Changes in productivity and ability to work with natalizumab treatment in relapsing-remitting multiple sclerosis patients and impact of the COVID19 containment measures in France: The TITAN study

ABSTRACT

Introduction: Multiple sclerosis is the major cause of non-traumatic disability in young people, reducing their ability to work. Natalizumab has been shown to improve productivity in previous European observational studies. Objectives: To assess natalizumab impact on the productivity at work in employed patients with Relapsing-Remitting Multiple Sclerosis (RR-MS) in France, by comparing the year before and after treatment initiation. Methods: TITAN is an observational, open-label, multicenter and national study. Patients were included between June 2017 and December 2019. Phone interviews were held at baseline and 12 months after treatment initiation with the patients to collect information on their professional situation, work stoppages and daily discomfort. An additional survey was carried out to collect changes during the COVID19 lockdown. This interim analysis mainly assessed changes in productivity at 12 months (M12) (number of worked hours before and after study enrollment), in the WPAI and the MSIS29. Results: Out of the 185 included patients, 140 (75.7%) were women, aged of 36.4 (+/- 9.5) years. The median EDSS score was of 2.0 and the median time since MS diagnosis of 3 years. Most patients had permanent contracts (82%), worked a high number of hours/year at baseline (mean 1295 +/- 495) and 67% of them had at least one work stoppage in the previous year. At M12, 77% of patients remained in an equivalent employment status. The annualized worked hours remained stable (median = 1389 h/y at M0 vs. 1348 h/y at M12;p-value 0.12), regardless the type of contract. During the pandemic period, the annualized median productivity dropped from 1384 h/y (between M0 and the lockdown) to 566 h/y (after the lockdown), regardless the type of contract. The ability to perform daily activities has improved significantly within 12 months after natalizumab initiation (WPAI;p-value <0.01 38% of discomfort at M0 vs. 29% at M12). The MSIS29 highlights a significant reduction in the physical impact (19.7% at M0 to 16.8 % at M12;p-value 0.01) and psychological impact of MS (32.2% at M0 to 26.7% at M12;p-value 0.001). Conclusions: While the number of hours worked did not change significantly, patients treated with natalizumab had a significant qualitative improvement in work discomfort and impact of MS.