Department of Public Health, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy.
Drug Policy and Devices Unit, Regione Campania Health Department, Naples, Italy.
Neurol Sci. 2023 Nov;44(11):3771-3779. doi: 10.1007/s10072-023-07052-9. Epub 2023 Sep 6.
COVID-19 pandemic has affected the management of multiple sclerosis (MS).
To explore the impact of COVID-19 on healthcare delivery to people with MS and the subsequent recovery of the system.
In this population-based study in the Campania Region (Italy), we included people with MS across pre-COVID-19, lockdown, pre-vaccination, and vaccination periods. Differences in continuous outcomes between periods were explored using linear mixed models (annualized hospitalization rate (AHR) and adherence measured as medication possession ratio (MPR)). Differences in disease-modifying treatment (DMT) prescription rates (first DMT prescription, any DMT switch, switch from platform to highly effective DMT, and combination of first DMT prescription and any DMT switch) were assessed using an interrupted time series design.
Compared with pre-COVID-19, AHR decreased during the lockdown (Coeff = 0.64;95%CI = -0.69, -0.59; p < 0.01), and remained lower during pre-vaccination and vaccination periods. Adherence decreased during pre-vaccination (Coeff = -0.04;95%CI = -0.05, -0.03; p < 0.01) and vaccination periods (Coeff = -0.07;95%CI = -0.08, -0.07; p < 0.01). After the lockdown, there was an increase in any DMT switch (IRR 2.05 95%CI 1.38,3.05; p < 0.01), in switch from platform to highly effective DMTs (IRR 4.45;95%CI 2.48,8.26; p < 0.01) and in first DMT prescriptions (IRR 2.48;95%CI 1.64,3.74; p < 0.01).
DMT prescriptions quickly returned to pre-pandemic levels, reflecting good health system recovery. However, adherence has remained lower than the past, as from suboptimal care. Assessing long-term COVID-19 impact on MS healthcare is warranted.
COVID-19 大流行影响了多发性硬化症（MS）的管理。
探讨 COVID-19 对 MS 患者医疗服务的影响，以及后续系统的恢复情况。
在坎帕尼亚地区（意大利）进行的这项基于人群的研究中，我们纳入了 COVID-19 之前、封锁期间、疫苗接种前和疫苗接种期间的 MS 患者。使用线性混合模型（年化住院率（AHR）和作为药物使用比例（MPR）的依从性）来探讨各时间段间连续结果的差异。使用中断时间序列设计评估疾病修饰治疗（DMT）处方率（首次 DMT 处方、任何 DMT 转换、从平台到高效 DMT 的转换，以及首次 DMT 处方和任何 DMT 转换的组合）的差异。
与 COVID-19 前相比，封锁期间 AHR 下降（Coeff=0.64；95%CI=-0.69，-0.59；p<0.01），且在疫苗接种前和疫苗接种期间持续较低。疫苗接种前（Coeff=-0.04；95%CI=-0.05，-0.03；p<0.01）和疫苗接种期间（Coeff=-0.07；95%CI=-0.08，-0.07；p<0.01）依从性下降。封锁结束后，任何 DMT 转换的比例增加（IRR 2.05；95%CI 1.38，3.05；p<0.01），从平台到高效 DMT 的转换比例增加（IRR 4.45；95%CI 2.48，8.26；p<0.01），首次 DMT 处方的比例增加（IRR 2.48；95%CI 1.64，3.74；p<0.01）。
DMT 处方迅速恢复到大流行前水平，反映出医疗系统的良好恢复。然而，由于护理水平欠佳，依从性仍低于过去水平。评估 COVID-19 对 MS 医疗保健的长期影响是必要的。
