Being employed has many benefits beyond the purely financial – it can improve our quality of life, provides social interaction and gives us a sense of purpose. So much so, that the MS International Federation ranks it as one of their seven principles to improve quality of life for people with MS.
Studies of people with MS in previous decades have shown that they are much more likely to fall out of employment than people with other chronic conditions and the general population. The financial impact of reduced employment for people with MS places a substantial burden on individuals, families and the wider community. The 2011 Australian MS Economic Impact Report put the cost of lost productivity at $0.5 billion/year, nearly half the total societal cost of MS.
Fortunately, recent research, published in 2016 by Dr Pieter Van Dijk and his team at Monash University, together with Associate Professor Ingrid van der Mei using data from MS Research Australia’s Australian MS Longitudinal Study, showed that the gap in employment rates between people with MS and the general population is closing and are now within 4% of the general population.
Now, researcher Jing Chen, Associate Professor Ingrid van der Mei, and their colleagues at the Menzies Institute for Medical Research have delved deeper into the data from the Australian MS Longitudinal Study to explore whether the use of disease-modifying therapies has played a role in this improvement in employment retention for people with MS.
In this latest study published in the prestigious Journal of Neurology, Neurosurgery, and Psychiatry , they show that people who are on high-efficacy disease-modifying therapies were 2-3 times more likely to report improved employment outcomes than those on the lower-efficacy first generation MS treatments.
In the study, 874 participants in the Australian MS Longitudinal Study (AMSLS) who used disease-modifying therapies in the previous 5 years were asked whether these therapies resulted in any changes in work-related outcomes. Participants in the AMSLS have been shown in a previous study to be highly representative of the Australian MS population.
Disease-modifying therapies were classified into three groups based on their clinical efficacy, β-interferons and glatiramer acetate as category 1; teriflunomide and dimethyl fumarate as category 2; and fingolimod, natalizumab, alemtuzumab and mitoxantrone as category 3. These category 3 medications are considered to be more efficacious based on the clinical trial results which showed strong suppression of relapses, MRI lesions and disability accumulation.
The results showed that while many participants did not report any changes to their employment outcomes, the users of the category 3 therapies (mainly represented by fingolimod and natalizumab) were 2.84 times more likely to report an increased amount of work, 3.14 times more likely to report an increased work attendance and 2.5 times more likely to report improved work productivity compared to those who used β-interferons and glatiramer acetate.
Employment, such a fundamental part of life, acts as a good real-life indicator of how well a person is doing. And this study indicates that the newer generation MS medications are having a positive effect on peoples’ quality of life. They are allowing people to maintain their health, keeping them well enough stay fully active and productively employed.
It is important to note that these results were looking at groups of people on therapies rather than individual cases. Many individuals respond very well to therapies categorised here as ‘lower efficacy’, as MS is a very varied disease and each individual can respond differently to different medications. For each individual, many personal factors need to be taken into consideration when choosing a medication, so it is important to discuss with your neurologist the most appropriate medication for you and your circumstances.