Differential multiple sclerosis treatment allocation between Australia and New Zealand associated with clinical outcomes but not mood or quality of life

https://doi.org/10.1016/j.msard.2019.01.037Get rights and content
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Highlights

  • The association of first-generation disease-modifying therapy with disability was significantly different between nations, being positively associated with greater disability in New Zealand participants but not Australians (pinteraction = 0.015).

  • No differences between nations were seen in the relationship between disease-modifying therapy and relapse.

  • Importantly, while expected differences were seen in disability, likely reflecting the requirement for more active disease to qualify for government subsidy of disease-modifying therapy in NZ, no differences were seen for either fatigue or quality of life.

Abstract

Background

Differential treatment allocation may impact on clinical phenotype in MS and in turn upon quality of life (QoL).

Objectives

(a) Investigate the association between disease-modifying drugs (DMDs) use and relapse frequency, disability, clinically significant fatigue, and physical and mental health-related QoL among participants with MS residing in Australia and New Zealand (NZ); (b) assess whether these associations differed between Australia and NZ.

Methods

Disability and fatigue were measured by PDDS and FSS, respectively. QoL was assessed by MSQOL-54. Associations were assessed by binomial and multinomial logistic regression, as appropriate. Multivariable models were adjusted for demographic and clinical covariates, as appropriate.

Results

837 participants (627 from Australia; 210 from NZ) were identified from an online cohort of people with MS. First- and second-generation DMD use was associated with higher adjusted-odds of fatigue and disability, though not with 12-month relapse number. DMD use was not independently associated with physical or mental QoL. The association of first-generation DMD use with moderate disability differed between nations, such that treatment was associated with lower odds in Australia but not in NZ; a similar but a small difference was found for severe disability. No differences were seen in the DMD association with relapse number, nor with fatigue or QoL, between Australia and NZ.

Conclusion

The differential treatment allocation associations in NZ are evident in the DMD-disability association, but there is no evidence that this treatment regimen has negative associations with fatigue, mood, or QoL.

Keywords

Multiple sclerosis
Disease modifying drug
Disability
Fatigue
Quality of life
Relapse

Abbreviations

DMD
disease modifying drug
EDSS
expanded disability status scale
FSS
fatigue severity scale
HOLISM
health outcomes and lifestyle interventions in a sample of people with multiple sclerosis
MS
multiple sclerosis
NZ
New Zealand
PDDS
patient-determined disease steps
PHARMAC
pharmaceutical management agency
QoL
quality of life

Cited by (0)

1

Denotes joint senior authors.