Open Access

Philip Lennart Poser, Barbara Gisevius, Marianne Tokic, Anne Lena Fisse, Theodoros Ladopoulos, Achim Berthele, Katrin Giglhuber, Martina Flaskamp, Vinzenz Fleischer, Stefan Bittner, Felix Lüssi, Antonios Bayas, Sven G. Meuth, Christoph Heesen, Corinna Trebst, Brigitte Wildemann, Florian Then Bergh, Gisela Antony, Tania Kümpfel, Joachim Havla, Friedemann Paul, Sandra Nischwitz, Hayrettin Tumani, Uwe Zettl, Bernhard Hemmer, Heinz Wiendl, Frauke Zipp, Nina Timmesfeld, Ralf Gold, Jeremias Motte, Anke Salmen

• 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 RRMSBackground: 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.…