Stratil Ann-Sophie, Papukchieva Steffeni, Neß Nils-Henning, Wolf Inge, Bayas Antonios, Flachenecker Peter, Friedrich Benjamin
Temedica GmbH, Munich, Germany.
Hexal AG, Holzkirchen, Germany.
Front Neurol. 2025 Apr 15;16:1561810. doi: 10.3389/fneur.2025.1561810. eCollection 2025.
Despite significant advances in multiple sclerosis (MS) treatment, a substantial proportion of people with MS (pwMS) remains untreated with disease-modifying therapies (DMTs). This study aimed to assess the proportion of DMT-untreated pwMS according to clinical and sociodemographic characteristics, the differences in healthcare utilization patterns, including MRI frequency and physiotherapy use, between DMT-treated and DMT-untreated pwMS, as well as to examine the time to first prescription among newly diagnosed pwMS in Germany from 2017 to 2022.
Longitudinal routine data from 4.5 million individuals insured by German statutory health insurance were analyzed. PwMS were identified by ICD-10-GM code G35 in at least two quarters within a calendar year. PwMS who filled a DMT prescription during the observation period were classified as DMT-treated. Newly diagnosed pwMS had no recorded G35 code and DMT prescription in the 2 years prior to initial MS coding. MRI scans and physiotherapy sessions were identified using OPS codes and the German . Group differences were tested with two-sided χ-tests and -tests.
In total, 45.6% of pwMS were DMT-untreated. DMT-untreated rates were higher in secondary progressive (SPMS) and primary progressive MS (PPMS) than relapsing-remitting MS (RRMS; < 0.0001). Older pwMS (>45 years) were more frequently DMT-untreated (56.0%) compared to younger pwMS (≤45 years; 27.4%; < 0.0001). Regional differences ranged from 37.5% in eastern Germany to 54.0% in the south-west. More than half of newly diagnosed pwMS did not receive their first prescription for DMT within 6 months of their initial MS coding, with longer times to first DMT prescription among pwMS with a progressive compared to a relapsing disease onset ( < 0.0001). DMT-untreated pwMS averaged more physiotherapy sessions (DMT-untreated: 23.7, SD 35.0; DMT-treated: 20.2, SD 28.7; < 0.0001) and less MRI scans (DMT-untreated: 0.8, SD 0.8; DMT-treated: 1.5, SD 0.8; < 0.0001) annually over the observation period than DMT-treated pwMS.
These real-world data offer valuable insights into patient care and treatment allocation.
尽管多发性硬化症（MS）治疗取得了重大进展，但仍有相当一部分多发性硬化症患者（pwMS）未接受疾病修正疗法（DMT）治疗。本研究旨在根据临床和社会人口学特征评估未接受DMT治疗的pwMS比例，比较接受DMT治疗和未接受DMT治疗的pwMS在医疗保健利用模式（包括MRI检查频率和物理治疗使用情况）方面的差异，并研究2017年至2022年德国新诊断的pwMS首次处方的时间。
分析了450万参加德国法定医疗保险的个人的纵向常规数据。通过在一个日历年内至少两个季度的ICD-10-GM代码G35识别pwMS。在观察期内开具DMT处方的pwMS被归类为接受DMT治疗。新诊断的pwMS在初次MS编码前2年内没有记录的G35代码和DMT处方。使用OPS代码和德国相关代码识别MRI扫描和物理治疗疗程。组间差异采用双侧χ检验和检验进行测试。
总体而言，45.6%的pwMS未接受DMT治疗。继发进展型（SPMS）和原发进展型MS（PPMS）中未接受DMT治疗的比例高于复发缓解型MS（RRMS；P<0.0001）。年龄较大的pwMS（>45岁）未接受DMT治疗的频率（56.0%）高于年龄较小的pwMS（≤45岁；27.4%；P<0.0001）。地区差异从德国东部的37.5%到西南部的54.0%不等。超过一半的新诊断pwMS在初次MS编码后6个月内未接受首次DMT处方，疾病起病为进展型的pwMS首次接受DMT处方的时间比复发型更长（P<0.0001）。在观察期内，未接受DMT治疗的pwMS每年平均接受的物理治疗疗程更多（未接受DMT治疗：23.7，标准差35.0；接受DMT治疗：20.2，标准差28.7；P<0.0001），而MRI扫描更少（未接受DMT治疗：0.8，标准差0.8；接受DMT治疗：1.5，标准差0.8；P<0.0001）。
这些真实世界的数据为患者护理和治疗分配提供了有价值的见解。
