Tysabri Beats Other DMTs in Helping With Symptoms, Work Productivity

Real-world data can assist doctors and patients in selecting appropriate treatment

Lindsey Shapiro, PhD avatar

by Lindsey Shapiro, PhD |

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Tysabri (natalizumab) outperforms other disease-modifying therapies (DMTs) in its ability to lessen a range of patient-reported symptoms in people with multiple sclerosis (MS), according to data from a large real-world study.

These symptoms include balance difficulties, sensory problems, feelings of anxiety, bladder problems, vision problems, and sexual dysfunction.

Tysabri, a high-efficacy DMT, was also better at boosting work productivity and lowering absenteeism in treated patients.

“This new information can contribute to the decision-making process of treatment selection for neurologists and people with MS,” the researchers wrote.

The study, “Superior effects of natalizumab versus other DMTs on patient-reported outcomes in people with multiple sclerosis,” was published in the Journal of Neurology, Neurosurgery & Psychiatry

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Biogen’s Tysabri is an approved antibody-based treatment for relapsing forms of MS. Essentially, it acts to block immune cells from entering the brain, thereby preventing the damaging inflammation that drives MS.

Across numerous clinical trials, Tysabri’s ability to slow disability progression and lessen disease activity has been well-documented.

Fewer studies have evaluated the effects of Tysabri on patient-reported outcomes like quality of life, interruptions to daily activities, or work ability compared with other available DMTs. Some evidence suggests that Tysabri may be superior to some DMTs at improving quality of life and work productivity.

Now, a team of researchers examined the effects of Tysabri against other DMTs on several patient-reported outcomes, including MS symptom severity, quality of life, disability, disease progression, and employment outcomes using real-world data.

Who was included in this real world study?

They analyzed 2015–2017 data from the Australian MS Long Study, a survey-based study established in 2002 and that currently has more than 3,000 MS patients in Australia completing questionnaires each year.

A total of 2,817 observations from 1,382 participants were included in the analysis. Participants were survey respondents reporting the use of a DMT available for reimbursement in Australia in any of the yearly questionnaires within that three-year period.

Their mean age was 52.5 years, 81% were women, and their mean disease duration since diagnosis was 12.2 years.

DMTs were grouped into three categories, the first being classic injectable medications like interferon-beta-1a (sold as Rebif, among others) and glatiramer acetate (sold as Copaxone, among others).

Category 2 included oral medicines like Aubagio (teriflunomide) and Tecfidera (dimethyl fumarate), and category 3 encompassed high-efficacy DMTs such as Tysabri, Gilenya (fingolimod), alemtuzumab (sold as Lemtrada, among others), and Novantrone (mitoxantrone).

Most patients were taking classic injectable DMTs (35.3%), followed by high-efficacy DMTs other than Tysabri (33.5%), oral therapies (19%), and Tysabri (12.2%).

At the study’s start, patients using Tysabri were younger, had a shorter disease duration, lower quality of life, and higher symptom severity compared with participants on other DMTs.

How did Tysabri compare with other DMTs?

Consistent with previously reported preliminary findings, results showed that Tysabri was associated with greater effects over time in several MS symptoms relative to any other DMT.

Specifically, the high-efficacy DMT resulted in greater reductions in patient-reported sensory symptoms, feelings of anxiety, sexual dysfunction, bladder problems, balance difficulties, and vision problems.

Tysabri-treated patients also showed a trend toward fewer bowel problems, walking difficulties, cognitive symptoms, and lower scores in the Hospital Anxiety and Depression Scale and lower self-assessed disease progression in the previous year. However, these differences failed to reach statistical significance.

Tysabri did not, however, outperform other DMTs in its ability to lessen pain, fatigue, or spasticity (muscle stiffness).

There were no differences in health-related quality of life — as assessed with the European Quality of Life with five dimensions — between patients on Tysabri and those using other DMTs.

While health-related quality of life remained generally stable over two years in Tysabri-treated patients, it got worse over time in patients on category 2 and 3 DMTs.

Tysabri was also associated with greater improvements in work productivity over time, relative to any other DMTs, which was largely driven by reduced absenteeism.

In contrast, patients in other DMT groups saw a small rise in absenteeism over time.

“Importantly, [Tysabri] did not perform significantly worse over time compared with any other DMTs for any of the outcomes,” the team wrote.

These findings highlight that “compared with other DMTs, [Tysabri] was associated with a significantly slower rate of deterioration in health and employment outcomes,” the researchers wrote.

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The team noted, among the study’s limitations, that the participants were slightly older, had a shorter disease duration, and higher education levels than those who did not respond to the survey, which may have influenced the results.

Also, other high-efficacy DMTs — like Ocrevus (ocrelizumab), which became available for reimbursement in Australia after 2015 — were not included in the analysis.

Nevertheless, the findings may help patients and their doctors in selecting an appropriate MS treatment, the researchers noted.

“Given that lost productivity represents one of the largest sources of indirect costs in MS cost of illness studies, the associated beneficial effect of [Tysabri] on employment outcomes should be taken into account in future cost-effectiveness analyses,” the researchers wrote.

This study was supported by a grant from Biogen Australia.

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