Kavaliunas Andrius, Manouchehrinia Ali, Gyllensten Hanna, Alexanderson Kristina, Hillert Jan
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Karolinska University Hospital, Stockholm, Sweden.
Mult Scler J Exp Transl Clin. 2020 Oct 7;6(4):2055217320959116. doi: 10.1177/2055217320959116. eCollection 2020 Oct-Dec.
Early initiation of disease-modifying treatment (DMT) is associated with better disability outcomes in multiple sclerosis (MS). However, little is known of how treatment decisions affect socio-economic outcomes.
To estimate the long-term impact of early initiation of DMT on the income of MS patients.
In total, 3610 MS patients were included in this register-based cohort study. We measured the association between the time to treatment and the outcome, defined as time from treatment initiation to a 95% decrease in annual earnings compared to each patient´s baseline level. Additionally, the association between time to treatment and increase of social benefits (sickness absence, disability pension) was investigated. A Cox model was adjusted for sex, onset age, education, family situation, country of birth, living area, and disability.
MS patients initiating treatment later had a higher risk of reaching the outcome- those who started treatment after 2 years from MS onset lost 95% of their earnings sooner (HR, 1.19; 95% CI, 1.04-1.37). Furthermore, risk to receive an annual compensation of SEK 100,000 (≈EUR 10,500) was higher for the delayed treatment group.
Early treatment initiation in MS is associated with better socioeconomic outcome, adding to previous studies showing benefits regarding disability.
在多发性硬化症（MS）中，早期开始疾病修饰治疗（DMT）与更好的残疾结局相关。然而，对于治疗决策如何影响社会经济结局却知之甚少。
评估早期开始DMT对MS患者收入的长期影响。
本基于登记的队列研究共纳入3610例MS患者。我们测量了治疗时间与结局之间的关联，结局定义为从治疗开始到年收入相较于每位患者的基线水平下降95%的时间。此外，还研究了治疗时间与社会福利增加（病假、残疾抚恤金）之间的关联。使用Cox模型对性别、发病年龄、教育程度、家庭状况、出生国家、居住地区和残疾情况进行了校正。
较晚开始治疗的MS患者达到该结局的风险更高——那些在MS发病2年后开始治疗的患者更快地失去了95%的收入（风险比，1.19；95%置信区间，1.04 - 1.37）。此外，延迟治疗组获得100,000瑞典克朗（约10,500欧元）年度补偿的风险更高。
MS早期开始治疗与更好的社会经济结局相关，这补充了先前显示在残疾方面有益的研究。
