Photo Credit: SewcreamStudio

An analysis of more than 5,300 patients with MS shows that access to early treatment in MS varies, though those with post-2017 diagnoses often began sooner.

The amount of time between the diagnosis of MS and the beginning of therapy varies among different populations, suggesting barriers are preventing some patients from obtaining early treatment, according to findings published in Therapeutic Advances In Neurological Disorders.

The European Academy of Neurology and the European Committee for Treatment and Research in MS recommend that disease-modifying therapy begin early in the disease course. While revisions of the disease case definition have shortened the time between the onset of symptoms and the start of treatment, not everyone gets treatment early on.

“There is growing emphasis on treating people with MS early, but there are challenges within health systems for clinicians trying to get an individual started on a disease-modifying therapy,” Amber Salter, PhD, tells Physician’s Weekly.

The researchers performed an observational study using data from MS registries in three countries: the North American Research Committee on MS Registry (NARCOMS), the United Kingdom MS Registry (UKMSR), and the German MS Registry (GMSR).

“We were interested in examining the time it took registry participants to initiate their first treatment,” Dr. Salter says. “We used individual-level data from three voluntary registries for people with MS and summarized the hazard ratios for initiating a disease-modifying therapy using a meta-analysis approach. The study examined the time from diagnosis to starting therapy and controlled for multiple factors harmonized across the three registries.”

All patients were diagnosed between 2014 and 2019. Dr. Salter and colleagues analyzed data from 5,395 people. Of these, 447 patients from the US were included in the NARCOMS registry, 2,290 from the UK registry, and 2,658 from the German registry.

Variations in Time to First Treatment

The Kaplan-Meier estimate for the median time to first treatment for patients in the German registry was 2 months (95% CI, 1.9-2), the researchers reported, whereas American patients had a median time of 3 months (95% CI, 2-4). Patients in the UK registry had a significantly longer time to treatment, at a median of 9 months (95% CI, 7.7-10.6), Salter and colleagues report.

Pooled analysis showed that patients with MS diagnosis after 2017 tended to initiate therapy sooner, after 1.65 months (1.42-1.92; P < 0.01). However, higher-efficacy treatments, such as alemtuzumab, natalizumab, and anti-CD20 monoclonal antibodies, took longer to initiate (0.69 months; 95% CI, 0.54-0.9; P < 0.001), according to the researchers.

Reasons for Longer Time to Treatment

“With a dataset of only 447 individuals analyzed from the NARCOMS Registry, the data may not be representative for early access to [disease-modifying therapy] in all areas of the United States,” the researchers wrote. “However, on average, this possibly reflects a heterogeneous healthcare system concerning insurance coverage and cost of disease-modifying therapies being possible barriers for early disease-modifying therapy start in a proportion of people with MS in the United States.”

In the UK, there may be other reasons for delays in starting treatment.

“The UKMSR data also suggested a delay of 6 months on average in initiating [disease-modifying therapy] in the United Kingdom compared to Germany. This possibly is explained by being diagnosed in the United Kingdom,” Salter and colleagues write. “General practitioners act as gatekeepers for specialist neurologists. If MS is suspected, patients are referred to a waiting list and picked up by a specialist treatment center, at which point confirming the diagnosis (MRI Scan per McDonald Criteria) begins and may account for some of the lag in diagnosis and, thus, treatment.”

Limitations & Future Applications

The researchers acknowledged that the study had some limitations.

“It is challenging to harmonize data across multiple data sources retrospectively,” Dr. Salter says. “As such, our study was not able to include factors such as socioeconomic status, comorbidities, race, and ethnicity in our analyses that may explain some of the differences we observed or associated with delays in initiating disease-modifying therapies.”

In addition, the data appears to point to some unmet needs in MS care.

“Clinically, we hope this study highlights the need for early access to treatment, and there may be a need to improve early access with higher efficacy therapies,” Dr. Salter notes. “We would like to continue investigating this question to see if more recent data showed improved access with these therapies and the effectiveness of earlier access on outcomes.”