Delays in treatment escalation after failure in multiple sclerosis: the role of therapy type and healthcare system.

BACKGROUND

Timely treatment optimization after therapeutic failure is essential in multiple sclerosis (MS), particularly when escalation to high-efficacy therapies (HET) is required. However, real-world delays in treatment initiation remain poorly characterized.

OBJECTIVE

To evaluate time to treatment initiation after therapeutic failure in MS according to treatment type and healthcare coverage.

METHODS

We conducted a retrospective observational study using a real-world registry of patients with relapsing-remitting MS. The first treatment switch due to failure per patient was analyzed. The primary outcome was time from failure identification to initiation of subsequent therapy. Treatments were classified as HET or non-HET and healthcare coverage as public, social security, or private. Multivariable analysis used linear regression with log-transformed time, expressed as time ratios (TR).

RESULTS

A total of 288 patients were included. Median time to treatment initiation was 142.0 days (IQR 89.0-247.0). Stratified analyses revealed different patterns across healthcare systems. The longest median time to HET initiation was observed with private insurance (211.0 days), whereas the largest within-system difference between HET and non-HET was observed in the public system (165.0 vs. 66.0 days). In multivariable analysis, the HET coefficient was associated with longer time to initiation (TR 3.8, 95% CI 2.5-5.5; p < 0.001), with a significant HET × public system interaction (TR 1.4, 95% CI 1.0-2.1;p = 0.04).

CONCLUSION

Treatment initiation delays after therapeutic failure were substantial and varied according to treatment category and healthcare coverage. These findings highlight the need to better understand barriers between treatment decisions and effective therapy initiation.