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

Alexander Stahmann, Elaine Craig, David Ellenberger, Firas Fneish, Niklas Frahm, Ruth Ann Marrie, Rod Middleton, Richard Nicholas, Jeff Rodgers, Clemens Warnke, Amber Salter

Research output: Contribution to journalArticlepeer-review


Background: Treatment guidelines recommend early disease-modifying therapy (DMT) initiation after diagnosis of multiple sclerosis (MS). Multinational comparative studies that assess time to DMT initiation in MS may allow detection of barriers inherent to healthcare systems to explain potential adverse systematic delays in commencing DMTs. Objectives: To investigate and compare the time to first DMT and its association with sociodemographic and clinical variables after MS diagnosis in three large MS registries. Design: This observational study was conducted using data from the German MS Registry (GMSR), the North American Research Committee on MS Registry (NARCOMS, US data only), and the United Kingdom MS Registry (UKMSR, both self- and clinician-reported). Methods: Data from relapsing people with MS (PwMS), with a diagnosis of MS between 2014 and 2019, and available DMT and disability status were pooled using a meta-analytic approach. Results: A total of 5395 PwMS were included in the analysis (GMSR: n = 2658; NARCOMS: n = 447; UKMSR: n = 2290). Kaplan–Meier estimates for the time to first DMT [median months (95% CI)] were 2.0 (1.9–2.0), 3.0 (2–4), and 9.0 (7.7–10.6) for GMSR, NARCOMS, and UKMSR, respectively. Pooled multivariable Cox regression demonstrated shorter time to first DMT for PwMS diagnosed after 2017 [1.65 (1.42–1.92), p < 0.01], and longer time to DMT when a higher-efficacy DMT was selected (0.69 (0.54–0.90), p < 0.0001]. Conclusion: Time to DMT initiation differs across the populations studied, indicating that barriers may exist in early access to DMT, particularly in the United Kingdom. However, a consistent decrease in time to DMT initiation was noted since 2017 across all registries. Further studies are warranted comparing the effects of time to DMT and time to higher-efficacy DMT on long-term outcome.

Original languageEnglish (US)
JournalTherapeutic Advances in Neurological Disorders
StatePublished - Jan 1 2024


  • disease-modifying therapy
  • healthcare
  • multiple sclerosis
  • therapy initiation

ASJC Scopus subject areas

  • Pharmacology
  • Neurology
  • Clinical Neurology


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