Sex-specific analysis of early disease course and treatment in a German multiple sclerosis cohort

BACKGROUND: Understanding sex differences in relapsing-remitting multiple sclerosis (RRMS) and initiation of disease-modifying treatments (DMTs) is crucial for tailored approaches.

OBJECTIVE: The objective of this study is to analyze sex-specific differences in early RRMS.

METHODS: We analyzed data of therapy-naïve adults from the German NationMS cohort to describe first symptoms, onset relapse treatment, disability evolution, and DMT exposure separated by sex to investigate previously described sex differences.

RESULTS: Relapse presentation and treatment were similar (p = n.s.). Time to Expanded Disability Status Scale (EDSS) ⩾3.0 was comparable between sexes (adjusted hazard ratio, 95% confidence interval (95% CI): 1.32 (0.95-1.81)). DMT exposure did not differ (p = 0.60). Around 5.0% of both sexes received initial high-efficacy (HE) DMT. Younger age (odds ratio (OR) (95% CI): 0.95 (0.92-0.98); p = 0.000847), higher baseline EDSS (1.79 (1.40-2.27); p = 0.00000218), and RRMS diagnosis (2.26 (1.28-4.17), p = 0.006703) were associated with initial HE-DMT, but not sex (0.99 (0.57-1.77), p = 0.943166).

CONCLUSION: We did not observe major sex differences in early MS as described earlier regarding initial presentation and disability evolution suggesting a change of MS course. The decision for initial HE-DMT was influenced by younger age and higher EDSS, but not sex suggesting a lower sex bias regarding the initial treatment decision, yet only investigated in specialized academic MS centers.