Factors associated with delays in multiple sclerosis disease-modifying therapy initiation

Background In multiple sclerosis (MS), delays in initiation of disease-modifying therapy (DMT) are associated with worse clinical outcomes. Methods This single-center retrospective chart review study included treatment-naive and previously treated people with MS (PwMS) initiated on DMT between 01 September 2021 and 01 September 2023. A generalized linear model was utilized to evaluate associations between start-up times (initial treatment decision to completion of first dose) and distance to the clinic, utilization of the center's infusion center and specialty pharmacy, insurance and educational status, route of administration, race/ethnicity, and household income. Results A total of 116 PwMS were included (median age 41 [15–74] years; 87.9% female). Increased geographic distance from the MS center correlated with longer start-up times (>100 km: 76.5 [0–393] days vs. ≤100 km: 53.5 [2–524] days); p = 0.04). People with MS with private insurers had longer start-up times (66 [0–524] vs. 50.5 [0–201] days; p = 0.016). The utilization of outside infusion centers and specialty pharmacies delayed initiation (82.5 [0–524] vs. 39.5 [0–372] days; p = 0.024). Conclusions This small retrospective study demonstrates an association between longer start-up times and greater geographic distance, private insurance status, and use of outside infusion centers and specialty pharmacies.