Objective:

To assess time to disease-modifying therapy (DMT) initiation and the influence of social determinants of health (SDoH) on access to high-efficacy treatment in a regional multiple sclerosis (MS) population. 

Background:

Early initiation of high-efficacy DMT (HEDMT) improves MS outcomes. Patients may experience diagnostic and treatment delays due to nonspecific symptoms or other barriers to care. Identifying factors contributing to these delays is essential to improving timely access and outcomes. 

Design/Methods:

This was a retrospective chart review of patients seen by a single provider from June 2023-June 2025. Demographic and clinical variables were collected in REDCap. The primary outcome was time from diagnosis to HEDMT. Secondary outcomes included time from diagnosis to any DMT and symptom onset to diagnosis. Differences across SDoH (sex, race, ethnicity, employment, insurance, rural/urban status, and distance from clinic) were analyzed using t-tests and ANOVAs (p<0.005). 

Results:

Among 371 patients, 71% were female, 55% White, 38% Black, and 83% Not Hispanic or Latino. Most have private insurance (47%) and resided in urban areas (88%) with a median travel distance of 19.7 miles. HEDMT was used in 77%, with 70% having prior non-HEDMT exposure. Mean time to HEDMT was 5.8 years (SD 7.4). Delays varied by employment and insurance. Retired (9.6 years, SD 10.0) and unemployed (6.1 years, SD 6.6) patients experienced longer delays than employed (3.4 years, SD 7.5; p<0.001). Longer delays were also associated with Medicare (10.4 years, SD 10.0, p<0.005). Mean time to any DMT was 1.1 years (SD 3.5) and from symptom onset to diagnosis was 2.2 years (SD 4.1). 

Conclusions:

Employment and insurance status influenced time to HEDMT initiation. Our cohort had longer times to diagnosis and to any DMT and HEDMT initiation compared to other populations studied elsewhere. Further research within at-risk populations is needed.