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Association between early treatment of multiple sclerosis and patient-reported outcomes: a nationwide observational cohort study

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 li...

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Autores principales: He, Anna, Spelman, Tim, Manouchehrinia, Ali, Ciccarelli, Olga, Hillert, Jan, McKay, Kyla
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10086460/
https://www.ncbi.nlm.nih.gov/pubmed/36600595
http://dx.doi.org/10.1136/jnnp-2022-330169
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author He, Anna
Spelman, Tim
Manouchehrinia, Ali
Ciccarelli, Olga
Hillert, Jan
McKay, Kyla
author_facet He, Anna
Spelman, Tim
Manouchehrinia, Ali
Ciccarelli, Olga
Hillert, Jan
McKay, Kyla
author_sort He, Anna
collection PubMed
description 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.
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spelling pubmed-100864602023-04-12 Association between early treatment of multiple sclerosis and patient-reported outcomes: a nationwide observational cohort study He, Anna Spelman, Tim Manouchehrinia, Ali Ciccarelli, Olga Hillert, Jan McKay, Kyla J Neurol Neurosurg Psychiatry Multiple Sclerosis 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. BMJ Publishing Group 2023-04 2022-12-07 /pmc/articles/PMC10086460/ /pubmed/36600595 http://dx.doi.org/10.1136/jnnp-2022-330169 Text en © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Multiple Sclerosis
He, Anna
Spelman, Tim
Manouchehrinia, Ali
Ciccarelli, Olga
Hillert, Jan
McKay, Kyla
Association between early treatment of multiple sclerosis and patient-reported outcomes: a nationwide observational cohort study
title Association between early treatment of multiple sclerosis and patient-reported outcomes: a nationwide observational cohort study
title_full Association between early treatment of multiple sclerosis and patient-reported outcomes: a nationwide observational cohort study
title_fullStr Association between early treatment of multiple sclerosis and patient-reported outcomes: a nationwide observational cohort study
title_full_unstemmed Association between early treatment of multiple sclerosis and patient-reported outcomes: a nationwide observational cohort study
title_short Association between early treatment of multiple sclerosis and patient-reported outcomes: a nationwide observational cohort study
title_sort association between early treatment of multiple sclerosis and patient-reported outcomes: a nationwide observational cohort study
topic Multiple Sclerosis
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10086460/
https://www.ncbi.nlm.nih.gov/pubmed/36600595
http://dx.doi.org/10.1136/jnnp-2022-330169
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