Factors associated with time from first-symptoms to diagnosis and treatment initiation of Multiple Sclerosis in Switzerland

Marco Kaufmann; Jens Kuhle; Milo A Puhan; Christian P Kamm; Andrew Chan; Anke Salmen; Jürg Kesselring; Pasquale Calabrese; Claudio Gobbi; Caroline Pot; Nina Steinemann; Stephanie Rodgers; Viktor von Wyl; Swiss Multiple Sclerosis Registry (SMSR)

doi:10.1177/2055217318814562

Factors associated with time from first-symptoms to diagnosis and treatment initiation of Multiple Sclerosis in Switzerland

Mult Scler J Exp Transl Clin. 2018 Dec 6;4(4):2055217318814562. doi: 10.1177/2055217318814562. eCollection 2018 Oct-Dec.

Affiliations

¹ Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland.
² Neurologic Clinic and Policlinic, University Hospital and University of Basel, Switzerland.
³ Neurology and Neurorehabilitation Centre, Luzerner Kantonsspital, Switzerland.
⁴ Department of Neurology, University Hospital Bern and University of Bern, Switzerland.
⁵ Department of Neurology and Neurorehabilitation, Rehabilitation Centre Kliniken Valens, Switzerland.
⁶ Division of Molecular and Cognitive Neuroscience, University of Basel, Switzerland.
⁷ Neurocentre of Southern Switzerland, Ospedale regionale di Lugano, Switzerland.
⁸ Department of Clinical Neurosciences, University Hospital of Lausanne, Switzerland.

Abstract

Background: Recent studies emphasise the importance of timely diagnosis and early initiation of disease-modifying treatment in the long-term prognosis of multiple sclerosis.

Objectives: The objective of this study was to investigate factors associated with extended time to diagnosis and time to disease-modifying treatment initiation in the Swiss Multiple Sclerosis Registry.

Methods: We used retrospective data (diagnoses 1996-2017) of the survey-based Swiss Multiple Sclerosis Registry and fitted logistic regression models (extended time to diagnosis ≥2 years from first symptoms, extended time to disease-modifying treatment initiation ≥1 year from diagnosis) with demographic and a priori defined variables.

Results: Our study, based on 996 persons with multiple sclerosis, suggests that 40% had an extended time to diagnosis, and extended time to disease-modifying treatment initiation was seen in 23%. Factors associated with extended time to diagnosis were primary progressive multiple sclerosis (odds ratio (OR) 5.09 (3.12-8.49)), diagnosis setting outside of hospital (neurologist (private practice) OR 1.54 (1.16-2.05)) and more uncommon first symptoms (per additional symptom OR 1.17 (1.06-1.30)). Older age at onset (per additional 5 years OR 0.84 (0.78-0.90)) and gait problems (OR 0.65 (0.47-0.89)) or paresthesia (OR 0.72 (0.54-0.95)) as first symptoms were associated with shorter time to diagnosis. Extended time to disease-modifying treatment initiation was associated with older age at diagnosis (per additional 5 years OR 1.18 (1.09-1.29)). In more recent years, time to diagnosis and time to disease-modifying treatment initiation tended to be shorter.

Conclusions: Even in recent periods, substantial and partially systematic variation regarding time to diagnosis and time to disease-modifying treatment initiation remains. With the emerging paradigm of early treatment, the residual variation should be monitored carefully.

Keywords: Registries; age of onset; disease-modifying treatment; logistic models; retrospective studies; time to diagnosis.