Neuro-Dol, Université Clermont Auvergne, CHU de Clermont-Ferrand, Inserm, Clermont-Ferrand, France.
Department of Neurology, Nancy University Hospital, Nancy, France.
Eur J Neurol. 2021 Jun;28(6):2026-2036. doi: 10.1111/ene.14790. Epub 2021 Mar 19.
Disease-modifying therapies (DMTs) have an impact on relapses and disease progression. Nonetheless, many patients with multiple sclerosis (MS) remain untreated. The objectives of the present study were to determine the proportion of untreated patients with MS followed in expert centers in France and to determine the predictive factors of nontreatment.
We conducted a retrospective cohort study. Data were extracted from the 38 centers participating in the European Database for Multiple Sclerosis (EDMUS) on December 15, 2018, and patients with MS seen at least once during the study period (from June 15, 2016 to June 14, 2017) were included.
Of the 21,189 patients with MS (age 47.1 ± 13.1 years; Expanded Disability Status Scale (EDSS) score 3.4 ± 2.4), 6,631 (31.3%; 95% confidence interval [CI] 30.7-31.9) were not receiving any DMT. Although patients with a relapsing-remitting course (n = 11,693) were the most likely to receive DMT, 14.8% (95% CI 14.2-15.4) were still untreated (6.8% never treated). After multivariate analysis among patients with relapsing-remitting MS, the main factors explaining never having been treated were: not having ≥9 lesions on brain magnetic resonance imaging (odds ratio [OR] 0.52 [95% CI 0.44-0.61]) and lower EDSS score (OR 0.78 [95% CI 0.74-0.82]). Most patients with progressive MS (50.4% for secondary and 64.2% for primary progressive MS) did not receive any DMT during the study period, while 11.6% of patients with secondary and 34.0% of patients with primary progressive MS had never received any DMT.
A significant proportion of patients with MS did not receive any DMT, even though such treatments are reimbursed by the healthcare system for French patients. This result highlights the unmet need for current DMTs for a large subgroup of patients with MS.
疾病修正疗法（DMT）对复发和疾病进展有影响。尽管如此，许多多发性硬化症（MS）患者仍未接受治疗。本研究的目的是确定在法国专家中心接受治疗的未接受治疗的 MS 患者的比例，并确定未治疗的预测因素。
我们进行了一项回顾性队列研究。数据来自于 2018 年 12 月 15 日参加欧洲多发性硬化症数据库（EDMUS）的 38 个中心，包括在研究期间至少接受过一次治疗的患者（2016 年 6 月 15 日至 2017 年 6 月 14 日）。
在 21189 例 MS 患者（年龄 47.1±13.1 岁；扩展残疾状况量表（EDSS）评分 3.4±2.4）中，6631 例（31.3%；95%置信区间[CI]30.7-31.9）未接受任何 DMT。虽然缓解复发型病程的患者（n=11693）最有可能接受 DMT，但仍有 14.8%（95%CI 14.2-15.4）未接受治疗（6.8%从未治疗）。在缓解复发型 MS 患者的多变量分析后，从未接受过治疗的主要解释因素是：脑部磁共振成像上无≥9 个病灶（比值比[OR]0.52[95%CI 0.44-0.61]）和较低的 EDSS 评分（OR 0.78[95%CI 0.74-0.82]）。大多数进展型 MS 患者（继发性进展型 50.4%，原发性进展型 64.2%）在研究期间未接受任何 DMT，而继发性进展型中有 11.6%的患者和原发性进展型中有 34.0%的患者从未接受过任何 DMT。
尽管医疗保健系统为法国患者报销此类治疗费用，但仍有相当一部分 MS 患者未接受任何 DMT。这一结果突显了当前 DMT 对大量 MS 患者亚组的未满足需求。
