Variation in Time to First Disease Modifying Therapy in people with MS in the United States, United Kingdom, and Germany (517)

Objective: To investigate the time to first Disease Modifying Therapy (DMT) after diagnosis in three large multiple sclerosis (MS) registry populations, NARCOMS, United Kingdom (UKMSR) and Germany (GMSR).

Background: The number of DMT options in MS has increased over time. Recent EAN/ECTRIMS guidelines have highlighted the need for early introduction of DMT. [Montalban et al. 2018] Still comparable data for the time from MS diagnosis till the start of the first DMT is scare.

Design/Methods: Each registry captures demographics, disability status (categorized as mild, moderate or severe) and treatment status. Inclusion criteria were a relapsing disease course, diagnosis in 2014–2018 and provided data on DMT and disability status. The overall and age-, gender- and disability-specific times to first DMT after diagnosis were summarized. Kaplan-Meier curves were used to examine the median time to first DMT (in years) and Cox regression models for covariates of interest (gender, age at diagnosis, disability) were performed. Participants were censored at the date of the last recorded visit. Comparisons between countries were evaluated in a meta-analytic approach.

Results: 2700 participants (NARCOMS:306, UKMSR:675, GMSR:1719) fulfilled the inclusion criteria. The overall median time to first DMT was shortest in Germany [0.21 (0.08, 0.78)] followed by the UK [0.55 (0.25, 2.33) ] and NARCOMS [1.0 (0.33, 1.00)]. 4.5 years after diagnosis, a vast majority (93.5%) of NARCOMS participants received a DMT where as in Germany 16.4% and more than 36.1 % in the UK have not received a DMT by that point. Cox regressions showed that higher age (61+) [p<0.001] and moderate disability [e.g. EDSS > 3 & < 6, p<0.035] are associated with a longer time to first DMT.

Conclusions: Time to first DMT varied across countries, however, a larger proportion of PwMS in NARCOMS did receive a DMT at last recorded visit within 5 years of diagnosis than in Germany and the UK.

Disclosure: Dr. Stahmann has received research support from Biogen, Celgene, Merck and Novartis.Dr. Ellenberger has nothing to disclose. Dr. Marrie has received personal compensation in an editorial capacity for SAGE Publications (MSJ-ETC).Dr. Middleton has nothing to disclose. Dr. Nicholas has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Biogen, Roche, Novartis. Dr. Nicholas has received research support from Biogen, Novartis and Roche. Dr. Rodgers has nothing to disclose. Dr. Salter has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with I receive consulting for statistical reviews for Circulation: Cardiovascular Imaging..