Impact of the COVID-19 pandemic on disease-modifying therapy utilization and perceptions in multiple sclerosis: A retrospective insurance claims analysis and survey study of people with MS and healthcare providers

Introduction: Since the beginning of the COVID-19 pandemic, healthcare providers (HCPs) and people with MS (pMS) have faced uncertainty regarding the potential risk of more severe infection with COVID-19 posed by the use of disease modifying therapies (DMT). Objectives: The CopeMS study led by The University of Texas and the MS Association of America investigates the indirect impact of the COVID-19 pandemic on pMS. Aims: To evaluate whether the COVID-19 pandemic led to changes in DMT utilization and how HCPs and pMS perceptions of DMTs during the pandemic influenced treatment decisions. Methods: This retrospective cohort analysis used OPTUM ClinformaticsR data to identify pMS who were continuously enrolled from 01/01/2019-12/31/2020 and assess changes in DMT prescription patterns before and during the pandemic. Surveys of HCPs and pMS were conducted to further understand perceptions regarding use and safety of MS DMTs. Results: In the Optum database, the prevalence of DMT utilization among pMS decreased from 77% in 2019 to 71% in 2020. DMT utilization in pMS who were newly diagnosed in 2019 decreased from 81% in 2019 to 65% during the COVID-19 pandemic. Similarly, the survey of pMS (n=644) showed that significantly more people reported being on no DMT during the COVID-19 pandemic compared to prior (p<0.01). Additionally, results showed that among pMS who did not change DMT during the pandemic, 94/526 (17.9%) experienced a relapse. 16.5% of pMS on infusion therapies reported an infusion delay with the most frequently cited reason being at the recommendation of their neurologist (61%). Survey of HCPs (n=48) showed significantly less comfort with the use of cell-depleting therapies in treatment-naive patients as a consequence of the pandemic (p<0.05). HCPs were split in their concerns about whether DMTs impact the risk of more severe COVID-19 disease in pMS. Treatment half-life, and impact on lymphocyte counts and vaccine efficacy were cited as important factors for treatment decisions by the majority of HCPs. Conclusions: Our findings suggest that the COVID-19 pandemic was associated with decreased use of DMTs in pMS and delays in infusion therapies. Furthermore, therapeutic inertia may have led to a high number of patients not switching treatment in spite of relapses. Survey of HCPs show concerns for the use of celldepleting therapies and impact of treatment half-life as well as concerns for vaccine efficacy as important factors for treatment decisions.