Delays in treatment initiation for patients with relapsing-remitting multiple sclerosis-A nationwide population-based study.

IF 2.3 Q2 CLINICAL NEUROLOGY

Multiple Sclerosis Journal - Experimental, Translational and Clinical Pub Date : 2025-08-04 eCollection Date: 2025-07-01 DOI:10.1177/20552173251360358

Maiju Savolainen, Matias Viitala, Katariina Kuutti, Hanna Kuusisto, Ilkka Rauma, Mervi Ryytty, Johanna Krüger, Päivi Hartikainen, Marja Niiranen, Jukka Saarinen, Merja Soilu-Hänninen, Sini M Laakso

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Abstract

Background: Early disease-modifying therapy (DMT) improves outcomes in patients with relapsing-remitting multiple sclerosis (pwRRMS), but reasons for delayed or absent initiation are unclear.

Objective: To investigate reasons and trends for delayed or absent DMT initiation among Finnish pwRRMS.

Methods: A nationwide retrospective study using the Finnish MS Registry identified 2363 pwRRMS diagnosed between 2010 and 2019 in the participating centers. Patients never receiving DMT or starting >2 years post-diagnosis were compared to those initiating DMT within a year of diagnosis.

Results: We identified 193 pwRRMS who never started DMT, 88 had delayed initiation over 2 years, and 1944 started within a year. The no/delayed DMT group was older at diagnosis (mean 38.7 vs 35.2 years, p < 0.001). Corticosteroid-treated relapses were more frequent among early initiators. Optic neuritis was more common in patients with delayed or no DMT. Treatment refusal was the primary reason for delayed/no DMT (35.6%), with 68% of refusers never starting. From 2010to 2019, delayed/no DMT initiation (p = 0.007) and treatment refusal (p = 0.004) decreased significantly.

Conclusion: Delayed or absent DMT initiation is linked to older age, optic neuritis, disease inactivity, and treatment refusal, which declined over time, likely due to expanded DMT options.

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复发缓解型多发性硬化症患者开始治疗的延迟——一项基于全国人群的研究

背景：早期疾病改善治疗（DMT）改善了复发缓解型多发性硬化症（pwRRMS）患者的预后，但延迟或不启动的原因尚不清楚。目的：调查芬兰pwRRMS中延迟或缺席DMT起始的原因和趋势。方法：使用芬兰MS登记处进行的一项全国性回顾性研究确定了2010年至2019年在参与中心诊断的2363例pwRRMS。将从未接受过DMT或在诊断后2年内开始接受DMT的患者与在诊断后1年内开始接受DMT的患者进行比较。结果：我们确定了193例从未开始使用DMT的pwRRMS， 88例延迟使用超过2年，1944年在一年内开始使用DMT。无/延迟DMT组在诊断时年龄较大（平均38.7岁vs 35.2岁，p = 0.007），拒绝治疗（p = 0.004）显著减少。结论：延迟或缺席DMT启动与年龄较大，视神经炎，疾病不活动和拒绝治疗有关，随着时间的推移，可能是由于扩大了DMT选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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