Current and Future Trends in MS Management: Near East Perspective

Objective(s): The objectives were to provide an overview of the current practices of Near East (NE) healthcare practitioners (HCPs) by probing their prescribing decisions, to report the COVID-19 impacts on neurologists' prescribing habits, and to explore the future relevance of current medication used in MS management among other newcomers Material(s) and Method(s): A cross-sectional study was carried out using an online survey from April 27, 2022, to July 5, 2022. The questionnaire was designed with the input of five neurologists representing five NE countries (Iran, Iraq, Lebanon, Jordan & Palestine). They identified several factors that play a crucial role in the optimal care of MS patients. The link was shared among neurologists using snowball sampling Result(s): The survey included 98 neurologists from the included NE countries, the majority of whom had more than 15 years of experience in the field, and 39% were seeing more than 40 MS patients a month. Effectiveness and safety balance was the most important factor considered when selecting the MS treatment. In the treatment of mild to moderate RRMS in men, Interferon beta 1a SC, Fingolimod, and Glatiramer acetate were the most commonly recommended treatments. Dimethyl fumarate substituted fingolimod in female patients. According to 80.7% of participants, interferon beta 1a SC was the safest treatment for mild to moderate RRMS. Interferon beta 1a SC was preferred over other treatments for patients with mild to moderate MS and planning for pregnancy (56.6%) or breastfeeding (60.2%). Fingolimod was not a choice for these patients. Neurologists seemed to discuss the top three treatments of Natalizumab, Ocrelizumab, and Cladribine with patients with highly active MS. Conclusion(s): Most neurologists in the NE region followed MENACTRIMS recommendations for prescribing treatment. The treatment choice also depended on the availability of DMTs in the region. Regarding the use of upcoming DMTs such as Ofatumumab, Siponimod, Ozanimod, and BTK inhibitors, there is a clear need for real-world data, long-term extension studies, and comparative studies to support their efficacy and safety profiles in treating patients with MSCopyright © 2022

Medication Adherence Among Patients with Multiple Sclerosis During the COVID-19 Pandemic: Perspective from the Near East Region

Background: Several factors rendered patients with multiple sclerosis (pwMS) likely to be affected by the rapidly evolving events of the COVID-19 pandemic. Globally, pwMS were confronted with limited access to their healthcare team, potential treatment interruption, and concerns about the risk of infection while treated with immunomodulatory disease-modifying therapies (DMTs), particularly high-efficacy DMTs. The current study explored treatment-related concerns and their impact on medication adherence during the COVID-19 pandemic in pwMS treated with subcutaneous interferon beta-1a (sc IFN β-1a) in the Near East region. Material(s) and Method(s): A total of 3,348 pwMS treated with sc IFN β-1a across five countries of the Near East region (Iran, Iraq, Jordan, Lebanon, and Palestine) participated in a telephone survey. The survey was conducted by nurses, on behalf of the Merck Patient Support Program in the Near East region, from May 1–30, 2021. A standardized questionnaire allowed participants to report their concerns related to COVID-19 and their MS treatment, along with medication adherence over the previous 3 months. Concern with current MS treatment was rated on a scale of 1–10, with levels 1–3 reflecting a low level of concern, levels 4–7 reflecting a moderate level of concern, and levels 8–10 reflecting a high level of concern. Adherence to sc IFN β-1a was defined as administration of the prescribed three weekly injections. Result(s): Amongst the countries surveyed, a total of 3,074 participants (92%) reported being concerned about sc IFN β-1a increasing their risk of COVID-19 infection. However, a majority of participants from Iraq (94%), Palestine (88%), Jordan (84%), and Iran (84%) reported a low level of concern.More participants from Lebanon reported high (51%) and moderate (38%) levels of concern about their MS treatment and the risk of COVID-19 infection. Full adherence to sc IFN β-1a over the previous 3 months was reported by 3,293 (98%) participants. Key factors influencing medication adherence included the lack of access to sc IFN β-1a, physician supervision, and adverse events. Conclusion(s): This study explored the impact of treatment-related concerns on medication adherence in pwMS treated with sc IFN β-1a during the COVID-19 pandemic in the Near East. Despite a large proportion of study participants being concerned about a potential increase in the risk of COVID-19 infection while on their current treatment, participants were only mildly concerned and the majority remained adherent to the prescribed medication. Furthermore, the fear of COVID-19 infection by participants was not a key factor associated with non-adherence. Instead, limited access to medication and decisions of supervising physicians negatively impacted medication adherence. More than a year after the World Health Organization declared the COVID-19 outbreak a pandemic, safety concerns related to DMTs still exist. Interferons can be prescribed as usual in COVID-19 times, and this should be communicated effectively to clinicians and patients.

Embracing Advanced Digital Services in the Charity and Voluntary Sector: a response to Covid-19

Charity and voluntary services require significant human-to-human interactions alongside integrative offerings inclusive of core and complementary services to yield value and improve the wellbeing of their often vulnerable service users. The Covid-induced digitalisation of such services can pose a challenge to the productivity and resilience of the charity and voluntary sector as the extent to which human interactions and holistic offerings are replicable in digital services can be limited and can diminish the wellbeing outcomes of offerings. This research employs a transformative service research lens to study the digital transformation of charity and voluntary services. It does this in accordance with the concept of advanced services to generate insight into the capabilities necessary at the organisational level, and quality of interactions required at the interactional level, that can enable the sector to offer digitally enhanced advanced services. By identifying the antecedents of advanced digital service in the charity and voluntary sector, this research provides new opportunities to the sector to capitalise on the advantages of digitalisation while responding to their service users' multiplex needs, which in turn improves the sector's resilience and productivity. © 2021 Institution of Engineering and Technology. All rights reserved.