Early RRMS Treatment Lessens Need for Disability Pension in Denmark

Lindsey Shapiro, PhD avatar

by Lindsey Shapiro, PhD |

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Delaying the start of disease-modifying therapies (DMTs) increases the risk of people with relapsing-remitting multiple sclerosis (RRMS) needing a disability pension to compensate for a permanent reduced capacity to work,  according to a Danish study.

The study, “Time to first treatment and risk of disability pension in relapsing-remitting multiple sclerosis,” was published in the Journal of Neurology, Neurosurgery and Psychiatry.

Beginning MS treatment early in the disease course is thought to improve long-term clinical outcomes for MS patients, with studies suggesting that intervening before the disease causes irreversible damage is critical for prolonging brain health.

However, whether DMT timing similarly influences socioeconomic outcomes has not been fully explored.

A team of researchers in Denmark now have examined the potential link between the timing of DMT initiation and the risk of needing a disability pension, which is granted to individuals in Denmark who have a substantially and permanently reduced working capacity.

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A total of 5,208 adult RRMS patients (ages 18–65) whose disease symptoms first appeared from January 1996 to April 2016 were included in the analyses. These patients had available data in the nationwide Danish Multiple Sclerosis Registry, which funded this study.

DMT initiation was considered early if administered within a year of symptom onset, intermediate if started between one to four years, and late if started between four and eight years after onset. Patients with a DMT delay of more than eight years were not included in the study.

A total of 1,922 patients (37%) received DMT early, 2,216 (41%) had an intermediate treatment initiation, and 1,160 (22%) started on an MS medication late.

While socioeconomic status and educational levels were similar across the three groups, patients in the early DMT group were diagnosed with RRMS earliest after symptom onset — less than a month, compared with 1.57 years for those in the intermediate group and 4.87 years for the late DMT group.

Those in the early group also had slightly lower scores in the Expanded Disability Status Scale at study’s start than those in the intermediate and late groups, suggesting a lower level of disability.

Results showed that over a median follow-up of 5.8 years, the risk of needing disability pension increased significantly with a longer delay in treatment initiation.

At 10 years after disease onset, the risk of disability pension was 10% in the early DMT group, 14.8% in the intermediate group, and 22.8% in the late group.

Further analyses, adjusted for differences in sex and level of education, indicated that patients in the intermediate DMT group had a 37% higher risk of disability pension than the early group, and those in the late group had a 94% greater risk.

“Part of the explanation why patients in the late group receive treatment later than the other groups might be because their capacity to work is not as negatively affected by the disease yet, reducing their inclination to seek neurological counselling,” the researchers wrote.

However, as the disease goes untreated, “their disability accumulation occurs at a faster rate compared with those receiving treatment early, in the end resulting in an increased [risk] of disability pension at later stages,” they added.

When the researchers examined disability pension by date, a significant link between greater DMT delay and higher risk of disability pension was observed only in earlier years — from 1996 to 2009 — but not after 2010.

This may be due to the fact that in the 2010–2016 period, patients were followed for a shorter time (median of 2.8 years vs. 8.8–13.8 years in the other periods) and fewer of them received pensions (6% vs. 17–35%).

“We hypothesize that with additional follow-up time, we would have seen a development similar to the other epochs,” the team wrote.

These findings highlight that beginning DMTs within one year of symptom onset is linked to a lower risk of needing disability pension among RRMS patients, which could reflect that early treatment prevents disability accumulation and preserves the ability to work.

The results were consistent with those from previous studies, but the fact that they all “stem from Scandinavian countries with free healthcare and extensive social security systems” may limit their generalization to other populations, the researchers wrote.