Changes in Multiple Sclerosis Clinical Care and Outcomes During the COVID‐19 Era: A Population‐Wide Study

Introduction The Coronavirus Disease 2019 (COVID‐19) pandemic has had a profound impact on healthcare systems globally, necessitating significant adaptations in the management of chronic conditions such as multiple sclerosis (MS). In Sweden, where a unique approach to pandemic mitigation was adopted, the effects on MS clinical care remain a subject of interest. This population‐based study is aimed at assessing changes in MS clinical care during the COVID‐19 era compared to the prepandemic period. Methods Using the data from the Swedish MS Registry, encompassing the periods from January 29, 2018, to February 29, 2020 (pre‐COVID‐19 era), and from March 1, 2020, to April 1, 2022 (COVID‐19 era), we analyzed MS incidence rates, clinic visits, relapse rates, initiation of disease‐modifying treatments (DMTs), and dosing intervals for infusion medications. Statistical analyses, including interrupted time series and mixed Poisson regression models, were employed to assess changes in outcomes while adjusting for relevant covariates. Results Our analysis included 19,959 MS patients. While there was a decrease in MS diagnoses during the pandemic period, this difference was not statistically significant. In contrast, a significant reduction in frequencies of physical clinical visits and relapse rates compared to the prepandemic period was evident. Treatment strategies shifted, with decreased utilization of anti‐CD20 therapies and increased use of platform and other high‐efficacy non–anti‐CD20 DMTs. Dosing intervals for infusion medications were also extended during the COVID‐19 era. Conclusion The findings underscore the substantial impact of the pandemic on MS clinical care practices and data capture in Sweden. Understanding these changes is crucial for monitoring or quality control of MS care, informing future research endeavors which access the Swedish MS Registry to measure disease outcomes in this population. The study highlights the responsiveness of healthcare systems in adapting to important challenges while emphasizing the importance of ongoing monitoring and adaptation in MS management practices.