Background

There have been >1.8 million cases of Sars-CoV-2 (Covid19) in the USA. and >100,000 deaths reported as of June 2020. Immunosuppression is reported as a risk factor for developing Covid19. Amidst this pandemic and declared national emergency in the USA, with a parallel response in Canada, neuroimmunologists are making important decisions and adjudicating complex situations of risk for their patients living with MS. No synthesized study of North American neuroimmunologists’ perceptions has been conducted.

Objectives

To report the experiences, opinions, and decision-making of U.S. and Canadian neuroimmunologists as they relate to the treatment of patients with multiple sclerosis (MS) during the Covid19 pandemic of 2020.

Methods

A new survey instrument was designed and distributed electronically. Invitations were sent via a known panel of MS neurologists and to publicly available e-mail addresses of MS-focused U.S. and Canadian neurologists, April 14-May 3, 2020. Inclusion criteria included treating at least 10 MS patients in the prior 6 months.

Results

243 respondents (average 197 MS patients seen in the prior 6 months (i.e. pre-Covid19); average practice duration 16 years; 92% USA, 8% Canada; 5% rural, 17% small city, 38% large city, 40% highly urbanized) met our inclusion criteria.

MS patient volume dropped by 79% on average (from 53 to 11 patients per month) during the time of Covid19. 23% of neurologists were aware of patients self-discontinuing a DMT due to fear of Covid19 with 43% estimated to be doing so against medical advice. 65% of respondents reported deferring >=1 doses of a disease modifying therapy (DMT) (49%), changing the dosing interval (34%), changing to home infusions (20%), switching a DMT (9%), and discontinuing DMTs altogether (8%) due to Covid19. Changes in DMT administration were most common among the higher-efficacy therapies alemtuzumab, cladribine, ocrelizumab, rituximab, and natalizumab; however, 35% of neurologists reported making no changes to DMT prescribing.

98% of respondents expressed worry about their patients contracting Covid19 and 78% expressed the same degree of worry about themselves. >50% reported believing that high-efficacy DMTs prolong viral shedding of SARS-CoV-2 and that B-cell therapies might prevent protective vaccine effects. Accelerated pace of telemedicine was identified as a major shift in practice.

Conclusions

Reported prescribing changes and practice disruptions due to Covid19 may be temporary but are likely to have a long-lasting influence on MS patients and their care.