Early initiation of disease modifying therapy (DMT) in patients diagnosed with relapsing-remitting multiple sclerosis (RRMS) is recommended for optimal patient outcome. However, there may be multiple barriers to timely DMT initiation. A better understanding of patient-intrinsic factors may help physicians to guide patients during this critical phase of newly diagnosed chronic neurological disease.
To determine rates of disease modifying therapy utilization and descriptive and demographic correlates of DMT use in individuals newly diagnosed with multiple sclerosis (MS).
A cohort of 230 individuals of two metropolitan MS centers was followed longitudinally assessing different psychological domains at 1, 2, 6, 9, and 12 months following their diagnosis of MS. The use of DMT throughout the first year following diagnosis of MS was assessed.
Patients were 70.9% female and 88.2% white with a mean age of 39 years (range 18-71), mean baseline EDSS of 3.9 (range 0-7) and predominantly relapsing-remitting MS (204 RRMS, others were clinically isolated syndrome or not specified). Participants had 15.3 years of education (10-21) and 176 (76.5%) were working (others unemployed, retired, sick leave, disabled or student).
During their first year after MS diagnosis, 133 of 210 (63%) were not on a DMT at 1 month, 46 of 210 (22%) at 6 months and 47 of 201 (22%) patients were not on a disease modifying therapy at 12 months. Not being on a DMT at month 1 was not correlated with employment (r=0.019), years of education (r=-0.042), gender (-0.006), age (0.052) or EDSS (-0.043). Of those individuals who had initiated a DMT at 12 months, 52.4% individuals were treated with first-line injectable DMTs (glatiramer acetate or beta interferon), 35.7% with oral DMT and 11.9% with an infusion DMT (natalizumab or ocrelizumab).
In this prospective observational longitudinal study, initiation of DMT following diagnosis of MS was done in less than half of patients within the first month of the study (which was up to the first 4 months after diagnosis of MS). 22% of participants were not started on a DMT at 1 year. No definite demographic factors associated with time to DMT initiation could be identified in our cohort. Since early initiation of DMT has been associated with improved outcome, this phenomenon deserves further investigation. When treating patients with MS, special attention should be paid to facilitate an early start of DMT.