Williams T, Mishra R, Bharkhada B, Shields A, Dorsey R, Chataway J, Brownlee WJ. Impact of the COVID-19 pandemic on the prescription of disease-modifying therapy for multiple sclerosis in England: a nationwide study. J Neurol Neurosurg Psychiatry. 2022 Mar 10:jnnp-2021-328340. doi: 10.1136/jnnp-2021-328340.
The provision of multiple sclerosis (MS) services in England was profoundly impacted by the COVID-19 pandemic in 2020.
The Association of British Neurologists issued guidance in March 2020, advising that the risk from COVID-19 may potentially be increased with fingolimod, ocrelizumab, alemtuzumab and cladribine treatment in people with MS, due to the immunosuppressive mechanism of action of these drugs.
If the impacts of the COVID-19 pandemic were to reduce or delay the initiation of DMTs, particularly high-efficacy therapies, this may result in worse long-term outcomes for people with MS.
Here, we use national data on all DMTs prescribed in NHS England between January 2016 and December 2020 in order to assess whether the COVID-19 pandemic.
As a compulsory requirement of National Health Service (NHS) payment, all licenced DMTs prescribed for MS within NHS England must be registered on the Blueteq high-cost drug database.
They obtained fully anonymised data on the number of patients with MS initiated on each of the licenced DMT across all 77 MS centres. Between 2016 and 2019, the overall number of DMT initiations consistently increased (+29.5%). This was followed by a 13.3% reduction in the number of DMTs initiated in 2020 compared with 2019. The greatest absolute reductions in treatments initiated in 2020, compared with 2019, were seen with alemtuzumab (−75.0%), ocrelizumab (−13.5%)) and dimethyl fumurate (−13.5%). Natalizumab, the only high-efficacy monoclonal antibody treatment initially recommended as ‘safe’ during the COVID-19 pandemic, saw a 46.9% increase in the number of initiations in 2020 compared with 2019. Lower efficacy treatments, such as interferon-beta and glatiramer acetate, were relatively unaffected.
The Scottish Multiple Sclerosis Register has reported fewer new MS diagnoses in 2020 compared with previous years (16.7% reduction)), suggesting the impact on MS care extends beyond DMT initiation. Independent of the underlying cause, our findings of suboptimal DMT provision during 2020 indicate that the long-term impact of the COVID-19 pandemic may extend beyond the short-term disruptions in the care for people with MS.
So it was evident the the number of high efficacy treatments were reduced during the COVID-19 pandemic.
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