Chen Jing, Diouf Ibrahima, Taylor Bruce V, Kalincik Tomas, van der Mei Ingrid
Department of Geriatrics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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.
J Neurol Neurosurg Psychiatry. 2022 Jul 28. doi: 10.1136/jnnp-2022-329223.
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.
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.
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.
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.
关于多发性硬化症（MS）疾病修饰疗法（DMTs）对MS患者报告结局的比较有效性，人们了解甚少。我们使用真实世界数据，比较了那他珠单抗与其他DMTs在MS症状严重程度、生活质量、残疾、疾病进展和就业结局方面的效果。
我们纳入了澳大利亚MS纵向研究中1382名参与者在2015年、2016年和2017年的2817条观察数据。通过问卷调查前瞻性收集治疗、健康和就业结局方面的信息。使用带有DMT×时间交互项的边际结构模型来比较那他珠单抗和其他对照治疗组。
随着时间推移，那他珠单抗与许多症状严重程度的改善或总体改善趋势以及工作生产力损失相关。与任何其他DMTs相比，在23项患者报告结局中的8项上，那他珠单抗随着时间推移具有更优效果，另外6项观察到类似的效果方向，显示出一致性。在痉挛、疲劳、疼痛、抑郁情绪、残疾、欧洲生活质量五维度指数、出勤主义和工作状态方面，效果没有差异。在任何结局方面，那他珠单抗随着时间推移与任何其他DMTs相比均未表现出显著更差的情况。
在这项大型前瞻性队列研究中，与其他DMTs相比，那他珠单抗在许多患者报告的健康和就业结局方面随着时间推移具有更优结果。这些发现可能会影响临床实践中的治疗选择以及未来的治疗成本效益分析。
