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

01/06/2026

AI Summary

No major sex differences in early RRMS regarding relapse presentation, treatment, disability progression, and overall DMT exposure.
Initial high efficacy DMTs were prescribed to about 5% of patients of both sexes, with no sex effect on selection.
Younger age, higher baseline EDSS and RRMS diagnosis predicted initial high efficacy DMT use, suggesting reduced sex bias in specialised centres.

AI Summary

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.

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.

Basic summary

Mult Scler. 2026 Jun 1:13524585261446846. doi: 10.1177/13524585261446846. Online ahead of print.

ABSTRACT

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.

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.

PMID:42224266 | DOI:10.1177/13524585261446846

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