{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T01:01:20Z","timestamp":1755219680781,"version":"3.43.0"},"reference-count":26,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Suomen MS-s\u00e4\u00e4ti\u00f6"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Multiple Sclerosis Journal \u2013 Experimental, Translational and Clinical"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>Early disease-modifying therapy (DMT) improves outcomes in patients with relapsing-remitting multiple sclerosis (pwRRMS), but reasons for delayed or absent initiation are unclear.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Objective<\/jats:title>\n            <jats:p>To investigate reasons and trends for delayed or absent DMT initiation among Finnish pwRRMS.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>A nationwide retrospective study using the Finnish MS Registry identified 2363 pwRRMS diagnosed between 2010 and 2019 in the participating centers. Patients never receiving DMT or starting &gt;2 years post-diagnosis were compared to those initiating DMT within a year of diagnosis.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>\n              We identified 193 pwRRMS who never started DMT, 88 had delayed initiation over 2 years, and 1944 started within a year. The no\/delayed DMT group was older at diagnosis (mean 38.7 vs 35.2 years,\n              <jats:italic>p<\/jats:italic>\n              &lt;\u20090.001). Corticosteroid-treated relapses were more frequent among early initiators. Optic neuritis was more common in patients with delayed or no DMT. Treatment refusal was the primary reason for delayed\/no DMT (35.6%), with 68% of refusers never starting. From 2010to 2019, delayed\/no DMT initiation (\n              <jats:italic>p<\/jats:italic>\n              \u2009=\u20090.007) and treatment refusal (\n              <jats:italic>p<\/jats:italic>\n              \u2009=\u20090.004) decreased significantly.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Delayed or absent DMT initiation is linked to older age, optic neuritis, disease inactivity, and treatment refusal, which declined over time, likely due to expanded DMT options.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1177\/20552173251360358","type":"journal-article","created":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T08:20:26Z","timestamp":1754295626000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Delays in treatment initiation for patients with relapsing-remitting multiple sclerosis\u2014A nationwide population-based study"],"prefix":"10.1177","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-1483-0279","authenticated-orcid":false,"given":"Maiju","family":"Savolainen","sequence":"first","affiliation":[{"name":"Department of Neurology, Brain center, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Helsinki, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2854-2410","authenticated-orcid":false,"given":"Matias","family":"Viitala","sequence":"additional","affiliation":[{"name":"StellarQ Ltd, Turku, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9642-2598","authenticated-orcid":false,"given":"Katariina","family":"Kuutti","sequence":"additional","affiliation":[{"name":"Clinical Neurosciences, Neurocenter, University of Turku and Turku University Hospital, Turku, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3697-4961","authenticated-orcid":false,"given":"Hanna","family":"Kuusisto","sequence":"additional","affiliation":[{"name":"Department of Neurology, Tampere University Hospital, Tampere, Finland; 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