Impact of the COVID-19 pandemic on the prescription of disease-modifying therapy for multiple sclerosis in England: a nationwide study

Introduction

The provision of multiple sclerosis (MS) services in England was profoundly impacted by the COVID-19 pandemic in 2020. Specialist staff were re-deployed to frontline services, social distancing measures resulted in reduced access to diagnostics and hospital facilities for infusion treatments, and concerns were raised over the safety of immunosuppressive disease-modifying therapies (DMTs). 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.1

Clinical trials and observational studies suggest that early use of high-efficacy DMTs results in improved long-term outcomes for people with MS.2 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.3

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