Objective

To report the understanding and decision-making of neuroimmunologists and their treatment of patients with multiple sclerosis (MS) during the early stages of the SARS-CoV-2 (COVID-19) outbreak.

Methods

A survey instrument was designed and distributed online to neurologists in April 2020.

Results

There were 250 respondents (response rate 21.8%). 243 saw > = 10 MS patients in the prior 6 months (average 197 patients) and were analyzed further (92% USA, 8% Canada; average practice duration 16 years; 5% rural, 17% small city, 38% large city, 40% highly urbanized). Patient volume dropped an average of 79% (53–11 per month). 23% were aware of patients self-discontinuing a DMT due to fear of COVID-19 with 43% estimated to be doing so against medical advice. 65% of respondents reported deferring > = 1 doses of a DMT (49%), changing the dosing interval (34%), changing to home infusions (20%), switching a DMT (9%), and discontinuing DMTs altogether (8%) as a result of COVID-19. Changes in DMTs were most common with the high-efficacy therapies alemtuzumab, cladribine, ocrelizumab, rituximab, and natalizumab. 35% made no changes to DMT prescribing. 98% expressed worry about their patients contracting COVID-19 and 78% expressed the same degree of worry about themselves. > 50% believed high-efficacy DMTs prolong viral shedding of SARS-CoV-2 and that B-cell therapies might prevent protective vaccine effects. Accelerated pace of telemedicine and practice model changes were identified as major shifts in practice.

Conclusions

Reported prescribing changes and practice disruptions due to COVID-19 may be temporary but could have a lasting influence on MS care.

中文翻译：

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COVID-19对美国和加拿大神经科医生对多发性硬化症的治疗方法的影响：知识，态度和做法的调查。

目的

报告在SARS-CoV-2（COVID-19）爆发早期，神经免疫学家对多发性硬化症（MS）的理解和决策。

方法

设计了一种调查工具，并于2020年4月在线分发给神经科医生。

结果

有250位回应者（回应率为21.8％）。在过去6个月中，有243例> 10名MS患者（平均197例），并进行了进一步分析（92％的美国，8％的加拿大；平均执业时间为16年； 5％的农村地区，17％的小城市，38％的大城市， 40％高度城市化）。患者数量平均下降了79％（每月53-11）。23％的患者由于担心COVID-19而意识到患者自行停用DMT，估计有43％的患者根据医学建议采取了这种方式。65％的受访者表示延迟> = 1剂DMT（49％），更改给药间隔（34％），更改为家庭输液（20％），更换DMT（9％）并完全停用DMT（8 ％）作为COVID-19的结果。DMT的改变最常见于高效疗法alemtuzumab，cladribine，ocrelizumab，rituximab和那他珠单抗。35％的人没有对DMT处方进行任何更改。98％的人表示担心患者感染COVID-19，78％的人表示对自己的担心程度相同。> 50％的人认为高效DMT可以延长SARS-CoV-2的病毒脱落，并且B细胞疗法可能会阻止疫苗的保护作用。远程医疗步伐的加快和实践模式的改变被认为是实践中的重大转变。

结论

已报告的因COVID-19导致的处方变更和操作中断可能是暂时的，但可能对MS护理产生持久影响。