Unemployment Status Linked to Disability in Secondary-Progressive Multiple Sclerosis

VBCN - July 2015 Volume 2, No 2

Indianapolis, IN—Patients with secondary-progressive multiple sclerosis (SPMS) have to endure more than just declining physical and cognitive function. MS-related disability has been shown to affect performance of activities of daily living, too, and patients with MS have lower employment rates than those for the general population.

Recent data presented at the 2015 Con­sortium of Multiple Sclerosis Centers annual meeting, however, also show a significant association between unemployment status and physical and cognitive impairment in the SPMS population.

“While significant differences were observed in all measures, greater differences between the employed and unemployed groups were noted in objective measures of physical function and cognition,” reported Myla D. Goldman, MD, Associate Professor of Neurology, University of Virginia, Charlottesville. “The extent of effect of physical versus cognitive impairment on unemployment remains to be determined.”

The Phase 3 ASCEND Study

ASCEND is an ongoing international, phase 3b, randomized, double-blind, placebo-controlled study to evaluate whether natalizumab reduces disability progression unrelated to relapses in patients with SPMS. Natalizumab-naïve patients (aged 18-58 years) with SPMS onset ≥2 years before enrollment, and with confirmed disease progression, were eligible for the study, Dr Goldman noted. The researchers randomized patients with SPMS to intravenous treatment with natalizumab 300 mg or to placebo every 4 weeks, for 2 years.

The researchers obtained detailed information on employment from all patients at enrollment, as well. Associations between employment status (full-time/part-time or unemployed) and baseline disability outcome measures were evaluated using pooled blinded subject data and stratified by standard demographic variables (age, sex, level of education) and employment. The researchers also investigated the association between employment status and standard demographic variables.

At baseline, 339 (38%) of 889 patients with SPMS enrolled in ASCEND were employed (29% outside the home, 3% employed at home, 6% homemakers, <0.5% students), and most (62%) were unemployed.

Dr Goldman reported the following conclusions:

  • There was no significant difference in age or sex between unemployed and employed patients
  • Employed patients were more likely than unemployed patients to be married, and had a greater number of years of education
  • At baseline, unemployed patients performed worse on walking measures with significantly longer Timed 25-Foot Walking times, shorter Six-Minute Walk Test distances, and higher 12-item MS walk scale scores than employed patients (all, P <.001)
  • Unemployed patients also had worse information processing scores than employed patients (all, P <.05)
  • The Median Expanded Disability Status Scale scores were worse in unemployed versus employed patients
  • Unemployed patients also had worse upper extremity function
  • In the novel composite end point, unemployed patients had worse cognitive function reflected by lower mean MS-COG z score.

“This analysis demonstrates a significant association between unemployment status and physical and cognitive impairment in the SPMS population at enrollment in the ASCEND study,” Dr Goldman and colleagues concluded. “These results suggest that differences in disability measures translate to real-world changes, such as employment. This study expands prior research on the impact of SPMS on employment by including both cognitive and physical impairment.”

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