Shorter time to 1st MS DMT found for more recent diagnoses: Study

Multiple sclerosis (MS) patients diagnosed in more recent years — specifically after 2017 — were more likely to start sooner on a first MS disease-modifying therapy (DMT) than were those diagnosed between 2014 and 2016, an analysis of data from three large MS registries found.

However, starting with a higher-efficacy DMT was associated with a longer time to treatment initiation, according to the data from registries in the U.S., the U.K., and Germany.

There were, however, some differences across the three nations, likely due to certain barriers in access to healthcare services and medications in specific regions.

“Differences in healthcare systems … may account for some of our findings, highlighting the need to advocate for better access to diagnosis and treatment still,” the researchers wrote, noting the fewest barriers were in Germany, followed by the U.S. The greatest barriers were seen in the U.K.

The study, ”Disease-modifying therapy initiation patterns in multiple sclerosis in three large MS populations,” was published in Therapeutic Advances in Neurological Disorders.

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Guidelines call for patients to start on MS DMT as soon as possible

An accumulating body of evidence suggests that starting treatment as early as possible is associated with better long-term outcomes for people with MS. Indeed, those who begin therapy sooner tend to experience fewer relapses and less severe disability than those who start their treatment later on in the disease course.

While current guidelines recommend early treatment initiation, barriers might exist that prevent patients from receiving treatment as recommended. These barriers may be poor access to healthcare services, a lack of information, delays in seeing a neurologist, and insurance coverage, among many others.

To know more about those barriers, a team of researchers examined data from three large voluntary MS registries: one in Germany, one covering North America from which data on U.S. patients was taken, and one in the U.K.

The researchers’ goal was to pinpoint specific sociodemographic and clinical features that impacted the time to a first MS DMT.

The data came from the German MS Registry, in which information is provided by clinical centers, and the United Kingdom MS Registry (UKMSR), which has both patient and clinician-reported data. The U.S. data came from the North American Research Committee on MS Registry (NARCOMS), which contains self-reported data from people with MS,

A total of 5,395 people with relapsing forms of MS were included. Among them, 2,658 were from Germany, 447 from the U.S., and 2,290 from the U.K.

In general, patients in Germany tended to be diagnosed much sooner after their first symptoms than those in the other countries — a median of three months vs. 60 months (five years) in the U.S. and 17-19 months (about 1.5 years) in the patient and clinical arms of UKMSR.

Consistently, patients in Germany also were diagnosed at younger ages, and the majority had only mild disability at the time of their diagnosis.

Across the three registries, more than half of patients started an MS DMT within nine months of their diagnosis.

But again, there were significant differences between the registries: those in Germany started treatment a median of two months after diagnosis, while those in the U.S. began treatment at a median of three months. Meanwhile, those in the U.K. began treatment at a median of 7.1 months for the patient-reported registry and nine months in clinician-reported data.

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Longer time to high-efficacy DMTs of concern to researchers

According to the researchers, these differences across the MS patient registries indicate that there may be barriers to early access to DMT for those diagnosed with the neurodegenerative disorder, particularly in the U.K.

For example, most people in Germany are insured and have reimbursed DMT starting from their first clinical episode, without needing to reach certain disability levels. Treatments also can be prescribed by outpatient neurologists and, in certain cases, by general practitioners, “facilitating easy and early access even in remote and rural areas.”

In the U.S., meanwhile, some barriers relating to insurance and DMT costs may be occurring that prevent certain patients from receiving early treatment, the data suggest.

Finally, the U.K. appeared to have a long diagnostic journey for patients that “may account for some of the lag in diagnosis and thus treatment,” the researchers wrote.

Patients in the U.K. must be seen by a general practitioner first before being referred to a neurologist to start the process of confirming an MS diagnosis.

Provided that early DMT use is beneficial for the long-term outcome of [people with] MS, it is reassuring that a consistent decrease in time to DMT was noted since 2017 across all registries.

Despite the differences, there were some commonalities across the three registries. For example, patients who started on a high-efficacy DMT took significantly longer to begin therapy than those prescribed a lower-efficacy drug.

In all three countries, being diagnosed in more recent years, after 2017, was linked with a shorter time to treatment start than a diagnosis between 2014 and 2016.

“Provided that early DMT use is beneficial for the long-term outcome of [people with] MS, it is reassuring that a consistent decrease in time to DMT was noted since 2017 across all registries,” the researchers wrote.

However, “further studies are warranted comparing the effects of time to DMT and time to higher-efficacy DMT on long-term outcomes,” the team concluded.