Background The direct comparative evidence on treatment effects of available multiple sclerosis (MS) disease-modifying therapies (DMTs) is limited, and few studies have examined the benefits of DMTs on employment outcomes. We compared the effects of DMTs used in the previous 5 years on improving the work attendance, amount of work and work productivity of people with MS.
Methods The Australian MS Longitudinal Study collected data from participants on DMTs usage from 2010 to 2015 and whether DMTs contributed to changes in employment outcomes. We classified 11 DMTs into three categories based on their clinical efficacy (β-interferons and glatiramer acetate as category 1; teriflunomide and dimethyl fumarate as category 2; fingolimod, natalizumab, alemtuzumab and mitoxantrone as category 3). Each DMT used by a participant was treated as one observation and analysed by log-multinomial regression.
Results Of the 874 participants included, 1384 observations were generated. Those who used category 3 (higher efficacy) DMTs were 2–3 times more likely to report improvements in amount of work, work attendance and work productivity compared with those who used category 1 (classical injectable) DMTs. Natalizumab was associated with superior beneficial effects on patient-reported employment outcomes than fingolimod (RR=1.76, 95% CI 1.02 to 3.03 for increased work attendance and RR=1.46, 95% CI 1.02 to 2.10 for increased work productivity).
Conclusions Those using the higher efficacy (category 3) DMTs, particularly fingolimod and natalizumab, reported significant increases in amount of work, work attendance and work productivity, suggesting they have important beneficial effects on work life in people with MS.
- multiple sclerosis
- disease-modifying therapy
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Contributors IM designed the study. JC performed the data analysis and drafted the manuscript. BT and LB provided advice on data analysis. IM, BT and JC were involved in the data interpretation; All authors critically revised the manuscript.
Funding This study was supported by the Multiple Sclerosis Research Australia.
Competing interests The authors have no conflicts of interest to declare.
Patient consent Patient consent obtained.
Ethical approval Ethical approval was obtained from the Australian Capital Territory Health Human Research Ethics Committee until 2014 when the AMSLS was relocated to Tasmania and then ethical approval was obtained from the Tasmanian Health and Medical Human Research Ethics Committee.
Provenance and peer review Not commissioned; externally peer reviewed.