A multi-centre longitudinal study analysing multiple sclerosis disease-modifying therapy prescribing patterns during the COVID-19 pandemic
Lal, Anoushka P. (The Alfred Hospital)
Foong, Yi Chao (Royal Hobart Hospital (Austràlia))
Sanfilippo, Paul G. (Central Clinical School. Department of Neurology (Austràlia))
Spelman, Tim (Central Clinical School. Department of Neuroscience (Austràlia))
Rath, Louise (Central Clinical School. Department of Neuroscience (Austràlia))
Levitz, David (Central Clinical School. Department of Neuroscience (Austràlia))
Fabis-Pedrini, Marzena (Centre for Molecular Medicine and Innovative Therapeutics. Murdoch University (Austràlia))
Foschi, Matteo (University of L'Aquila. Department of Biotechnological and Applied Clinical Sciences (DISCAB)(Itàlia))
Habek, Mario (University of Zagreb (Croàcia))
Kalincik, Tomas (CORe. University of Melbourne (Austràlia))
Roos, Izanne (Royal Melbourne Hospital (Austràlia))
Lechner-Scott, Jeannette (Hunter Medical Research Institute. University Newcastle (Austràlia))
John, Nevin (Monash Health (Austràlia))
Soysal, Aysun (Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases (Istanbul, Turquia))
D'Amico, Emanuele (Medical and Surgical Sciences. Universita Di Foggia (Itàlia))
Gouider, Riadh (University of Tunis El Manar (Tunísia))
Mrabet, Saloua (University of Tunis El Manar (Tunísia))
Gross-Paju, Katrin (Multiple Sclerosis Centre. West-Tallinn Central Hospital (Estònia))
Cárdenas-Robledo, Simón (Universidad Nacional de Colombia)
Moghadasi, Abdorreza Naser (Multiple Research Centre. Neuroscience Institute. Tehran University of Medical Science (Iran))
Sa, Maria Jose (Centro Hospitalar Universitario de Sao Joao (Portugal))
Gray, Orla (South Eastern HSC Trust (Regne Unit))
Oh, Jiwon (St. Michael's Hospital (Canadà))
Reddel, Stephen (Concord Repatriation General Hospital (Austràlia))
Ramanathan, Sudarshini (Concord Hospital (Austràlia))
Al-Harbi, Talal (King Fahad Specialist Hospital-Dammam (Aràbia Saudita))
Altintas, Ayse (School of Medicine and Koc University Research Center for Translational Medicine (KUTTAM)(Turquia))
Hardy, Todd A. (Concord Repatriation General Hospital (Austràlia))
Ozakbas, Serkan (Multiple Sclerosis Research Association (Turquia))
Alroughani, Raed (Amiri Hospital (Kuwait))
Kermode, Allan G. (Centre for Molecular Medicine and Innovative Therapeutics. Murdoch University (Austràlia))
Surcinelli, Andrea (MS Center. Neurology Unit. S. Maria Delle Croci Hospital. AUSL Romagna (Itàlia))
Laureys, Guy (University Hospital Ghent (Bèlgica))
Eichau, Sara (Hospital Universitario Virgen Macarena (Sevilla, Andalusia))
Prat, Alexandre (CHUM and Universite de Montreal (Canadà))
Girard, Marc (CHUM and Universite de Montreal (Canadà))
Duquette, Pierre (CHUM and Universite de Montreal (Canadà))
Hodgkinson, Suzanne (Immune Tolerance Laboratory Ingham Institute and Department of Medicine. UNSW (Austràlia))
Ramo-Tello, Cristina (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Maimone, Davide (Azienda Ospedale-Università Padova)
McCombe, Pamela (Royal Brisbane and Women's Hospital (Austàlia))
Spitaleri, Daniele (Azienda Ospedaliera Di Rilievo Nazionale San Giuseppe Moscati Avellino (Itàlia))
Sánchez Menoyo, José Luis (Hospital de Galdakao (Usansolo, Biscaia))
Yetkin, Mehmet Fatih (Erciyes University (Turquia))
Baghbanian, Seyed Mohammad (Faculty of Medicine. Mazandaran University of Medical Sciences (Iran))
Karabudak, Rana (Neuroimmunology Unit. Koşuyolu Hospitals (Turquia))
Al-Asmi, Abdullah (Health Sciences and Sultan Qaboos University Hospital. Sultan Qaboos University (Oman))
Jakob, Gregor Brecl (Univerza V Ljubljani (Eslovènia))
Khoury, Samia J. (Nehme and Therese Tohme Multiple Sclerosis Center. American University of Beirut Medical Center (Líban))
Etemadifar, Masoud (Etemadifar MS Institute. Isfahan University of Medical Sciences (Iran))
van Pesch, Vincent (Cliniques Universitaires Saint-Luc (Bèlgica))
Buzzard, Katherine (Box Hill Hospital (Victòria, Austràlia))
Taylor, Bruce (Royal Hobart Hospital (Austràlia))
Butzkueven, Helmut (The Alfred Hospital (Austràlia))
Van der Walt, Anneke (The Alfred Hospital (Austràlia))

Data:	2024
Resum:	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.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Multiple sclerosis ; COVID-19 ; Disease-modifying therapy ; Anti-CD20 monoclonal antibodies ; Cladribine ; Natalizumab
Publicat a:	Journal of neurology, Vol. 271 Núm. 9 (June 2024) , p. 5813-5824, ISSN 1432-1459

DOI: 10.1007/s00415-024-12518-7
PMID: 38935148

12 p, 600.8 KB

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