ZoomRx

Author Of 2 Presentations

Disease Modifying Therapies – Risk Management Poster Presentation

LB1146 - Covid19 on U.S. and Canadian Neurologists’ Therapeutic Approach to Multiple Sclerosis: A Survey of Knowledge, Attitudes, and Practices (ID 403)

Speakers
Presentation Number
LB1146
Presentation Topic
Disease Modifying Therapies – Risk Management

Abstract

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.

Collapse
Neuromyelitis Optica and Anti-MOG Disease Poster Presentation

LB1148 - Neuromyelitis optica (NMO) practice and prescribing changes in the setting of Covid19: A survey of neurologists (ID 441)

Speakers
Presentation Number
LB1148
Presentation Topic
Neuromyelitis Optica and Anti-MOG Disease

Abstract

Background

The Sars-CoV-2 (Covid19) pandemic has caused >100,000 deaths in the USA and has the potential to disrupt the care of NMO patients to a great extent. A unified and thorough set of guidelines for NMO management across countries has yet to be established.

Objectives

To document the prescribing and treatment patterns of North American neurologists with expertise in NMO patient care during the Covid19 pandemic.

Methods

We created a new survey instrument to query the practices, decision-making, and perspectives of a group of neuroimmunology-focused neurologists who actively care for patients with NMO in the USA or Canada. Survey responses included rating of statements for agreement, open-ended questions, multiple choice, and estimates of current practices in gradient forms. The survey was circulated from April 14, 2020 to May 4, 2020.

Results

192 neurologists met our inclusion criteria and were most often from academic hospitals (51%), followed by single specialty groups (21%). The volume of in-person NMO visits declined from 4 NMO patients per typical month pre-Covid19 to <1 patient in the prior month (approximately April 2020). More than half of neurologists indicated NMO patients were delaying their scheduled MRIs (57%), two-thirds indicated patients were delaying clinical visits (67%) and roughly half indicated patients were delaying laboratory testing (52%) due to fear of contracting Covid19. Seventeen percent of neurologists have deferred one or more doses of NMO patients’ immunosuppressive drug, 16% changed the dosing interval, and 15% switched health facility-based infusions to home-based infusions. Roughly half of all neurologists were uncomfortable with prescribing tocilizumab (48%), though 19% of neurologists anticipated using tocilizumab more often for their NMO patients given its current investigation as a treatment for Covid19.

Conclusions

The prescribing patterns and treatment decisions of NMO care providers during the Covid19 pandemic indicate a need for evidence-based, comprehensive guidelines for treating NMO patients amid healthcare crises moving forward.

Collapse