Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.
Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
J Neurol Neurosurg Psychiatry. 2018 Nov;89(11):1200-1207. doi: 10.1136/jnnp-2018-318228. Epub 2018 Jun 19.
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.
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.
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).
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.
目前可用的多发性硬化症（MS）疾病修正治疗（DMT）的直接对照疗效证据有限，很少有研究考察 DMT 对就业结果的益处。我们比较了过去 5 年内使用的 DMT 对改善 MS 患者的工作出勤率、工作量和工作生产力的影响。
澳大利亚 MS 纵向研究从 2010 年至 2015 年收集参与者使用 DMT 的数据以及 DMT 是否有助于改变就业结果。我们根据临床疗效将 11 种 DMT 分为三类（β干扰素和聚乙二醇干扰素为第 1 类；特立氟胺和富马酸二甲酯为第 2 类；芬戈莫德、那他珠单抗、阿仑单抗和米托蒽醌为第 3 类）。参与者使用的每种 DMT 都作为一个观察进行分析，采用对数多项回归分析。
在 874 名参与者中，共产生了 1384 次观察。与使用第 1 类（经典注射）DMT 的患者相比，使用第 3 类（高疗效）DMT 的患者报告的工作量、工作出勤率和工作生产力的改善情况增加了 2-3 倍。与芬戈莫德相比，那他珠单抗对患者报告的就业结果有更好的有益影响（增加工作出勤率的 RR=1.76，95%CI 1.02 至 3.03；增加工作生产力的 RR=1.46，95%CI 1.02 至 2.10）。
使用高疗效（第 3 类）DMT 的患者，特别是芬戈莫德和那他珠单抗，报告工作量、工作出勤率和工作生产力显著增加，表明它们对 MS 患者的工作生活有重要的有益影响。
