复发缓解型多发性硬化症患者治疗起始延迟——一项基于全国人口的研究。
Delays in treatment initiation for patients with relapsing-remitting multiple sclerosis-A nationwide population-based study.
作者信息
Savolainen Maiju, Viitala Matias, Kuutti Katariina, Kuusisto Hanna, Rauma Ilkka, Ryytty Mervi, Krüger Johanna, Hartikainen Päivi, Niiranen Marja, Saarinen Jukka, Soilu-Hänninen Merja, Laakso Sini M
机构信息
Department of Neurology, Brain center, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Helsinki, Finland.
StellarQ Ltd, Turku, Finland.
出版信息
Mult Scler J Exp Transl Clin. 2025 Aug 4;11(3):20552173251360358. doi: 10.1177/20552173251360358. eCollection 2025 Jul-Sep.
BACKGROUND
Early disease-modifying therapy (DMT) improves outcomes in patients with relapsing-remitting multiple sclerosis (pwRRMS), but reasons for delayed or absent initiation are unclear.
OBJECTIVE
To investigate reasons and trends for delayed or absent DMT initiation among Finnish pwRRMS.
METHODS
A nationwide retrospective study using the Finnish MS Registry identified 2363 pwRRMS diagnosed between 2010 and 2019 in the participating centers. Patients never receiving DMT or starting >2 years post-diagnosis were compared to those initiating DMT within a year of diagnosis.
RESULTS
We identified 193 pwRRMS who never started DMT, 88 had delayed initiation over 2 years, and 1944 started within a year. The no/delayed DMT group was older at diagnosis (mean 38.7 vs 35.2 years, < 0.001). Corticosteroid-treated relapses were more frequent among early initiators. Optic neuritis was more common in patients with delayed or no DMT. Treatment refusal was the primary reason for delayed/no DMT (35.6%), with 68% of refusers never starting. From 2010to 2019, delayed/no DMT initiation ( = 0.007) and treatment refusal ( = 0.004) decreased significantly.
CONCLUSION
Delayed or absent DMT initiation is linked to older age, optic neuritis, disease inactivity, and treatment refusal, which declined over time, likely due to expanded DMT options.
背景
早期疾病修饰治疗（DMT）可改善复发缓解型多发性硬化症（pwRRMS）患者的预后，但延迟开始治疗或未开始治疗的原因尚不清楚。
目的
调查芬兰pwRRMS患者延迟或未开始DMT治疗的原因及趋势。
方法
一项全国性回顾性研究利用芬兰多发性硬化症登记处，确定了2010年至2019年期间在参与中心诊断出的2363例pwRRMS患者。将从未接受DMT治疗或在诊断后超过2年开始治疗的患者与在诊断后一年内开始DMT治疗的患者进行比较。
结果
我们确定了193例从未开始DMT治疗的pwRRMS患者，88例延迟治疗超过2年，1944例在一年内开始治疗。未/延迟DMT治疗组诊断时年龄较大（平均38.7岁对35.2岁，<0.001）。早期开始治疗者中接受皮质类固醇治疗的复发更为频繁。视神经炎在延迟或未接受DMT治疗的患者中更为常见。拒绝治疗是延迟/未接受DMT治疗的主要原因（35.6%），68%的拒绝治疗者从未开始治疗。从2010年到2019年，延迟/未开始DMT治疗（=0.007）和拒绝治疗（=0.004）显著减少。
结论
延迟或未开始DMT治疗与年龄较大、视神经炎、疾病不活动和拒绝治疗有关，随着时间的推移这些情况有所下降，可能是由于DMT治疗选择的增加。
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