Impact of COVID-19 on Treatment Selection for Multiple Sclerosis

Background: Multiple Sclerosis (MS) is an immune-mediated central nervous system disease that is treated with disease modifying therapies (DMTs). Among the DMTs, certain classes of therapies have been associated with an increased risk of severe COVID-19 resulting in prescribers to consider changing their practice habits during the COVID-19 pandemic.

Objectives: To assess the impact of COVID-19 on prescribing patterns of DMTs for MS patients at a large academic health-system.

Methods: A retrospective review of the electronic health record at Johns Hopkins Health System was performed from April 2019 to December 2021. Study Timeframes: pre-pandemic (April 2019 – March 2020), pre-vaccine pandemic (April 2020 – March 2021), and post-vaccine pandemic (April 2021 – December 2021).

Patients will be identified through dispense reports from pharmacy dispensing system, and prescribing report from the health-system electronic health record (EHR). EHR will also be utilized to conduct chart reviews for a subset of patients that have a modification in their therapy during the specified timeframe.

Inclusion: adult patients prescribed at least one DMT through Johns Hopkins (JH) Pharmacy Services during the study timeframe and those who stay on their DMT for at least 2 months without any tolerability issues.

Descriptive statistics will be used to compare the prescribing practices during the timeframes with the percentage of prescribing for each type of treatment and to assess the percentage of patients that switched therapies in the different time periods. Chi-square test will be performed to assess the significance of the various changes in DMTs during the 3 timeframes.

Results: 949 patients were identified that have been prescribed at least one DMT at JH Pharmacy Services between study timeframe. During the pre-pandemic period, 591 patients were prescribed a DMT; mean age of patients was 46 years and 75% were female. Majority of the patients were prescribed an infusion therapy (72%) with Ocrevus being the most prescribed therapy (42%) followed by Tysabri (22.8%). Among self-administered therapies, dimethyl fumarate was the most prescribed therapy (12.3%) followed by glatiramer acetate (9.3%). In comparison, a total of 614 patients were prescribed a DMT during pre-vaccine pandemic; mean age of these patients was 45 years and majority were females (76%). Compared to pre-pandemic time period, no major change in prescribing habits was observed; 74% infusion therapy (47% Ocrevus, 21% Tysabri) and 26% self-administered therapies (dimethyl fumarate 12.9%, glatiramer acetate 7.3%). Analyses is ongoing to identify prescribing patterns during post-vaccine timeframe. Additionally, chart reviews are being conducted to assess prescribing changes due to COVID-19.

Conclusions: The results of this study will be utilized to understand the prescribing practice changes due to COVID-19 and provide background for future outcomes-focused research studies for MS patients.