Disease Modifying Therapies Impact Quality of Life Differently for Women/Men Over Time

Background: Research literature presents conflicting results regarding the impact of disease modifying therapies (DMTs) on the health-related quality of life (HRQL) of persons with multiple sclerosis (MS).  Some studies show improvement, some no change, and some worsening over time.  The majority of studies assessing HRQL after DMT treatment had a maximum follow-up time of one year, and no studies report differences in HRQL over time by gender. However, one year of follow-up may not be long enough to identify the course of changes in HRQL or to ascertain whether DMTs impact on the lives of women and men in different ways over time.

Objectives: The purpose of this study was to determine the course of changes in HRQL over a three year period of women and men with relapsing-remitting MS (RRMS) who were being treated with DMTs.

Methods: We used data from a study of RRMS patients carried out in Saskatchewan, Canada, designed to evaluate the long-term impact of DMTs (N=185).  Participants completed the SF-36 HRQL survey at three time points: pre-DMT, with follow up at one year and three years. We investigated the course of changes over time in SF-36 subscale scores and the summary scale scores stratified by sex.

Results: The majority of the sample was female (70.3%).  The average age of the sample at the beginning of the study was 39.2 years, and the average Expanded Disability Status Scale (EDSS) was 2.4 (ambulatory with minimal to mild disability).  For women, there were initial improvements in all scores at one year.  At two years, all scores had again decreased and 3 of the physical health subtest scores (but not the mental health scores) had fallen below initial values.  Men showed improvement at one year on role limitations due physical and mental health problems and on the mental health summary scale. Most gains were retained through year three, but there were substantial declines in the physical HRQL domain scores and to a greater degree than the women.

Conclusions: Compared with pre-DMT scores, there were sustained improvements in mental health at three years, but declines in physical health.  Sex differences were apparent in the patterns of improvement and worsening over the course of the three-year follow up, with the degree of improvement and worsening being especially marked for men.  The sustained improvement in mental health scores suggest that, despite a worsening physical health, DMTs may lead to better mental and social health. This is important, since psychosocial well-being has been reported to be the most salient aspect of health for persons with RRMS.