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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. A multi-centre longitudinal study analysing multiple sclerosis disease-modifying therapy prescribing patterns during the COVID-19 pandemic. J Neurol 2024:10.1007/s00415-024-12518-7. [PMID: 38935148 DOI: 10.1007/s00415-024-12518-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 06/09/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024]
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.
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Affiliation(s)
- Anoushka P Lal
- Department of Neuroscience, Central Clinical School, The Alfred, Melbourne, VIC, Australia
- Department of Neurology, The Alfred Hospital, 55 Commercial Road, Melbourne, 3004, Australia
| | - Yi Chao Foong
- Department of Neuroscience, Central Clinical School, The Alfred, Melbourne, VIC, Australia
- Department of Neurology, The Alfred Hospital, 55 Commercial Road, Melbourne, 3004, Australia
- Royal Hobart Hospital, Hobart, Australia
| | - Paul G Sanfilippo
- Department of Neuroscience, Central Clinical School, The Alfred, Melbourne, VIC, Australia
| | - Tim Spelman
- Department of Neuroscience, Central Clinical School, The Alfred, Melbourne, VIC, Australia
| | - Louise Rath
- Department of Neuroscience, Central Clinical School, The Alfred, Melbourne, VIC, Australia
| | - David Levitz
- Department of Neuroscience, Central Clinical School, The Alfred, Melbourne, VIC, Australia
| | - Marzena Fabis-Pedrini
- Perron Institute for Neurological and Translational Science, The University of Western Australia, Perth, Australia
- Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, Perth, Australia
| | - Matteo Foschi
- Department of Neuroscience, MS Center, Neurology Unit, S. Maria Delle Croci Hospital, AUSL Romagna, Ravenna, Italy
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, L'Aquila, Italy
| | - Mario Habek
- Department of Neurology, University Hospital Center Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Tomas Kalincik
- Department of Neurology, Neuroimmunology Centre, Royal Melbourne Hospital, Melbourne, Australia
- CORe, Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Izanne Roos
- Department of Neurology, Neuroimmunology Centre, Royal Melbourne Hospital, Melbourne, Australia
| | | | - Nevin John
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Australia
- Department of Neurology, Monash Health, Clayton, Australia
| | - Aysun Soysal
- Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey
| | - Emanuele D'Amico
- Medical and Surgical Sciences, Universita Di Foggia, Foggia, Italy
| | - Riadh Gouider
- Department of Neurology, LR 18SP03, Clinical Investigation Centre Neurosciences and Mental Health, Razi University Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Saloua Mrabet
- Department of Neurology, LR 18SP03, Clinical Investigation Centre Neurosciences and Mental Health, Razi University Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Katrin Gross-Paju
- Multiple Sclerosis Centre, West-Tallinn Central Hospital, Tallinn, Estonia
| | - Simón Cárdenas-Robledo
- Department of Neurology, Centro de Esclerosis Múltiple (CEMHUN), Hospital Universitario Nacional de Colombia Bogota, Bogota, Colombia
- Departamento de Medicina InternaFacultad de Medicina, Universidad Nacional de Colombia, Bogota, Colombia
| | - Abdorreza Naser Moghadasi
- Multiple Research Centre, Neuroscience Institute, Tehran University of Medical Science, Tehran, Iran
| | - Maria Jose Sa
- Department of Neurology, Centro Hospitalar Universitario de Sao Joao, Porto, Portugal
| | - Orla Gray
- South Eastern HSC Trust, Belfast, UK
| | - Jiwon Oh
- St. Michael's Hospital, Toronto, Canada
| | - Stephen Reddel
- Department of Neurology, Concord Repatriation General Hospital, Sydney, Australia
| | - Sudarshini Ramanathan
- Translational Neuroimmunology Group, Kids Neuroscience Centre and Brain and Mind Centre, Concord Hospital, Sydney, Australia
| | - Talal Al-Harbi
- Neurology Department, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - Ayse Altintas
- Department of Neurology, School of Medicine and Koc University Research Center for Translational Medicine (KUTTAM), İstanbul, Turkey
| | - Todd A Hardy
- Department of Neurology, Concord Repatriation General Hospital, Sydney, Australia
| | - Serkan Ozakbas
- Izmir University of Economics, Medical Point Hospital, Izmir, Turkey
- Multiple Sclerosis Research Association, Izmir, Turkey
| | - Raed Alroughani
- Division of Neurology, Department of Medicine, Amiri Hospital, Sharq, Kuwait
| | - Allan G Kermode
- Perron Institute for Neurological and Translational Science, The University of Western Australia, Perth, Australia
- Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, Perth, Australia
| | - Andrea Surcinelli
- Department of Neuroscience, MS Center, Neurology Unit, S. Maria Delle Croci Hospital, AUSL Romagna, Ravenna, Italy
| | - Guy Laureys
- Department of Neurology, University Hospital Ghent, Ghent, Belgium
| | - Sara Eichau
- Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain
| | | | - Marc Girard
- CHUM and Universite de Montreal, Montreal, Canada
| | | | - Suzanne Hodgkinson
- Immune Tolerance Laboratory Ingham Institute and Department of Medicine, UNSW, Sydney, Australia
| | | | - Davide Maimone
- Centro Sclerosi Multipla, UOC Neurologia, Azienda Ospedaliera Per L'Emergenza Cannizzaro, Catania, Italy
| | - Pamela McCombe
- University of Queensland, Brisbane, Australia
- Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Daniele Spitaleri
- Azienda Ospedaliera Di Rilievo Nazionale San Giuseppe Moscati Avellino, Avellino, Italy
| | - Jose Luis Sanchez-Menoyo
- Department of Neurology, Galdakao-Usansolo University Hospital, Osakidetza-Basque Health Service, Galdakao, Spain
| | | | - Seyed Mohammad Baghbanian
- Neurology Department, Booalisina Hospital, Mazandaran University of Medical Sciences, Sari, Iran
- Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Rana Karabudak
- Department of Neurological Sciences, Faculty of Medicine, Yeditepe University, Istanbul, Turkey
- Neuroimmunology Unit, Koşuyolu Hospitals, Istanbul, Turkey
| | - Abdullah Al-Asmi
- College of Medicine & Health Sciences and Sultan Qaboos University Hospital, Sultan Qaboos University, Al-Khodh, Oman
| | - Gregor Brecl Jakob
- Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Samia J Khoury
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
| | - Masoud Etemadifar
- Neurology, Dr. Etemadifar MS Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Vincent van Pesch
- Department of Neurology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | | | | | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, The Alfred, Melbourne, VIC, Australia
- Department of Neurology, The Alfred Hospital, 55 Commercial Road, Melbourne, 3004, Australia
| | - Anneke Van der Walt
- Department of Neuroscience, Central Clinical School, The Alfred, Melbourne, VIC, Australia.
- Department of Neurology, The Alfred Hospital, 55 Commercial Road, Melbourne, 3004, Australia.
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Jamali E, Shapoori S, Farrokhi MR, Vakili S, Rostamzadeh D, Iravanpour F, Tavakoli Oliaee R, Jafarinia M. Effect of Disease-Modifying Therapies on COVID-19 Vaccination Efficacy in Multiple Sclerosis Patients: A Comprehensive Review. Viral Immunol 2023; 36:368-377. [PMID: 37276047 DOI: 10.1089/vim.2023.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
According to current knowledge, the etiopathogenesis of multiple sclerosis (MS) is complex, involving genetic background as well as several environmental factors that result in dysimmunity in the central nervous system (CNS). MS is an immune-mediated, inflammatory neurological disease affecting the CNS. As part of its attack on the axons of the CNS, MS witnesses varying degrees of myelin and axonal loss. A total of about 20 disease-modifying therapies (DMTs) are available today that, both in clinical trials and in real-world studies, reduce disease activity, such as relapses, magnetic resonance imaging lesions, and disability accumulation. Currently, the world is facing an outbreak of the new coronavirus disease 2019 (COVID-19), which originated in Wuhan, Hubei Province, China, in December 2019 and spread rapidly around the globe. Viral infections play an important role in triggering and maintaining neuroinflammation through direct and indirect mechanisms. There is an old association between MS and viral infections. In the context of MS-related chronic inflammatory damage within the CNS, there has been concern regarding COVID-19 worsening neurological damage. A high rate of disability and increased susceptibility to infection have made MS patients particularly vulnerable. In addition, DMTs have been a concern during the pandemic since many DMTs have immunosuppressive properties. In this article, we discuss the impact of DMTs on COVID-19 risks and the effect of DMTs on COVID-19 vaccination efficacy and outcome in MS patients.
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Affiliation(s)
- Elham Jamali
- Diagnostic Laboratory Sciences and Technology Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
- Peyvand Pathobiology and Genetic Laboratory, Shiraz, Iran
| | - Shima Shapoori
- Science Foundation Ireland (SFI), Center for Research in Medical Devices (CÚRAM), University of Galway, Galway, Ireland
| | - Majid Reza Farrokhi
- Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Neurosurgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sina Vakili
- Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Davoud Rostamzadeh
- Medicinal Plants Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
- Department of Immunology, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Farideh Iravanpour
- Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Razieh Tavakoli Oliaee
- Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Morteza Jafarinia
- Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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