From platform therapies to high-efficacy treatments: nationwide trends in multiple sclerosis care in Poland

AIM OF THE STUDY: In recent years, the therapeutic landscape of multiple sclerosis (MS) has evolved substantially, with the increasing availability of disease-modifying therapies (DMTs) and a shift toward early use of high-efficacy therapies (HET). This study aimed to evaluate nationwide trends in MS treatment in Poland. MATERIAL AND METHODS: This observational, multicenter study was based on real-world data extracted from the Therapeutic Program Monitoring System (SMPT), covering patients treated within the Polish National Health Fund drug program between 2013 and 2024. The analysis included trends in patient numbers, disease phenotypes, and use of specific DMT classes. Data were analyzed descriptively at the national and regional levels. RESULTS: The number of treated patients increased more than 15-fold, from 1,569 in 2013 to 23,871 in 2024. The median time from diagnosis to treatment initiation decreased substantially over the study period. Among first-line patients with relapsing-remitting MS (RRMS), it decreased from approximately 8 months in 2013-2015 to 2-2.5 months in 2020-2024. Among second-line patients with RRMS, including those with treatment failure or highly active disease, it decreased from 5-6 years in 2013-2015 to 9 months in 2023-2024. RRMS remained the most common phenotype (90.3% in 2024); however, the proportion of progressive MS (secondary progressive MS and primary progressive MS: 4.5% and 4.6% in 2024, respectively) increased following the inclusion of dedicated therapies into the program. A marked shift in treatment patterns was observed, from platform therapies to HET, with HET accounting for approximately 48% of all treatments at the end of 2024. Anti-CD20 monoclonal antibodies became the dominant therapeutic class (34.3%) by 2024. Despite overall expansion, regional disparities in treatment access persisted. CONCLUSIONS: MS treatment in Poland underwent a significant transformation, characterized by expanded and faster access to therapy and a shift toward high-efficacy treatments. These changes reflect the modernization of the national treatment landscape and extensive educational efforts resulting in closer alignment with contemporary therapeutic strategies.