Survey reveals profound pandemic changes to MS care
By Kate Johnson
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Clinicians across the Unites States who specialize in multiple sclerosis (MS) care report profound changes to their clinical practice because of the COVID-19 pandemic, according to the results of a nationwide survey through the National Multiple Sclerosis Society. The findings were published online in Multiple Sclerosis and Related Disorders.
“Four out of five specialists indicated that COVID-19 had changed how they were recommending and prescribing MS disease-modifying therapies (DMTs), and some are less likely to use the highest-efficacy therapies, Elizabeth H. Morrison, MD, lead author of the study, told MS Journey. “For instance, during the pandemic, respondents tended to prescribe more “platform” injectable therapies as well as natalizumab and teriflunomide, while prescribing fewer immunosuppressive agents,” said Dr. Morrison, who is a health sciences clinical professor at the University of California, Riverside.
The changes were likely reflective of a couple of different factors, according to coauthor Carrie M. Hersh, DO, staff neurologist at Cleveland Clinic Lou Ruvo Center for Brain Health in Las Vegas. Those included “concerns regarding potential safety risks of immunosuppressive and certain lymphocyte trafficking DMTs in the midst of a highly contagious viral infection with unanticipated and potentially long-term sequelae,” as well as “the frequency of visits, lab work, and MRIs that would otherwise be needed for close safety monitoring and surveillance,” she said in an interview.
The 28-item anonymous questionnaire was distributed electronically in June 2020 to 188 health care providers who participated in one of the NMSS’s 22 Healthcare Provider Councils across the United States.
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Questions on the survey explored MS specialists’ perceptions of how the pandemic has altered their prescribing of MS DMTs and provision of telehealth and other services, as well as issues affecting their own well-being including redeployment to the front lines of COVID-19 care and availability of personal protective equipment.
Eighty-six respondents (45.7%) from 32 states completed the survey between June and August of 2020, including 45 physicians (41 of whom were neurologists), 18 rehabilitation therapists, 7 clinical psychologists, 8 advanced practice clinicians, 4 social workers, and 4 health professionals from other disciplines (2 nurses, 1 clinical researcher and 1 pharmacist).
Nearly 10% of respondents reported they had been redeployed to the front lines of COVID-19 patient care, and an additional 16.9% anticipated redeployment. “This finding led us to consider the extent to which the pandemic has challenged the capacity of the MS health care work force,” said Dr. Morrison.
“We hope that people living with MS will not avoid seeing their clinicians because they’re afraid of getting exposed to COVID-19,” she added. “This survey suggested that the vast majority of MS specialists are offering at least some telehealth services so that their patients can feel safer as they continue receiving care.”
The authors cited need for further research on the pandemic-related trends in MS care, as well as consensus guidelines on best treatment practices for people living with MS during and after the global pandemic.
“It will be fascinating to learn how clinical practice patterns in multiple sclerosis care will change as more research data are published over the upcoming months, including from ongoing studies that are exploring how various multiple sclerosis disease-modifying therapies affect outcomes from SARS-CoV-2 infection,” said Dr. Morrison.
Dr. Morrison has received honoraria, consulting fees or research support from AbbVie, Acorda, Biogen, EMD Serono, Genentech, Landon Pediatric Foundation, Neurosearch, and Teva Neuroscience. Dr. Hersh has received honoraria, consulting fees or research support from Biogen, Bristol-Myers Squibb, EMD Serono, Genentech, Genzyme, Novartis, and the Patient-Centered Outcomes Research Institute.
Morrison EH et al. Mult Scler Relat Disord. 2021 Mar 18;51:102913.