Part 1

A majority of patients with multiple sclerosis in Canada are advised to start treatment with a disease-modifying therapy, most commonly with an anti-CD20 treatment, according to the results of a recent survey on NeuroSens. The survey was conducted from 27 February-31 March 2025 and received 64 responses from MS neurologists and nurses.

A total of 73.4% of respondents said they see >300 MS patients per year. A majority of patients were aged 30-45 years (34.3%) and 46-60 years (30.5%). A small proportion of patients was aged <30 years (19.3%), which may reflect the recent trend to older age at diagnosis. In addition, 15.8% were aged >60 years.

A majority of HCPs said they recommend starting a DMT in >75% of patients (51.6%) or in 51-75% of patients (45.3%). However, these estimates differed between neurologists and MS nurses (>75%: 56.3% vs. 37.5%; 51-75%: 39.6% vs. 62.5%). Neurologists and nurses also differed in their estimates of how many MS patients start treatment within a year of diagnosis. For the category of >75% starting within a year, physicians estimated 89.6% compared to nurses’ estimate of 70.6%.

Overall, the results suggest that about 30% of patients do not start treatment within the first year of diagnosis. According to respondents, the two most important reasons why patients opted not to start treatment were that the patient felt fine (48.8%) or the patient needed time to make a decision (26.6%). The least important reason for not starting treatment was patient support program-associated delays.

When asked why a clinician would not prescribe a DMT for a given patient, the most common reason overall was that the patient was not a candidate for therapy. The survey did not determine whether this was due to age, level of disability and/or comorbidities. The reasons that were most often cited as most important were diagnostic uncertainty and the patient refused treatment.

The overall proportion of currently untreated patients was 24%. Physician estimates of the untreated population were lower than those of MS nurses (21% vs. 31%). These results differ substantially from recent Canadian health database analyses that have reported that only 25-30% of MS patients filled a DMT prescription in the preceding year (Graf and colleagues. Lancet Reg Health Am 2024:29:100667. Ng and colleagues. Mult Scler 2022;28:583-596). One interpretation is that MS patients stop seeing a neurologist once they stop treatment.

According to survey respondents, the largest proportion of MS patients are currently being treated with an anti-CD20 agent (44.4%). Other commonly prescribed DMTs are platform orals (18.4%) and oral cladribine (12.5%). These findings are consistent with the increasing use of higher-efficacy DMTs as first- or second-choice agents due to their more favourable benefit/risk profile compared to earlier agents.

Most patients in all categories were seen annually. Interestingly, the results showed that MS patients currently on a DMT are seen more frequently than untreated patients. The proportion of physicians seeing patients every six months was 36.2% for relapsing MS patients on treatment (vs. 23.4% for untreated RMS patients), and 40.4% for progressive MS patients on treatment (vs. 14.9% of untreated PMS patients). A total of 4.3% of physicians said they see older MS patients every six months.

In Part 2 we will compare and contrast the survey results with those obtained from a patient survey conducted on MSology, our sister website (www.msology.com).