Impact of natalizumab on quality of life in a real-world cohort of patients with multiple sclerosis: Results from MS PATHS.

Background: Optimizing multiple sclerosis treatment warrants understanding of changes in physical, mental, and social health.

Objective: To assess the impact of natalizumab on Quality of Life in Neurological Disorders (Neuro-QoL) scores.

Methods: Annualized change in T-scores and likelihood of ≥5-point improvement over baseline were calculated for each Neuro-QoL domain after natalizumab initiation. Comparisons with ocrelizumab-treated patients were conducted after propensity score weighting and adjustment for relevant co-medications, year, and drug-year interaction.

Results: Among 164 natalizumab patients analyzed, 8 of 12 Neuro-QoL domains improved significantly, with greater improvement in patients with abnormal baseline Neuro-QoL. In the subgroup comparison of natalizumab-treated ( = 145) and ocrelizumab-treated ( = 520) patients, significant improvement occurred in 9 of 12 and 4 of 12 domains, respectively. The difference between groups was statistically significant for positive affect and well-being ( = 0.02), sleep ( = 0.003), and satisfaction with social roles and activities (SRA) ( = 0.03) in the overall population and for emotional and behavioral dyscontrol ( = 0.01), participation in SRA ( = 0.0001), and satisfaction with SRA ( = 0.02) in patients with abnormal baseline Neuro-QoL.

Conclusions: Natalizumab can produce clinically meaningful improvements in mental and social health. Such improvements are unlikely to be primarily driven by expectation bias, as their magnitude exceeded improvements with another high-efficacy therapy, ocrelizumab.