Menzies

Author Of 1 Presentation

Patient-Reported Outcomes and Quality of Life Oral Presentation

FC04.02 - Effects of natalizumab on patient-reported MS outcomes using prospective data from the Australian MS longitudinal study

Speakers
Presentation Number
FC04.02
Presentation Topic
Patient-Reported Outcomes and Quality of Life
Lecture Time
13:12 - 13:24

Abstract

Background

There is limited evidence on the effects of disease modifying therapies (DMTs) on MS symptoms, health-related quality of life (HRQoL) and employment outcomes, particularly the comparative effectiveness between different available DMTs.

Objectives

By using the prospectively collected patient-reported data in the Australian MS Longitudinal Study (AMSLS) from 2015 to 2017, we aimed to compare natalizumab to other DMTs in relation to employment outcomes, MS symptom severity, HRQoL, and progression in the previous 12 months.

Methods

Medication and Disease Course surveys were conducted in 2015, 2016 and 2017, and collected data on DMTs, severity of 13 MS symptoms (0-10 scale), disability, HRQoL by European Quality of Life with five dimensions (EQ-5D) and work productivity loss (absenteeism, presenteeism, total work productivity loss in the previous 4 weeks). We used marginal structural models to estimate causal effect of natalizumab versus other DMT comparators (any other DMT, classic injectables, oral therapies (teriflunomide and dimethyl fumarate), higher efficacy DMTs (fingolimod, alemtuzumab and mitoxantrone), fingolimod, and alemtuzumab), while adjusting for time-varying confounders and intermediates of treatment effects.

Results

The analysis included 2836 observations. Compared to any other DMTs, natalizumab was associated with superior effects over time on improving balance, vision symptoms, sensory symptoms, bladder symptoms, sexual dysfunction, and feelings of anxiety. The strongest effect was seen for improving sensory problems (mean coefficient -0.44 (-0.66 to -0.22) per year). There was no evidence of an effect of natalizumab over time on improving HRQoL measured by the EQ-5D, but use of any other DMTs were associated with a significant decrease in EQ-5D. The use of natalizumab was associated with a marginal decrease in self-reported progression in the previous 12 months while the use of injectable DMTs and fingolimod were associated with an increased self-reported progression. The use of natalizumab was associated with a reduction in work productivity loss due to absenteeism compared to a worsening for any other DMT, and similar trends were less pronounced for presenteeism and total work productivity loss.

Conclusions

Compared to other DMTs, the use of natalizumab was associated with superior effects over time for several MS symptoms and absenteeism.

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Author Of 3 Presentations

Epidemiology Poster Presentation

P0471 - Intra-individual variations in multiple sclerosis symptoms are associated with changes in work productivity of people living with multiple sclerosis (ID 1721)

Speakers
Presentation Number
P0471
Presentation Topic
Epidemiology

Abstract

Background

Multiple sclerosis (MS) symptoms are associated with MS-related work productivity loss. But it is unknown whether changes in MS symptoms would lead to changes in work productivity in people living with MS (PwMS).

Objectives

To determine whether intra-individual variations in MS symptoms over time are associated with corresponding changes in work productivity in PwMS.

Methods

Study participants were employed Australian MS Longitudinal Study (AMSLS) participants followed from 2015 to 2019 with at least two repeated measures (n=2121). We used mixed effect models to examine if the within-individual variations in MS symptoms are associated with changes in work productivity.

Results

The mean annual change in work productivity between 2015 and 2019 was -0.23% (SD = 18.68%), with 39% experiencing no change, 31% decreasing in work productivity and 30% increasing in work productivity. Our analysis showed that disability and symptom scores at the start of the year were not associated with subsequent annual change in work productivity. However, the annual change in disability and annual change in symptom severity clusters were associated with the annual change in work productivity in the same year. In a multivariable model, annual change in ‘pain and sensory symptoms’, ‘feelings of anxiety and depression’, and ‘fatigue and cognitive symptom’ were independently associated with annual change in work productivity. Every unit increase in mean annual change of the symptom clusters were associated with 2.44%, 1.57% and 1.01% annual reduction in work productivity, respectively.

Conclusions

Individual change in work productivity seems to be driven by the changes in symptom severity rather than the absolute severity. To improve work productivity, management should focus on stabilising or improving symptoms.

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Epidemiology Poster Presentation

P0513 - Work productivity trajectories in Australians living with multiple sclerosis: a group-based modelling approach (ID 1737)

Speakers
Presentation Number
P0513
Presentation Topic
Epidemiology

Abstract

Background

Studies have documented loss of work capacity and work productivity loss in multiple sclerosis (MS). Little is known about the longitudinal trajectories of work productivity in MS.

Objectives

To explore trajectories of work productivity in people living with multiple sclerosis (PwMS) and examine the baseline factors associated with assignment to the trajectories group.

Methods

Study participants were from the Australian MS Longitudinal Study (AMSLS) from 2015 to 2019 who were employed and had more than two follow-ups (n=2121). We used group-based trajectory modelling to identify unique work productivity trajectories in PwMS. Multinomial logistic regression was used to assess associations with the work productivity trajectories.

Results

We identified three distinct trajectories of work productivity: ‘moderately worsened’ (16.7% of participants) with a mean work productivity of 47.6% in 2015, ‘mildly worsened’ (50.1%) with a mean work productivity of 86.3% in 2015 and ‘normal’ (33.2%) with a mean work productivity of 99.7% in 2015. The relative probability of being in a moderately or mildly worsened work productivity trajectory were higher for those with a higher education level, baseline work productivity, and high MS symptom severity. For example, the relative probability of being in ‘moderately worsened’ rather than ‘normal’ work productivity trajectory increased by 36% (RRR:1.36 ; 95% confidence interval:1.09 –1.71) for each unit increase in ‘fatigue and cognitive symptoms’ cluster.

Conclusions

Higher education level, and MS symptom severity increased the relative probability of following a low work productivity trajectory. Work productivity interventions should target MS symptoms severity and disability reduction.

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Patient-Reported Outcomes and Quality of Life Poster Presentation

P1037 - Impact of remoteness on patient-reported outcomes in Australians with multiple sclerosis (ID 1550)

Speakers
Presentation Number
P1037
Presentation Topic
Patient-Reported Outcomes and Quality of Life

Abstract

Background

Inequity in the availability and quality of health care may exist across geographical locations. Little is known about whether living in remote areas is associated with worse health outcomes in Australians with multiple sclerosis (MS), which is important information for health care planning.

Objectives

We aimed to evaluate whether living in regional or remote areas was associated with worse disease outcomes, employment outcomes, health-related quality of life (HRQoL), disease modifying therapy (DMT) utilisation and cost of illness among Australians with MS.

Methods

Around 3000 participants of the Australian MS Longitudinal Study were invited to participate in three surveys in 2016. Level of remoteness (major cities, inner regional, outer regional, remote and very remoted Australia) was determined using postcode. Information on MS type, DMT use, HRQoL, severity of 13 MS symptoms, disability and employment outcomes were collected. Data were analysed using linear regression, log-binomial regression, log-multinomial regression and negative binomial regression.

Results

Living in more remote areas was not associated with substantially worse health/employment outcomes, or higher MS costs among Australians with MS. There was a consistent pattern of those living in inner regional areas having slightly worse health outcomes and higher costs, but the effect sizes were relatively small and there were no clear dose-response relationships with increasing remoteness. They were also less likely to use high efficacy DMTs compared to those living in major cities. Adjusting for factors such as age, disease duration, and education level only marginally reduced the associations.

Conclusions

There is no large inequity in outcomes within the Australian MS population as a result of remoteness, although those living in inner regional areas had slightly worse health outcomes and higher MS costs.

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