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Disease-modifying therapy initiation patterns in multiple sclerosis in three large MS populations.

Alexander Stahmann¹, Elaine Craig², David Ellenberger³

¹MS Forschungs- und Projektentwicklungs-gGmbH, German MS-Registry by the German MS Society, Krausenstr. 50, Hanover 30171, Germany.

Therapeutic Advances in Neurological Disorders

|March 18, 2024

Summary

Early initiation of disease-modifying therapy (DMT) is recommended for multiple sclerosis (MS). This study found significant delays in DMT initiation in the UK compared to Germany and the US, highlighting potential healthcare system barriers.

Keywords:

disease-modifying therapy healthcare multiple sclerosis therapy initiation

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Area of Science:

Neurology
Clinical Research
Healthcare Systems Analysis

Background:

Treatment guidelines emphasize prompt initiation of disease-modifying therapies (DMTs) following multiple sclerosis (MS) diagnosis.
Comparative studies assessing time to DMT initiation are crucial for identifying healthcare system barriers and systematic delays.

Purpose of the Study:

To compare the time to first DMT initiation after MS diagnosis across three large international MS patient registries.
To investigate the association of sociodemographic and clinical variables with the time to DMT initiation.

Main Methods:

Observational study utilizing pooled data from the German MS Registry (GMSR), North American Research Committee on MS Registry (NARCOMS), and United Kingdom MS Registry (UKMSR).
Included relapsing-remitting MS patients diagnosed between 2014-2019 with available DMT and disability status.
Meta-analytic approach, including Kaplan-Meier estimates and multivariable Cox regression.

Main Results:

Analysis included 5395 people with MS (PwMS). Median time to first DMT was 2.0 months (GMSR), 3.0 months (NARCOMS), and 9.0 months (UKMSR).
Shorter time to DMT initiation was observed for patients diagnosed after 2017 (HR 1.65, p<0.01).
Longer time to DMT initiation was associated with the selection of higher-efficacy DMTs (HR 0.69, p<0.0001).

Conclusions:

Significant variations in time to DMT initiation exist across registries, suggesting potential access barriers, particularly in the UK.
A consistent trend of decreased time to DMT initiation was observed across registries since 2017.
Further research is needed to evaluate the long-term impact of time to DMT and higher-efficacy DMT initiation on patient outcomes.