The initiation and persistence of disease-modifying treatments in relapsing–remitting multiple sclerosis in real-world clinical practice. Associations with clinical factors, fatigue, and quality of life

The treatment of MS is increasingly initiated with high-efficacy medications. In this doctoral thesis, it was found that the proportion of high-efficacy medications as initial treatments increased more than fivefold in Finland between 2013 and 2022, although medium-efficacy medications remained the most common choice. Multicomorbidity – especially the presence of psychiatric or autoimmune comorbidity – was associated with earlier discontinuation of the initial medication. Comorbidity was common, as approximately half of the patients had at least one additional disease at the time of MS diagnosis. Premature discontinuation of treatment also appeared to be associated with fatigue, which was present in approximately 75% of patients.

The onset of MS usually occurs between the ages of 20 and 40 and is more common in women. In Finland, MS is exceptionally common, affecting over 11,000 Finns. The pharmacological treatment of MS has progressed significantly in recent years; since 2010, as many as 11 new medications have received marketing authorization. As a result of these new therapies, treatment strategies are changing. Based on previous studies conducted abroad, treatment is increasingly initiated with high-efficacy rather than medium-efficacy medications. This topic has not previously been studied in Finland. The choice of medication is an important decision. Previous studies have shown that fatigue and comorbidities are common in patients with MS, but there is limited information on their impact on persistence with pharmacological treatment.

This doctoral thesis is based on four original studies, two of which were based on the Finnish MS Registry (2,479 and 1,630 patients) covering the years 2013–2022 and two on hospital records from 1986–2021, which included patients from the University Hospitals of Oulu and Kuopio, as well as Mikkeli Central Hospital (198 and 421 patients).

It was found in this doctoral thesis that pharmacological treatment for MS has evolved in Finland in a manner similar to other Western countries: high-efficacy medication is increasingly being started as the first medication. The importance of carefully managing comorbid conditions – especially psychiatric and autoimmune diseases – can be emphasized in patient care when initiating MS medication. Fatigue should also be addressed, as it may be associated with a higher risk of early medication discontinuation. A medicine can only help if it is taken.