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  • Clinically stable disease is associated with a lower risk of both income loss and disability pension for patients with multiple sclerosis

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Multiple sclerosis
Original research
Clinically stable disease is associated with a lower risk of both income loss and disability pension for patients with multiple sclerosis
  1. Thor Ameri Chalmer1,2,
  2. Mathias Buron1,2,
  3. Zsolt Illes3,4,
  4. Viktoria Papp3,
  5. Asta Theodorsdottir3,
  6. Jakob Schäfer5,
  7. Victoria Hansen5,
  8. Nasrin Asgari6,7,
  9. Pernille Bro Skejø8,
  10. Henrik Boye Jensen9,10,
  11. Per Soelberg Sørensen1,2,
  12. Melinda Magyari1,2
  1. 1 Danish Multiple Sclerosis Center, Department of Neurology, University of Copenhagen, Rigshospitalet Glostrup, Copenhagen, Denmark
  2. 2 Danish Multiple Sclerosis Registry, Department of Neurology, Rigshospitalet Glostrup, Copenhagen, Denmark
  3. 3 Department of Neurology, Odense University Hospital, Odense, Denmark
  4. 4 Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
  5. 5 Department of Neurology, Aalborg University Hospital, Aalborg, Denmark
  6. 6 Department of Neurology, Slagelse Hospital, Slagelse, Denmark
  7. 7 Department of Neurobiology, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
  8. 8 Department of Radiology, Slagelse Hospital, Slagelse, Denmark
  9. 9 Department of Brain and Nerve Diseases, Lillebealt Hospital, Kolding, Denmark
  10. 10 Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
  1. Correspondence to Dr Thor Ameri Chalmer, Danish Multiple Sclerosis Center, Department of Neurology, University of Copenhagen, Rigshospitalet Glostrup, Copenhagen 2100, Denmark; thor.ameri.chalmer.01{at}regionh.dk

Abstract

Objective To assess the risk of losing income from salaries and risk disability pension for multiple sclerosis patients with a clinically stable disease course 3 years after the start of disease-modifying therapy (DMT).

Methods Data from the Danish Multiple Sclerosis Registry were linked to other Danish nationwide population-based databases. We included patients who started treatment with a DMT between 2001 and 2014. Patients were categorised into a clinically stable group (No Evidence of Disease Activity (NEDA-2)) and a clinically active group (relapse activity or 6-month confirmed Expanded Disability Status Scale worsening). Outcomes were: (1) loss of regular income from salaries and (2) a transfer payment labelled as disability pension. We used a Cox proportional hazards model to estimate confounder-adjusted HRs, and absolute risks were plotted using cumulative incidence curves accounting for competing risks.

Results We included 2406 patients for the income analyses and 3123 patients for the disability pension analysis. Median follow-up from index date was ~5 years in both analyses. The NEDA-2 group had a 26% reduced rate of losing income (HR 0.74; 95% CI 0.60 to 0.92). HRs were calculated for 5-year intervals in the disability pension analysis: year 0–5: a 57% reduced rate of disability pension for the NEDA-2 group (HR 0.43; 95% CI 0.33 to 0.55) and year 5–10: a 36% reduced rate (HR 0.64; 95% CI 0.40 to 1.01).

Conclusion Clinically stable disease course (NEDA-2) is associated with a reduced risk of losing income from salaries and a reduced risk of disability pension.

http://dx.doi.org/10.1136/jnnp-2019-321523

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    Footnotes

    • Contributors TAC: study concept and design, analysis and interpretation of data and drafting/revising the manuscript. MM and PSS: study concept and design, acquisition of data, analysis or interpretation of data and revising the manuscript. MB: study design and revising the manuscript. ZI, VP, AT, JS, VH, NA, PBS and HBJ: acquisition of data and revising the manuscript

    • Funding This study was funded by Ejnar Jonasson called Johnsen and wife’s memorial fund, Danish Multiple Sclerosis Society, Fonden for neurologisk forskning.

    • Competing interests TAC has received support for congress participation from Merck, Novartis, Biogen and Roche. MB has received support for congress participation from Roche. ZI has served on scientific advisory boards, served as a consultant, received support for congress participation, received speaker honoraria and received research support from Biogen, Merck-Serono, Sanofi-Genzyme, Lundbeck and Novartis. VP has received support for congress participation from Merck. AT has received support for congress participation from Merck, Novartis, Biogen and Roche. JS has received support for congress participation from Genzyme, Biogen, Roche and Merck. VH has received support for congress participation from Roche, Biogen, Merck, Sanofi Genzyme and Almirall. NA has nothing to disclose. PBS has nothing to disclose. HBJ has nothing to disclose. PSS has received personal compensation for serving on advisory boards for Biogen, Merck, Novartis, Teva, MedDay Pharmaceuticals and GSK; has served on steering committees or independent data monitoring boards in trials sponsored by Merck, Teva, GSK and Novartis; and has received speaker honoraria from Biogen, Merck Serono, Teva, Sanofi-Aventis, Genzyme and Novartis. MM has served on scientific advisory boards for Biogen, Sanofi, Teva, Roche, Novartis and Merck; has received honoraria for lecturing from Biogen, Merck, Novartis, Sanofi and Genzyme; and has received support for congress participation from Biogen, Genzyme, Teva and Roche.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data may be obtained from a third party and are not publicly available

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