{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T04:05:28Z","timestamp":1791518728362,"version":"4.3.4"},"reference-count":35,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,2,11]],"date-time":"2025-02-11T00:00:00Z","timestamp":1739232000000},"content-version":"vor","delay-in-days":10,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Brain and Behavior"],"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The treatment of relapsing\u2010remitting multiple sclerosis (RRMS) is changing. There are limited data about initial treatment of RRMS in Finland.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Our objectives were to study the trends of initial disease\u2010modifying treatments (DMTs) for patients with RRMS from 2013 to 2022, treatment delays, factors associated with DMT choice, DMT switch patterns, and the effect of the COVID\u201019 pandemic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective register study used secondary data from the Finnish MS register. The DMTs were classified into medium\u2010efficacy DMTs (meDMTs; beta interferons, glatiramer acetate, fumarates, and teriflunomide) and high\u2010efficacy DMTs (heDMTs; alemtuzumab, cladribine, daclizumab, natalizumab, ocrelizumab, ofatumumab, and rituximab).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The inclusion criteria were fulfilled by 2479 individuals. From 2013 to 2022, the proportion of heDMTs as the initial therapy increased by 5.3\u2010fold from 6.9% to 43.7% (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001). Median diagnostic delay decreased from 10.1 to 4.6\u00a0months (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001). The COVID\u201019 pandemic did not cause treatment delays. Higher disease activity and younger age were associated with the choice of heDMT as the initial DMT. heDMTs were the preferred second DMT in patients switching due to lack of efficacy.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In Finland, the treatment of RRMS has shifted toward earlier diagnosis and earlier initiation of heDMTs, likely improving the prognosis of the patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/brb3.70326","type":"journal-article","created":{"date-parts":[[2025,2,12]],"date-time":"2025-02-12T01:43:42Z","timestamp":1739324622000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Evolving Patterns of Initial RRMS Treatment in Finland (2013\u20132022): Insights From a Nationwide Multiple Sclerosis Register"],"prefix":"10.1002","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3641-3504","authenticated-orcid":false,"given":"Henrik","family":"Ahvenj\u00e4rvi","sequence":"first","affiliation":[{"name":"Research Unit of Clinical Medicine, Neurology University of Oulu Oulu Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elina","family":"Jokinen","sequence":"additional","affiliation":[{"name":"Novartis Finland Ltd Espoo Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matias","family":"Viitala","sequence":"additional","affiliation":[{"name":"StellarQ Ltd Turku Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henri","family":"Autio","sequence":"additional","affiliation":[{"name":"Novartis Finland Ltd Espoo Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne M.","family":"Portaankorva","sequence":"additional","affiliation":[{"name":"Research Unit of Clinical Medicine, Neurology University of Oulu Oulu Finland"},{"name":"Medical Research Center Oulu University Hospital Oulu Finland"},{"name":"Clinical Neurosciences University of Helsinki Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6930-0229","authenticated-orcid":false,"given":"Merja","family":"Soilu\u2010H\u00e4nninen","sequence":"additional","affiliation":[{"name":"Clinical Neurosciences University of Turku Turku Finland"},{"name":"Neurocenter Turku University Hospital Turku Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna","family":"Kr\u00fcger","sequence":"additional","affiliation":[{"name":"Research Unit of Clinical Medicine, Neurology University of Oulu Oulu Finland"},{"name":"Medical Research Center Oulu University Hospital Oulu Finland"},{"name":"Neurocenter, Neurology Oulu University Hospital Oulu Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mervi","family":"Ryytty","sequence":"additional","affiliation":[{"name":"Research Unit of Clinical Medicine, Neurology University of Oulu Oulu Finland"},{"name":"Medical Research Center Oulu University Hospital Oulu Finland"},{"name":"Neurocenter, Neurology Oulu University Hospital Oulu Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,2,11]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/13524585211039753"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1107829"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000010135"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/ene.13692"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415\u2010018\u20109126\u2010y"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000004354"},{"key":"e_1_2_9_8_1","unstructured":"European Medicines Agency.2019. \u201cLemtrada Assessment Report: Procedure under Article 20 of Regulation (EC) No 726\/2004 Resulting from Pharmacovigilance 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MS Registry (SMSREG).2024. \u201cWeb\u2010Based Platform for Live Visualization And Interactive Statistical Analysis: Average Time Between Onset And Diagnosis Divided by Year of Diagnosis.\u201dhttps:\/\/vap.carmona.se\/open\/msvap\/graf\/medeltid_deb_dia\/."},{"key":"e_1_2_9_32_1","unstructured":"The Finnish Medical Society Duodecim and the Finnish Neurological Society.2020. \u201cHelsinki: The Finnish Medical Society Duodecim. Multiple Sclerosis. Current Care Guidelines.\u201dhttps:\/\/www.kaypahoito.fi\/hoi36070."},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474\u20104422(17)30470\u20102"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hlpt.2020.08.005"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD011381.pub2"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(07)61602\u2010X"}],"container-title":["Brain and Behavior"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/brb3.70326","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:07:16Z","timestamp":1760162836000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/brb3.70326"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2]]},"references-count":35,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2025,2]]}},"alternative-id":["10.1002\/brb3.70326"],"URL":"https:\/\/doi.org\/10.1002\/brb3.70326","archive":["Portico"],"relation":{"has-review":[{"id-type":"doi","id":"10.1002\/BRB3.70326\/v1\/decision1","asserted-by":"object"},{"id-type":"doi","id":"10.1002\/BRB3.70326\/v2\/response1","asserted-by":"object"},{"id-type":"doi","id":"10.1002\/BRB3.70326\/v2\/decision1","asserted-by":"object"},{"id-type":"doi","id":"10.1002\/BRB3.70326\/v1\/review2","asserted-by":"object"},{"id-type":"doi","id":"10.1002\/BRB3.70326\/v1\/review1","asserted-by":"object"}]},"ISSN":["2162-3279","2162-3279"],"issn-type":[{"value":"2162-3279","type":"print"},{"value":"2162-3279","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2]]},"assertion":[{"value":"2024-04-08","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-12-07","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-02-11","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70326"}}