Similar to the trends in overall DMT initiation, 2016вЂ“2019 saw increasing use of high-efficacy, monoclonal antibody therapies. This was followed by a 13.3% reduction in the number of DMTs initiated in 2020 compared with 2019.Д¬hanges in the initiation of individual DMTs are shown in figure 1. Between 20, the overall number of DMT initiations consistently increased, from 7241 in 2016 to 9377 in 2019 (+29.5%). 3Д«etween 1 January 2016 and 31 December 2020, 41вЂ‰632 DMT initiations were recorded within NHS England.

2 If the impacts of the COVID-19 pandemic were to reduce or delay the initiation of DMTs, particularly high-efficacy therapies, this may result in worse long-term outcomes for people with MS. 1Д¬linical trials and observational studies suggest that early use of high-efficacy DMTs results in improved long-term outcomes for people with MS. The Association of British Neurologists issued guidance in March 2020, advising that the risk from COVID-19 may potentially be increased with fingolimod, ocrelizumab, alemtuzumab and cladribine treatment in people with MS, due to the immunosuppressive mechanism of action of these drugs.

Specialist staff were re-deployed to frontline services, social distancing measures resulted in reduced access to diagnostics and hospital facilities for infusion treatments, and concerns were raised over the safety of immunosuppressive disease-modifying therapies (DMTs). The provision of multiple sclerosis (MS) services in England was profoundly impacted by the COVID-19 pandemic in 2020.

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