Association between early treatment of multiple sclerosis and patient-reported outcomes: a nationwide observational cohort study. Issue 4 (7th December 2022)

• Record Type: Journal Article
• Authors: He, Anna; Spelman, Tim; Manouchehrinia, Ali; Ciccarelli, Olga; Hillert, Jan; McKay, Kyla
• Is Part Of: Journal of neurology, neurosurgery and psychiatry. Volume 94:Issue 4(2023)
• Page Start: 284
• Page End: 289
• Publication Date: 2022-12-07
• Subjects: multiple sclerosis -- neuroepidemiology -- quality of life; Neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; Psychiatry -- Periodicals; 616.8
• DOI: 10.1136/jnnp-2022-330169
• Languages: English
• ISSNs: 0022-3050

Abstract

Abstract : Background: Timing of disease-modifying therapy affects clinical disability in multiple sclerosis, but it is not known whether patient reported outcomes are also affected. This study investigates the relationship between treatment timing and patient-reported symptoms and health-related quality of life. Methods: This was a nationwide observational cohort study of adults with relapsing multiple sclerosis, with disease onset between 2001 and 2016, and commenced on disease-modifying treatment within 4 years from disease onset. Patients commencing treatment within 0–2 years were compared with patients commencing treatment at 2–4 years. Indication bias was mitigated by propensity matching. Outcomes were patient-reported symptoms and health-related quality of life as measured by the Multiple Sclerosis Impact Scale (MSIS-29) and EuroQol-5 Dimensions-3 Level (EQ-5D). The follow-up period was 4–10 years from disease onset. Results: There were 2648 patients (69% female, median age 32.8) eligible for matching. Mean follow-up time was 3.7 years. Based on 780 matched patients, each year of treatment delay was associated with a worse MSIS physical score by 2.75 points (95% CI 1.29 to 4.20), and worse MSIS psychological score by 2.02 points (95% CI 0.03 to 3.78), in the adjusted models. Among 690 matched patients, earlier treatment start was not associated with EQ-5D score during the follow-up. Conclusions: Earlier commencement of disease-modifying treatment was associated with better patient-reported physical symptoms when measured using a disease-specific metric; however, general quality of life was not affected. This indicates that other factors may inform patients' overall quality of life.