Unemployment rates can be high among patients with multiple sclerosis (MS), and a return to work after unemployment can be difficult, highlighting the importance of treatment in preventing a departure from the workforce due to MS. Natalizumab is a highly effective treatment for patients with relapsing-remitting MS (RRMS) and was associated with positive employment outcomes in real-world studies.
To evaluate changes in employment status in RRMS patients treated with natalizumab in the TYSABRI Observational Program (TOP), a large observational study assessing the long-term safety and effectiveness of natalizumab.
This retrospective analysis included patients aged ≤65 years at TOP enrolment (i.e., baseline [BL]) who were surveyed on their employment status in the year before natalizumab initiation and in the period since treatment initiation (N=2004). Multivariate logistic regression tested the association between BL characteristics and employment outcomes.
At BL, patients had a mean (standard deviation [SD]) Expanded Disability Status Scale (EDSS) score of 3.5 (1.5). At the survey, patients had a mean (SD) of 5.5 (3.3) years of natalizumab treatment. Survey responses indicated that in the year before natalizumab initiation, 1107 patients (55.2%) were working; 814 patients (40.6%) were working full time, 53 (2.6%) were working part time due to MS, 265 (13.2%) were not working due to MS, and 240 (12.0%) and 632 (31.5%) were working part time or not at all, respectively, for other reasons. After natalizumab initiation, 861 patients (43.0%) improved (1.3%) or maintained (41.6%) their employment level, whereas 170 (8.5%) experienced a decline in employment level due to MS and 256 (12.8%) remained unemployed due to MS. Significant predictors of improving/maintaining employment status were younger age (adjusted odds ratio [aOR]: 0.756; P=0.005), lower BL EDSS score (aOR: 0.747; P<0.001), and fewer relapses in the year before natalizumab initiation (aOR: 0.829; P=0.042), but did not include sex, prior therapy use, or RRMS duration.
Of patients who were working prior to natalizumab initiation, 77.0% maintained or improved their employment level with an average follow up of 5.5 years. Overall, favourable outcomes were predicted by younger age and less BL disease activity, supporting the importance of natalizumab initiation early in the disease course to help prevent patients from leaving the workforce due to MS.
The TOP study is funded by Biogen. Biogen funded the analyses and writing support for this abstract. Writing support was provided by Ashfield Healthcare Communications (Middletown, CT, USA).