Article Text

Download PDFPDF
Original research
Superior effects of natalizumab versus other DMTs on patient-reported outcomes in people with multiple sclerosis
  1. Jing Chen1,2,
  2. Ibrahima Diouf3,
  3. Bruce V Taylor4,
  4. Tomas Kalincik3,5,
  5. Ingrid van der Mei4
  1. 1 Department of Geriatrics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
  2. 2 Key Laboratory of Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases of Zhejiang Province, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
  3. 3 Clinical Outcomes Research Unit (CORe), Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
  4. 4 Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
  5. 5 Department of Neurology, The Royal Melbourne Hospital City Campus, Parkville, Victoria, Australia
  1. Correspondence to Professor Ingrid van der Mei, Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS 7005, Australia; ingrid.vandermei{at}


Background Little is known about the comparative effectiveness of multiple sclerosis (MS) disease-modifying therapies (DMTs) on patient-reported outcomes in MS. We compared the effects of natalizumab to other DMTs in relation to MS symptom severity, quality of life, disability, disease progression and employment outcomes using real-world data.

Methods We included 2817 observations in 2015, 2016 and 2017 from 1382 participants in the Australian MS Longitudinal Study. Information on treatment, health and employment outcomes was prospectively collected by questionnaires. Marginal structural models with interaction terms for DMT×time were used to compare natalizumab and other comparator treatment groups.

Results Natalizumab was associated with improvements over time, or general trends of improvement, in the severity of many symptoms and work productivity loss. Compared with any other DMTs, natalizumab was associated with superior effects over time for 8 of 23 patient-reported outcomes, with similar directions of effect observed for another 6, demonstrating consistency. There were no differences in effect for spasticity, fatigue, pain, feelings of depression, disability, European quality of life five dimension index, presenteeism and work status. Natalizumab did not perform significantly worse over time compared with any other DMTs for any of the outcomes.

Conclusions Natalizumab was associated with superior outcomes over time for many patient-reported health and employment outcomes when compared with other DMTs in this large prospective cohort study. These findings may influence treatment selection in clinical practice and future treatment cost-effectiveness analyses.

  • multiple sclerosis
  • neuroepidemiology
  • quality of life

Data availability statement

Data are available upon reasonable request.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

Data are available upon reasonable request.

View Full Text


  • JC and ID are joint first authors.

  • TK and IvdM are joint senior authors.

  • Contributors JC: acquisition, management and analysis of data and drafting of the manuscript. ID: analysis of data and cowriting the manuscript. IvdM:conception and design of the study, design of the survey, acquisition of data. BVT: data interpretation. TK: supervision of data analysis and data interpretation. All authors revised the manuscript and approved the final draft. IvdM is responsible for the overall content as guarantor.

  • Funding The Australian Multiple Sclerosis Longitudinal Study is funded by MS Australia. This analysis was supported by a grant from Biogen Australia. The funders had no role in study design, data collection, data analysis, data interpretation or writing of the manuscript.

  • Competing interests TK has served on scientific advisory boards for Roche, Sanofi-Genzyme, Novartis, Merck and Biogen; served on a steering committee for Brain Atrophy Initiative by Sanofi-Genzyme; received conference travel support and/or speaker honoraria from WebMD Global, Novartis, Biogen, Sanofi-Genzyme, Teva, BioCSL and Merck; and received research support from Biogen. Dr. Taylor Bruce is a JNNP Associate Editor/Editorial Board Member.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.