{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T05:37:35Z","timestamp":1788845855033,"version":"build-2803163510"},"reference-count":18,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,4,15]],"date-time":"2025-04-15T00:00:00Z","timestamp":1744675200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Despite significant advances in multiple sclerosis (MS) treatment, a substantial proportion of people with MS (pwMS) remains untreated with disease-modifying therapies (DMTs). This study aimed to assess the proportion of DMT-untreated pwMS according to clinical and sociodemographic characteristics, the differences in healthcare utilization patterns, including MRI frequency and physiotherapy use, between DMT-treated and DMT-untreated pwMS, as well as to examine the time to first prescription among newly diagnosed pwMS in Germany from 2017 to 2022.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Longitudinal routine data from 4.5 million individuals insured by German statutory health insurance were analyzed. PwMS were identified by ICD-10-GM code G35 in at least two quarters within a calendar year. PwMS who filled a DMT prescription during the observation period were classified as DMT-treated. Newly diagnosed pwMS had no recorded G35 code and DMT prescription in the 2 years prior to initial MS coding. MRI scans and physiotherapy sessions were identified using OPS codes and the German <jats:italic>Heilmittelkatalog<\/jats:italic>. Group differences were tested with two-sided \u03c7<jats:sup>2<\/jats:sup>-tests and <jats:italic>t<\/jats:italic>-tests.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 45.6% of pwMS were DMT-untreated. DMT-untreated rates were higher in secondary progressive (SPMS) and primary progressive MS (PPMS) than relapsing-remitting MS (RRMS; <jats:italic>p<\/jats:italic> &amp;lt; 0.0001). Older pwMS (&amp;gt;45 years) were more frequently DMT-untreated (56.0%) compared to younger pwMS (\u226445 years; 27.4%; <jats:italic>p<\/jats:italic> &amp;lt; 0.0001). Regional differences ranged from 37.5% in eastern Germany to 54.0% in the south-west. More than half of newly diagnosed pwMS did not receive their first prescription for DMT within 6 months of their initial MS coding, with longer times to first DMT prescription among pwMS with a progressive compared to a relapsing disease onset (<jats:italic>p<\/jats:italic> &amp;lt; 0.0001). DMT-untreated pwMS averaged more physiotherapy sessions (DMT-untreated: 23.7, SD 35.0; DMT-treated: 20.2, SD 28.7; <jats:italic>p<\/jats:italic> &amp;lt; 0.0001) and less MRI scans (DMT-untreated: 0.8, SD 0.8; DMT-treated: 1.5, SD 0.8; <jats:italic>p<\/jats:italic> &amp;lt; 0.0001) annually over the observation period than DMT-treated pwMS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>These real-world data offer valuable insights into patient care and treatment allocation.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fneur.2025.1561810","type":"journal-article","created":{"date-parts":[[2025,4,15]],"date-time":"2025-04-15T04:12:42Z","timestamp":1744690362000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Disparities in patient share and characteristics between disease-modifying therapy-treated and -untreated people with multiple sclerosis in Germany: a claims data analysis from 2017 to 2022"],"prefix":"10.3389","volume":"16","author":[{"given":"Ann-Sophie","family":"Stratil","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steffeni","family":"Papukchieva","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nils-Henning","family":"Ne\u00df","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inge","family":"Wolf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonios","family":"Bayas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Flachenecker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Friedrich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,4,15]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"103326","DOI":"10.1016\/j.msard.2021.103326","article-title":"Multiple sclerosis by phenotype in Germany","volume":"57","author":"Engelhard","year":"2022","journal-title":"Mult. Scler. Relat. Disord."},{"key":"B2","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1177\/1352458517708141","article-title":"New insights into the burden and costs of multiple sclerosis in Europe: results for Germany","volume":"23","author":"Flachenecker","year":"2017","journal-title":"Mult Scler."},{"key":"B3","unstructured":"Deutsche\n              Gesellschaft f\u00fcr Neurologie (DGN)\n            \n          \n          Diagnose und Therapie der Multiplen Sklerose, Neuromyelitis-optica-Spektrum-Erkrankungen und MOG-IgG-assoziierten Erkrankungen, S2k-Leitlinie.\n          \n          2023"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1147","DOI":"10.1007\/s40120-022-00358-4","article-title":"Patterns of utilization and expenditure across multiple sclerosis disease-modifying therapies: a retrospective cohort study using claims data from a commercially insured population in the United States, 2010\u20132019","volume":"11","author":"Zhu","year":"2022","journal-title":"Neurol Ther."},{"key":"B5","doi-asserted-by":"publisher","first-page":"P4","DOI":"10.1212\/WNL.92.15_supplement.P4.2-060","article-title":"Untreated patients with multiple sclerosis: prevalence and characteristics in Denmark and in the United States (P4","volume":"92","author":"N\u00f8rgaard","year":"2019","journal-title":"Neurology."},{"key":"B6","doi-asserted-by":"publisher","first-page":"381","DOI":"10.1186\/1472-6963-14-381","article-title":"Multiple sclerosis in Germany: data analysis of administrative prevalence and healthcare delivery in the statutory health system","volume":"14","author":"H\u00f6er","year":"2014","journal-title":"BMC Health Serv Res."},{"key":"B7","unstructured":"Ocrevus. European Medicines Agency\n          \n          2018"},{"key":"B8","unstructured":"European\n              Medicines Agency\n            \n          \n          Mayzent: EPAR - Product Information\n          \n          2020"},{"key":"B9","doi-asserted-by":"publisher","first-page":"e446","DOI":"10.1212\/NXI.0000000000000446","article-title":"Treatment choices and neuropsychological symptoms of a large cohort of early MS","volume":"5","author":"von Bismarck","year":"2018","journal-title":"Neurol Neuroimmunol Neuroinflamm."},{"key":"B10","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1007\/s11910-020-01046-2","article-title":"Impact of age on multiple sclerosis disease activity and progression","volume":"20","author":"Zeydan","year":"2020","journal-title":"Curr Neurol Neurosci Rep."},{"key":"B11","doi-asserted-by":"publisher","first-page":"1197212","DOI":"10.3389\/fneur.2023.1197212","article-title":"Impact of aging on treatment considerations for multiple sclerosis patients","volume":"14","author":"Macaron","year":"2023","journal-title":"Front Neurol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"577","DOI":"10.3389\/fneur.2017.00577","article-title":"Meta-analysis of the age-dependent efficacy of multiple sclerosis treatments","volume":"8","author":"Weideman","year":"2017","journal-title":"Front Neurol."},{"key":"B13","doi-asserted-by":"publisher","first-page":"e0231846","DOI":"10.1371\/journal.pone.0231846","article-title":"Epidemiology, characteristics and treatment of patients with relapsing remitting multiple sclerosis and incidence of high disease activity: real world evidence based on German claims data","volume":"15","author":"Ohlmeier","year":"2020","journal-title":"PLoS One."},{"key":"B14","doi-asserted-by":"publisher","first-page":"17562864241237857","DOI":"10.1177\/17562864241237857","article-title":"Shifting from the treat-to-target to the early highly effective treatment approach in patients with multiple sclerosis \u2013 real-world evidence from Germany","volume":"17","author":"Papukchieva","year":"2024","journal-title":"Ther Adv Neurol Disord."},{"key":"B15","doi-asserted-by":"crossref","unstructured":"K\u00f6nig\n            \n            \n              C\n            \n            \n              Altevers\n              J\n            \n            \n              Maas\n              C\n            \n            \n              Meise\n              D\n            \n            \n              Bierbaum\n              M\n            \n            \n              Riederer\n              C\n            \n          \n          Burden Of Multiple Sclerosis In Germany - A Matched Cohort Study Using A Large Claims Database. Copenhagen, Denmark.\n          \n          2019","DOI":"10.1016\/j.jval.2019.09.1818"},{"key":"B16","doi-asserted-by":"publisher","first-page":"3794","DOI":"10.1007\/s00415-024-12384-3","article-title":"Management of multiple sclerosis in older adults: review of current evidence and future perspectives","volume":"271","author":"DiMauro","year":"2024","journal-title":"J Neurol."},{"key":"B17","doi-asserted-by":"publisher","first-page":"2385","DOI":"10.1111\/ene.15862","article-title":"Association between age and inflammatory disease activity on magnetic resonance imaging in relapse onset multiple sclerosis during long-term follow-up","volume":"30","author":"Coerver","year":"2023","journal-title":"Eur J Neurol."},{"key":"B18","doi-asserted-by":"publisher","first-page":"1756286420960274","DOI":"10.1177\/1756286420960274","article-title":"Gender disparities in health resource utilization in patients with relapsing\u2013remitting multiple sclerosis: a prospective longitudinal real-world study with more than 2000 patients","volume":"13","author":"Schriefer","year":"2020","journal-title":"Ther Adv Neurol Disord."}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2025.1561810\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,15]],"date-time":"2025-04-15T04:12:45Z","timestamp":1744690365000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2025.1561810\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,15]]},"references-count":18,"alternative-id":["10.3389\/fneur.2025.1561810"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2025.1561810","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,15]]},"article-number":"1561810"}}