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

Abstract

<h3>Background</h3><p>Early disease-modifying therapy (DMT) improves outcomes in patients with relapsing-remitting multiple sclerosis (pwRRMS), but reasons for delayed or absent initiation are unclear.</p><h3>Objective</h3><p>To investigate reasons and trends for delayed or absent DMT initiation among Finnish pwRRMS.</p><h3>Methods</h3><p>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.</p><h3>Results</h3><p>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, <em>p</em> < 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 (<em>p</em> = 0.007) and treatment refusal (<em>p</em> = 0.004) decreased significantly.</p><h3>Conclusion</h3><p>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.</p>