The association between an active disease course and later risk of losing income from salaries and risk of early disability pension for patients with multiple sclerosis
ECTRIMS Online Library. Chalmer T. Sep 11, 2019; 279015; P655
Thor Ameri Chalmer
Thor Ameri Chalmer

Abstract: P655

Type: Poster Sessions

Abstract Category: Therapy - Long-term treatment monitoring

T.A. Chalmer1,2, M. Buron1,2, J. Schäfer3, H.B. Jensen4, Z. Illes5,6, V. Papp5, A. Theodorsdottir5, N. Asgari7,8, H.P.B. Skejø9, P.S. Sørensen1,2, M. Magyari1,2

1Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, University of Copenhagen, 2The Danish Multiple Sclerosis Registry, Rigshospitalet, Copenhagen, 3Department of Neurology, Aalborg University Hospital, Aalberg, 4Department of Brain and Nerve Diseases, Lillebaelt Hospital, Institute of Regional Health Research, University of Southern Denmark, Kolding, 5Department of Neurology, Odense University Hospital, 6Department of Clinical Research, University of Southern Denmark, Odense, 7Department of Neurology, Slagelse Hospital, Slagelse, 8Department of Neurobiology, Institute of Molecular Medicine, University of Southern Denmark, Odense, 9Department of Radiology, Slagelse Hospital, Slagelse, Denmark

Introduction: MS is characterized by neurological, cognitive and social disability, which can have substantial negative consequences, as many patients find it difficult to maintain a job.
Objective: To assess whether MS patients with an unstable disease course three years after the start of disease-modifying therapy (DMT) have an increased risk of losing income from salaries and increased risk of early disability pension.
Methods: Data from the Danish Multiple Sclerosis Registry were linked to other nationwide population-based registries and databases; most importantly the Income Statistics Register and the DREAM database of occupations and employment. We included all patients who started treatment with DMT between 2001 and 2014. We required exposure to DMT for at least 75% of a 3-year definition period. Patients were categorized into an unstable group, defined by the presence of relapses and/or 6-month EDSS confirmed worsening and the remaining patients were defined as stable. Baseline was defined as the EDSS record closest to 3 years after treatment start (+/-1 year). Outcomes were a year without income from salaries and a transfer payment labeled as early disability pension. We used a Cox proportional hazards model to estimate confounder-adjusted hazard ratios (HR) and absolute risks were plotted using cumulative incidence curves accounting for competing risks.
Results: For the disability pension outcome, 3173 patients were included in the analysis. For the loss of income outcome, we further excluded 744 patients who did not have income from salaries at baseline. Accordingly, 2429 patients were included. Median follow-up from baseline was ~5 years in both analyses. A total of 500 patients lost income from salaries (stable: 17.7%; unstable 23.3%) and 398 patients received early disability pension (stable: 8.5%; unstable 16.5%) during follow-up. The unstable group had a 21% increased rate of losing income (HR 1.21; 95% CI 1.01-1.44). Due to non-proportional hazards, follow-up for the disability pension outcome was split in two. In year 0-5 after baseline, the unstable group had a 213% increased rate of disability pension (HR 2.13; 95% CI: 1.66-2.72) and in year 5-10 they had a 50% increased rate (HR 1.50; 95% CI: 0.96-2.34).
Conclusion: Relapses and EDSS worsening are associated with increased risk of socioeconomic decline defined as an increased rate of losing income from salaries and an increased rate of early disability pension.
Disclosure: Thor Ameri Chalmer has received support for congress participation from Merck, Novartis, Biogen, and Roche.
Mathias Buron has received support for congress participation from Roche.
Jakob Schäfer has received support for congress participation from Genzyme, Biogen, Roche, Teva and Merck
Zsolt Illes has served on scientific advisory boards, served as a consultant, received support for congress participation, received speaker honoraria, and received research support among others from Biogen, Merck-Serono, Sanofi-Genzyme, Novartis, Roche, Lundbeckfonden.
Viktoria Papp has received support for congress participation from Merck
Asta Theodosdottir has served on a scientific advisory board, received support for congress participation, and received research support from Biogen, Roche, Novartis and Sanofi-Genzyme
Hanne Pernille Bro Skejø: Nothing to disclose
Nasrin Asgari: Nothing to disclose
Henrik Boye Jensen: Nothing to disclose
Per Soelberg Sørensen has received personal compensation for serving on advisory boards for Biogen, Merck, Novartis, Teva, MedDay Pharmaceuticals, and GSK; has served on steering committees or independent data monitoring boards in trials sponsored by Merck, Teva, GSK, and Novartis; and has received speaker honoraria from Biogen, Merck Serono, Teva, Sanofi-Aventis, Genzyme, and Novartis
Melinda Magyari has served on scientific advisory board for Biogen, Sanofi, Teva, Roche, Novartis, Merck, has received honoraria for lecturing from Biogen, Merck, Novartis, Sanofi, Genzyme, has received research support and support for congress participation from Biogen, Genzyme, Teva, Roche, Merck, Novartis

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