MS treatment trends before, during, and after the COVID-19 pandemic: insights from the German MS Register.

Background: The COVID-19 pandemic affected healthcare management for people with multiple sclerosis (PwMS), leading to alterations in disease-modifying therapies (DMTs) due to concerns about COVID-19 outcomes and vaccine efficacy.

Objective: To compare DMT prescription patterns in PwMS before, during, and after the COVID-19 pandemic.

Methods: PwMS from the German MS Register, between 2019 and 2024, either newly diagnosed (Cohort A) or who discontinued or switched DMT (Cohort B), were analyzed over a follow-up period of 3 months. Data from the pre-pandemic period were compared to early-, late-, and post-pandemic periods. DMTs were categorized as medium efficacy (meDMT) or high efficacy (heDMT).

Results: In Cohort A (n = 1810), pre-pandemic 46% had no DMT within 3 months of diagnosis, 39% received meDMT, and 15% heDMT (7.5% B cell-depleting therapies (BCD)). heDMT use increased during later periods ("early" 19%, "late" 29%, "post" 41%), with a shift toward BCD. In cohort B (n = 4246), pre-pandemic 47% paused DMT, 19% switched to meDMT, and 34% to heDMT (17% BCD). heDMT use also rose during the pandemic ("early" 37%, "late" 47%, "post" 48%), with increased BCD use.

Conclusions: There were no delays in DMT initiation or resumption during the pandemic with a notable increase in heDMT and BCD use, reflecting growing confidence in these treatment options.