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Original research
Time to first treatment and risk of disability pension in relapsing-remitting multiple sclerosis
  1. Malthe Faurschou Wandall-Holm1,
  2. Mathias Due Buron1,
  3. Tine Iskov Kopp1,
  4. Karsten Thielen2,
  5. Finn Sellebjerg3,
  6. Melinda Magyari1,3
  1. 1Danish Multiple Sclerosis Registry, Department of Neurology, University of Copenhagen, Rigshospitalet Glostrup, Glostrup, Denmark
  2. 2Department of Occupational and Social Medicine, Holbæk Hospital, Copenhagen University Hospital, Holbæk, Denmark
  3. 3Danish Multiple Sclerosis Center, Department of Neurology, University of Copenhagen, Rigshospitalet Glostrup, Glostrup, Denmark
  1. Correspondence to Dr Malthe Faurschou Wandall-Holm, Danish Multiple Sclerosis Registry, Department Of Neurology. University of Copenhagen, Rigshospitalet Glostrup, Glostrup, Denmark; malthe.faurschou.wandall-holm{at}regionh.dk

Abstract

Background Initiation of disease-modifying therapy early in the disease course of relapsing-remitting multiple sclerosis (RRMS) has demonstrated beneficial effects on clinical outcomes, but socioeconomic outcomes remain largely unexplored.

Objective To investigate the association between the delay from disease onset to first treatment and the hazard of disability pension.

Methods We performed a population-based cohort study with data from the nationwide Danish Multiple Sclerosis Registry and Danish nationwide registries. Patients with a disease onset between 1 January 1996 to 5 April 2016 were followed until disability pension or a competing risk/censoring event. 7859 patients were assessed for eligibility of which 5208 were included in the final cohort. Key inclusion criteria were: a diagnosis of multiple sclerosis, relapsing-remitting phenotype, treatment in history, age 18–65 years and an Expanded Disability Status Scale≤4. Patients were categorised according to time from onset to first treatment: within 1 year (early), between 1 and 4 years (intermediate) and from 4 to 8 years (late).

Results Of the 5208 patients, 1922 were early, 2126 were intermediate and 1160 were late. Baseline clinical and socioeconomic variables were well balanced. The hazard of receiving disability pension increased with increasing delay of treatment initiation compared with the early group. Cox regression estimates adjusted for clinical and socioeconomic confounders: intermediate (HR, 1.37; 95% CI, 1.12 to 1.68) and late (HR, 1.97; 95% CI, 1.55 to 2.51).

Conclusion Early treatment initiation is associated with a reduced risk of disability pension in patients with RRMS. This finding underlines the importance of early diagnosis and treatment on a patient-centred, socioeconomic disability milestone.

  • MULTIPLE SCLEROSIS
  • EPIDEMIOLOGY

Data availability statement

Data are available upon reasonable request. Danish data regulations dictate that access to data are obtainable upon reasonable request, registration of the project at the Capital Region of Denmark’s internal record of processing activities (cf. EU GDPR article 30) and approval by the Danish Multiple Sclerosis Group.

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Data availability statement

Data are available upon reasonable request. Danish data regulations dictate that access to data are obtainable upon reasonable request, registration of the project at the Capital Region of Denmark’s internal record of processing activities (cf. EU GDPR article 30) and approval by the Danish Multiple Sclerosis Group.

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Footnotes

  • Contributors MM conceived the original idea. MFW-H analysed the data and wrote the manuscript. MDB, TIK, KT, FS and MM assisted with study design and refined, revised and supervised from drafting to final manuscript. Author responsible for the overall content as guarantor: MFW-H.

  • Funding This work was funded by Danish Multiple Sclerosis Registry.

  • Competing interests MFW-H, MDB, TIK and KT report no competing interests. FS has served on scientific advisory boards, been on the steering committees of clinical trials, served as a consultant, received support for congress participation, received speaker honoraria and received research support for his laboratory from Biogen, Merck, Novartis, Roche, Sanofi Genzyme and Teva. MM has served on scientific advisory board for Biogen, Sanofi, Roche, Novartis, Merck and AbbVie, has received honoraria for lecturing from Biogen, Merck, Novartis, Sanofi and Genzyme and has received research support and support for congress participation from Biogen, Genzyme, Teva, Roche, Merck and Novartis.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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