Observational studyNeurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology2026
Delays in treatment escalation after failure in multiple sclerosis: the role of therapy type and healthcare system.
Observational study in Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundTimely 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.
objectiveTo evaluate time to treatment initiation after therapeutic failure in MS according to treatment type and healthcare coverage.
methodsWe 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).
resultsA 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).
conclusionTreatment 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.
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