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

Kaufmann, M.; Kuhle, J.; Puhan, M. A.; Kamm, Christian Philipp; Chan, Andrew; Salmen, Anke; Kesselring, J.; Calabrese, P.; Gobbi, C.; Pot, C.; Steinemann, N.; Rodgers, S.; von Wyl, V. (2018). Factors associated with time from first-symptoms to diagnosis and treatment initiation of Multiple Sclerosis in Switzerland. Multiple sclerosis journal - experimental, translational and clinical, 4(4), p. 2055217318814562. Sage Publications 10.1177/2055217318814562

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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.

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