MS Care Experienced Profound Changes During COVID-19 Pandemic

Carrie Hersh, DO, MSc

A nationwide survey polling multiple sclerosis (MS) specialist physicians and other clinicians serving on regional National Multiple Sclerosis Society (NMSS) Healthcare Provider Councils showed a number of profound clinical practice patterns changed during the COVID-19 pandemic.

A total of 86 respondents completed the newly developed 28-item electronic questionnaire, including 45 physicians, 18 rehabilitation therapists, 7 psychologists, 6 nurse practitioners, 4 social workers, 2 physician assistants, 2 nurses and 2 health professionals from other disciplines. Senior author Carrie Hersh, DO, MSc, assistant professor of neurology at the Cleveland Clinic Lerner College of Medicine, and colleagues sent out a recruitment email containing the survey in June of 2020 and sent 2 reminder emails in July and August of 2020 to those who did not respond. Once responses were finalized, the researchers found that nearly one-third of an MS specialist physician subgroup reported using telemedicine to provide more than 75% of their clinical care, along with a number of other profound changes.

Only 4 (4.9%) of 82 respondents in active clinical practice at the time of the survey reported not using telehealth when providing patient care services. In total, 42 respondents (53.8%) claimed they used telehealth less than 50% of the time, while 36 respondents (46.2%) reported using telehealth less than 50% to 100% of the time.

The investigators also documented changes in how they prescribe disease-modifying therapies (DMTs) to their patients and which agents they choose. The survey showed that 23 MS Physicians (54.8%) responded “Yes” to whether COVID-19 had changed how they recommend and prescribe MS DMTs, compared to 12 (28.6%) who said “Maybe,” and 7 (16.7%) who responded “No.” Physician respondents reported a mean number of 4.4 patients each who had COVID-19 (standard deviation [SD], 14.1; range, 0-32; 95% CI, 1.42-7.38).

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During the pandemic, DMTs prescribed more often included ß-inteferons (28.6% of prescribers), natalizumab (Tyasbri; Biogen; 23.8%), glatiramer acetate (21.4%) and teriflunomide (Aubagio; Sanofi; 19%).

On the other hand, DMTsprescribed less often throughout that time included alemtuzumab (Lemtrada; Sanofi Genzyme; 64.3% of prescribers), cladribine (Mavenclad; EMD Serono; 54.8%), ocrelizumab (Ocrevus; Genentech; ) and rituximab (Rituxan; Genentech/Biogen; 50%), and fingolimod (Gilenya; Novartis; 40.5%) and siponimod (Mayzent; Novartis; 40.5%). Suspension of certain DMTs during the pandemic included alemtuzumab (21.4% of prescribers), ocrelizumab and rituximab (16.7%) and cladribine (11.9%). Others used extended DMT dosing intervals, particularly for natalizumab (38.1%), fingolimod, and siponimod (11.9%).

The availability of adequate personal protective equipment (PPE) was reported by 80.5% of responders. Additionally, 32 (41.6%) of the participating on-site clinicians had adequate ability to physically distance themselves at work, while 11 (14.3%) did not.

Throughout the pandemic, clinicians were on alert for being deployed to the front lines. Among the respondents, 57 (74%) claimed they had not been redeployed to the front lines of caring for patients with COVID-19 and did not anticipate being redeployed. Another 13 (16.9%) had not been redeployed yet but anticipated redeployment in the future. Notably, redeployment was reported by 7 (9.1%) respondents, including 5 (6.5%) individuals to the front lines of COVID-19 care.

"Further research is needed to explore these trends and develop consensus guidelines on the best treatment practices for people living with MS during and after the global pandemic,” Hersh et al. concluded.

Research presented at the Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) Forum 2021, February 25-27, showed that a majority of MS health care professionals used clinical video telemedicine with their patients and were satisfied with its use. Led by Peter Keszler, DO, the study not only highlighted the wide majority of clinicians who were fond of telemedicine, but demonstrated the vast acceleration of its utilization, going from a usage rate of 15% of practice encounters prior to the pandemic, to 72.8% of encounters during it.²

REFERENCES

1. Morrison EH, Michtich K, Hersh CM. How the COVID-19 pandemic has changed multiple sclerosis clinical practice: results of a nationwide provider survey. Mult Scler Relat Discord. Published online March 18, 2021. doi: 10.1016/j.msard.2021.102913

2. Keszler P, Maloni H, Miles Z, Jin S, Wallin M. Telemedicine utilization and perceptions of multiple sclerosis health care providers. Presented at ACTRIMS Annual Forum; February 25-27, 2021. Abstract P172