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Importance of early treatment decisions on future income of multiple sclerosis patients.

ABSTRACT: Background: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. Objective:To estimate the long-term impact of early initiation of DMT on the income of MS patients. Methods: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. Results: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. Conclusion:Early treatment initiation in MS is associated with better socioeconomic outcome, adding to previous studies showing benefits regarding disability.

SUBMITTER: Kavaliunas A

PROVIDER: S-EPMC7564625 | biostudies-literature | 2020 Oct-Dec

REPOSITORIES: biostudies-literature

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Importance of early treatment decisions on future income of multiple sclerosis patients.

Kavaliunas Andrius A Manouchehrinia Ali A Gyllensten Hanna H Alexanderson Kristina K Hillert Jan J

Multiple sclerosis journal - experimental, translational and clinical 20201007 4

<h4>Background</h4>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.<h4>Objective</h4>To estimate the long-term impact of early initiation of DMT on the income of MS patients.<h4>Methods</h4>In total, 3610 MS patients were included in this register-based cohort study. We measured the association between the time to treatment and the out ...[more]

PMID: 33110615

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Project description:The development of accurate prognoses in multiple sclerosis is difficult, as the disease is characterized by heterogeneous patterns of brain abnormalities that relate in an unclear way to future impairments. Here, we use a statistical modeling approach to determine if the baseline pattern of connectome disruption due to T2-FLAIR lesions could predict a patient's future processing speed, as measured using the Symbol Digits Modality Test scores. Imaging data, demographics and Symbol Digits Modality Test scores were collected from 61 early relapsing remitting multiple sclerosis patients. The Network Modification Tool was used to estimate damage to the connectome by quantifying white matter abnormalities' effects on 1) global network properties, 2) regional connectivity and 3) connectivity between pairs of regions. MS subjects showed significant improvement of processing speed between baseline and follow-up (t?=?-2.6, p?=?0.0096); however, both baseline (t?=?-4.01, p?=?0.00012) and follow-up (t?=?-2.10, p?=?0.038) processing speed were significantly lower than age-matched healthy controls. Partial Least Squares Regression was used to create models that predict future processing speed from between baseline imaging metrics and demographics. The model based on region-pair disconnection and gray matter atrophy had the lowest AIC and highest prediction accuracy (R2?=?0.79) compared to models based on global (R2?=?0.41) or regional (R2?=?0.66) disconnection and gray matter atrophy, overlap with an ROI-based atlas and gray matter atrophy (R2?=?0.73) or gray matter atrophy alone (R2?=?0.71). We found that baseline measures of connectivity disruption in various parietal, temporal, occipital and subcortical regions and atrophy in the putamen were important predictors of future processing speed. We conclude that information about disruptions to pairwise brain connections is more informative of future processing speed than regional or global metrics or gray matter atrophy alone. The combination of quantitative disconnectome metrics, gray matter atrophy and statistical modeling approaches could enable clinicians in developing more accurate, individualized prognoses of future cognitive status in multiple sclerosis patients.

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Importance of early treatment decisions on future income of multiple sclerosis patients.

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Importance of early treatment decisions on future income of multiple sclerosis patients.

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