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PLoS One. 2018 Feb 1;13(2):e0191646. doi: 10.1371/journal.pone.0191646. eCollection 2018.

Socio-economic status influences access to second-line disease modifying treatment in Relapsing Remitting Multiple Sclerosis patients.

Author information

CHU de Caen, Department of Neurology, Caen, FR.
Normandie Université, UNICAEN, INSERM 1237, Physiopathology and Imaging of Neurological Disorders, Caen, FR.
CHU de Caen, Pôle de Recherche, Caen, FR.
Normandie Université, UNICAEN, INSERM 1086, ANTICIPE « Cancers et Préventions » Caen, FR.
Réseau Bas-Normand pour la SEP, Caen, FR.



In MS, Socio-Economic status (SES) may influence healthcare and access to disease-modifying treatments (DMTs). Optimising delays to switch patients to a second-line DMT may hamper disease progression most effectively and achieve long term disease control. The objective of this study is to identify the influence of SES on the delay between first and second line DMT in RRMS patients, in Western-Normandy, France.


The association between SES and the delay to access a second-line DMT were studied using data from the MS registry of Western-Normandy including 733 patients with a diagnosis of RRMS during the period in question [1982-2011]. We used the European Deprivation Index (EDI), a score with a rank level inversely related to SES. We performed multivariate adjusted Cox models for studying EDI effect on the delay between first and second line DMT.


No significant influence of SES was observed on delay to access a second-line DMT if first-line DMT exposure time was less than 5 years. After 5 years from initiation of first-line treatment the risk of accessing a second-line DMT is 3 times higher for patients with lower deprivation indices (1st quintile of EDI) ([HR] 3.14 95%CI [1.72-5.72], p-value<0.001) compared to patients with higher values (EDI quintiles 2 to 5).


In RRMS, a high SES may facilitate access to a second-line DMT a few years after first-line DMT exposure. Greater consideration should also be given to the SES of MS patients as a risk factor in therapeutic healthcare issues throughout medical follow-up.

[Indexed for MEDLINE]
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