, Australia
Surcinelli, A:
S Maria Croci Hosp, Dept Neurosci, Neurol Unit, AUSL Romagna,MS Ctr, Ravenna, Italy
Laureys, G:
Univ Hosp Ghent, Dept Neurol, Ghent, Belgium
Eichau, S:
Hosp Univ Virgen Macarena, Dept Neurol, Seville, Spain
Prat, A:
CHUM, Montreal, PQ, Canada
Univ Montreal, Montreal, PQ, Canada
Girard, M:
CHUM, Montreal, PQ, Canada
Univ Montreal, Montreal, PQ, Canada
Duquette, P:
CHUM, Montreal, PQ, Canada
Univ Montreal, Montreal, PQ, Canada
Hodgkinson, S:
UNSW, Ingham Inst, Immune Tolerance Lab, Sydney, Australia
UNSW, Dept Med, Sydney, Australia
:
Hosp Germans Trias i Pujol, Dept Neurosci, Badalona, Spain
Maimone, D:
UOC Neurol, Ctr Sclerosi Multipla, Azienda Osped Emergenza Cannizzaro, Catania, Italy
Mccombe, P:
Univ Queensland, Brisbane, Australia
Royal Brisbane & Womens Hosp, Brisbane, Qld, Australia
Spitaleri, D:
Azienda Osped Rilievo Nazl San Giuseppe Moscati Av, Avellino, Italy
Sanchez-Menoyo, JL:
Galdakao Usansolo Univ Hosp, Dept Neurol, Osakidetza Basque Hlth Serv, Galdakao, Spain
Yetkin, MF:
Erciyes Univ, Dept Neurol, Kayseri, Turkiye
Baghbanian, SM:
Mazandaran Univ Med Sci, Booalisina Hosp, Dept Neurol, Sari, Iran
Mazandaran Univ Med Sci, Fac Med, Sari, Iran
Karabudak, R:
Yeditepe Univ, Fac Med, Dept Neurol Sci, Istanbul, Turkiye
Kosuyolu Hosp, Neuroimmunol Unit, Istanbul, Turkiye
Al-Asmi, A:
Sultan Qaboos Univ, Coll Med & Hlth Sci, Al Khoud, Oman
Sultan Qaboos Univ, Sultan Qaboos Univ Hosp, Al Khoud, Oman
Jakob, GB:
Univ Med Ctr Ljubljana, Dept Neurol, Ljubljana, Slovenia
Univ Ljubljana, Fac Med, Ljubljana, Slovenia
Khoury, SJ:
Amer Univ, Beirut Med Ctr, Nehme & Therese Tohme Multiple Sclerosis Ctr, Beirut, Lebanon
Etemadifar, M:
Isfahan Univ Med Sci, Dr Etemadifar MS Inst, Neurol, Esfahan, Iran
van Pesch, V:
Clin Univ St Luc, Dept Neurol, Brussels, Belgium
Buzzard, K:
Box Hill Hosp, Dept Neurosci, Box Hill, Australia
Taylor, B:
Royal Hobart Hosp, Hobart, Australia
Butzkueven, H:
The Alfred, Cent Clin Sch, Dept Neurosci, Melbourne, Vic, Australia
The Alfred Hosp, Dept Neurol, 55 Commercial Rd, Melbourne, Vic 3004, Australia
Van der Walt, A:
The Alfred, Cent Clin Sch, Dept Neurosci, Melbourne, Vic, Australia
The Alfred Hosp, Dept Neurol, 55 Commercial Rd, Melbourne, Vic 3004, Australia
Green Published, hybrid
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