Author: Gavin Giovannoni

Chen et al. Effects of multiple sclerosis disease-modifying therapies on employment measures using patient-reported data. JNNP 2018; http://dx.doi.org/10.1136/jnnp-2018-318228

Background: The direct comparative evidence on treatment effects of available multiple sclerosis (MS) disease-modifying therapies (DMTs) is limited, and few studies have examined the benefits of DMTs on employment outcomes. We compared the effects of DMTs used in the previous 5 years on improving the work attendance, amount of work and work productivity of people with MS.

Methods: The Australian MS Longitudinal Study collected data from participants on DMTs usage from 2010 to 2015 and whether DMTs contributed to changes in employment outcomes. We classified 11 DMTs into three categories based on their clinical efficacy (β-interferons and glatiramer acetate as category 1; teriflunomide and dimethyl fumarate as category 2; fingolimod, natalizumab, alemtuzumab and mitoxantrone as category 3). Each DMT used by a participant was treated as one observation and analysed by log-multinomial regression.

Results: Of the 874 participants included, 1384 observations were generated. Those who used category 3 (higher efficacy) DMTs were 2–3 times more likely to report improvements in amount of work, work attendance and work productivity compared with those who used category 1 (classical injectable) DMTs. Natalizumab was associated with superior beneficial effects on patient-reported employment outcomes than fingolimod (RR=1.76, 95% CI 1.02 to 3.03 for increased work attendance and RR=1.46, 95% CI 1.02 to 2.10 for increased work productivity).

Conclusions: Those using the higher efficacy (category 3) DMTs, particularly fingolimod and natalizumab, reported significant increases in amount of work, work attendance and work productivity, suggesting they have important beneficial effects on work life in people with MS.

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We know you are the best value for money health service in the world and that you try your best with limited resources. We want to pledge our support for you and help you make the next 70 years even better. 


At your heart you espouse several principles that are worth remembering and fighting for: 

1. Healthcare is a basic human right
2. Healthcare should be equitable; no matter who you are you should have access to the same level of care
3. Healthcare should be free at the point of access. 

We know your principles are being eroded and people with MS (pwMS) have highly variable access to care across the UK. Variance in MS Services, for example, access to and the prescribing of disease-modifying therapies, have been well documented by the MS Society, MS Trust and the Royal College of Physicians. This has been backed up by new data presented at the recent ABN meeting in Birmingham from the NHS England’s Bluteq database. 

The Dream Team

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People with relapsing-remitting MS can only be treated with ocrelizumab if alemtuzumab is contraindicated or otherwise unsuitable. The latter is a very grey area and will be open to interpretation. My question is how does patient choice taken into account? NICE clearly does not think this is a priority; for NICE cost-effectiveness trumps patient safety and choice.


This appraisal does not refer to the primary progressive indication. If you think ocrelizumab has had a hard time in RRMS it is going to have an even harder time in PPMS. 

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