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Health-Related Quality of Life in Multiple Sclerosis

Current Evidence, Measurement and Effects of Disease Severity and Treatment

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Abstract

Health-related quality of life (HR-QOL) is an important measure of health in patients with multiple sclerosis (MS), given that MS symptoms affect many aspects of everyday living. Physicians may tend to focus on physical or cognitive changes in patients with MS because these measures involve physician-or psychologist-administered tests rather than patient self-reporting. However, a number of validated instruments are available to evaluate HR-QOL in clinical studies. Several studies have used these instruments to evaluate the effects of traditional disease-modifying therapies (DMTs), i.e. interferon-β and glatiramer acetate on HR-QOL in patients with MS. The results of many of these studies showed that DMTs improved some aspects of patients’ HR-QOL, but study design issues such as small patient numbers or lack of placebo control for comparison have made it difficult to interpret these results. Two large, randomized, placebo-controlled studies of the newest DMT, natalizumab, showed that this therapy resulted in significant improvements in HR-QOL in patients with relapsing MS. Furthermore, the effects of natalizumab on HR-QOL were apparent, regardless of disease characteristics. The natalizumab studies definitively show that HR-QOL measures can be informative in a clinical trial setting and support the position that patient-reported outcomes, including HR-QOL measures, should be included in clinical trials to more fully assess therapeutic efficacy.

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  1. 1 The use of trade names is for product identification purposes only and does not imply endorsement.

References

  1. Ffrench-Constant C. Pathogenesis of multiple sclerosis. Lancet 1994; 343: 271–5

    Article  PubMed  CAS  Google Scholar 

  2. Noseworthy JH, Lucchinetti C, Rodriguez M, et al. Multiple sclerosis. N Engl J Med 2000; 343: 938–52

    Article  PubMed  CAS  Google Scholar 

  3. Weinshenker BG, Bass B, Rice GPA, et al. The natural history of multiple sclerosis: a geographically based study. Brain 1989; 112: 133–46

    Article  PubMed  Google Scholar 

  4. Lublin FD, Reingold SC. Defining the clinical course of multiple sclerosis: results of an international survey. Neurology 1996; 46: 907–11

    Article  PubMed  CAS  Google Scholar 

  5. Calabresi PA. Diagnosis and management of multiple sclerosis. Am Fam Physician 2004; 70: 1935–44

    PubMed  Google Scholar 

  6. Division of Mental Health, World Health Organization. The World Health Organization quality of life-100. Geneva: World Health Organization, 1995

    Google Scholar 

  7. Schipper H, Clinch JJ, Olweny CLM. Quality of life studies: definitions and conceptual issues. In: Spiler B, editor. Quality of life and pharmacoeconomics in clinical trials. Philadelphia (PA): Lippincott-Raven, 1996: 11–23

    Google Scholar 

  8. Canadian Burden of Illness Study Group. Burden of illness of multiple sclerosis: part II. Quality of life. Can J Neurol Sci 1998; 25: 31–8

    Google Scholar 

  9. Bethoux F, Miller DM, Kinkel RP. Recovery following acute exacerbations of multiple sclerosis: from impairment to quality of life. Mult Scler 2001; 7: 137–42

    PubMed  CAS  Google Scholar 

  10. IFNB Multiple Sclerosis Study Group. Interferon beta-1b is effective in relapsing-remitting multiple sclerosis: clinical results of a multicenter, randomized, double-blind, placebo-controlled trial. Neurology 1993; 43: 655–61

    Article  Google Scholar 

  11. Jacobs LD, Cookfair DL, Rudick RA, et al. Intramuscular interferon beta-1a for disease progression in relapsing multiple sclerosis. Ann Neurol 1996; 39: 285–94

    Article  PubMed  CAS  Google Scholar 

  12. Johnson KP, Brooks BR, Cohen JA, et al. Copolymer 1 reduces relapse rate and improves disability in relapsing-remitting multiple sclerosis: results of a phase III multicenter, double-blind, placebo-controlled trial. Neurology 1995; 45: 1268–76

    Article  PubMed  CAS  Google Scholar 

  13. PRISMS Study Group. Randomised, double-blind, placebo-controlled study of interferon beta-1a in relapsing/remitting multiple sclerosis. PRISMS (Prevention of Relapses and Disability by Interferon beta-1a Subcutaneously in Multiple Sclerosis) Study Group. Lancet 1998; 352: 1498–504

    Google Scholar 

  14. Polman CH, O’Connor PW, Havrdova E, et al. A randomized, placebo-controlled trial of natalizumab for relapsing multiple sclerosis. N Engl Med 2006; 354: 899–910

    Article  CAS  Google Scholar 

  15. Rudick RA, Miller D, Hass S, et al. Health-related quality of life in multiple sclerosis: effects of natalizumab. Ann Neurol 2007; 62: 335–46

    Article  PubMed  CAS  Google Scholar 

  16. Nortvedt MW, Riise T, Myhr KM, et al. Quality of life in multiple sclerosis: measuring the disease effects more broadly. Neurology 1999; 53: 1098–103

    Article  PubMed  CAS  Google Scholar 

  17. Hermann BP, Vickrey B, Hays RD, et al. A comparison of health-related quality of life in patients with epilepsy, diabetes and multiple sclerosis. Epilepsy Res 1996; 25: 113–8

    Article  PubMed  CAS  Google Scholar 

  18. Riazi A, Hobart JC, Lamping DL, et al. Using the SF-36 measure to compare the health impact of multiple sclerosis and Parkinson’s disease with normal population health profiles. J Neurol Neurosurg Psychiatry 2003; 74: 710–4

    Article  PubMed  CAS  Google Scholar 

  19. Rothwell PM, McDowell Z, Wong CK, et al. Doctors and patients don’t agree: cross sectional study of patients’ and doctors’ perceptions and assessments of disability in multiple sclerosis. BMJ 1997; 314: 1580–3

    Article  PubMed  CAS  Google Scholar 

  20. Bergner M, Bobbitt RA, Carter WB, et al. The Sickness Impact Profile: development and final revision of a health status measure. Med Care 1981; 19: 787–805

    Article  PubMed  CAS  Google Scholar 

  21. Ware Jr JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Med Care 1992; 30: 473–83

    Article  PubMed  Google Scholar 

  22. Ritvo PG, Fischer JF, Miller DM, et al. Multiple sclerosis quality of life inventory: a user’s manual. New York (NY): National Multiple Sclerosis Society, 1997

    Google Scholar 

  23. National Multiple Sclerosis Society, Consortium of Multiple Sclerosis Centers. Multiple sclerosis quality of life inventory: a user’s manual. New York: National Multiple Sclerosis Society, 1997

    Google Scholar 

  24. Vickrey BG, Hays RD, Harooni R, et al. A health-related quality of life measure for multiple sclerosis. Qual Life Res 1995; 4: 187–206

    Article  PubMed  CAS  Google Scholar 

  25. Cella DF, Dineen K, Arnason B, et al. Validation of the functional assessment of multiple sclerosis quality of life instrument. Neurology 1996; 47: 129–39

    Article  PubMed  CAS  Google Scholar 

  26. Ford HL, Gerry E, Tennant A, et al. Developing a diseasespecific quality of life measure for people with multiple sclerosis. Clin Rehab 2001; 15: 247–58

    Article  CAS  Google Scholar 

  27. Brazier J, Jones N, Kind P. Testing the validity of the Euroqol and comparing it with the SF-36 health survey questionnaire. Qual Life Res 1993; 2: 169–80

    Article  PubMed  CAS  Google Scholar 

  28. Marrie RM, Miller DM, Chelune GJ, et al. Validity and reliability of the MSQLI in cognitively impaired patients with multiple sclerosis. Mult Scler 2003; 9: 621–6

    Article  PubMed  Google Scholar 

  29. Lankhorst GJ, Jelles F, Smits RC, et al. Quality of life in multiple sclerosis: the disability and impact profile (DIP). J Neurol 1996; 243: 469–74

    Article  PubMed  CAS  Google Scholar 

  30. Schwartz CE, Couldhard-Morris L, Zeng Q, et al. Measuring self-efficacy in people with multiple sclerosis: a validation study. Arch Phys Med Rehab 1996; 77: 394–8

    Article  CAS  Google Scholar 

  31. Ferrans CE, Powers MJ. Quality of life index: development and psychometric properties. Res Nurs Health1985; 15: 29–38

    Article  Google Scholar 

  32. Simeoni M, Auquier P, Fernandez O, et al. Validation of the Multiple Sclerosis Quality of Life Questionnaire. Mult Scler 2008; 14: 219–30

    Article  PubMed  Google Scholar 

  33. Gold SM, Heesen C, Schulz H, et al. Disease specific quality of life instruments in multiple sclerosis: validation of the Hamburg Quality of Life Questionnaire in Multiple Sclerosis (HAQUAMS). Mult Scler 2001; 7: 119–30

    PubMed  CAS  Google Scholar 

  34. Hobart J, Lamping D, Fitzpatrick R, et al. The Multiple Sclerosis Impact Scale (MSIS-29): a new patient-based outcome measure. Brain 2001; 124: 962–73

    Article  PubMed  CAS  Google Scholar 

  35. Rotstein Z, Barak Y, Noy S, et al. Quality of life in multiple sclerosis: development and validation of the ‘RAYS’ Scale and comparison with the SF-36. Int J Qual Health Care 2000; 12: 511–7

    Article  PubMed  CAS  Google Scholar 

  36. Freeman JA, Hobart JC, Thompson AJ. Does adding MS-specific items to a generic measure (the SF-36) improve measurement? Neurology 2001; 57: 68–74

    Article  PubMed  CAS  Google Scholar 

  37. Miller DM, Cohen JA, Kooijmans M, et al. Change in clinicain-assessed measures of multiple sclerosis and subject-reported quality of life: results from the IMPACT study. Mult Scler 2006; 12: 180–6

    Article  PubMed  CAS  Google Scholar 

  38. Pfennings LEMA, van der Oloeg HM, Cohen L, et al. A comparison of responsiveness indices in multiple sclerosis patients. Qual Life Res 1999; 8: 481–9

    Article  PubMed  CAS  Google Scholar 

  39. Gruenewald DA, Higginson IJ, Vivat B, et al. Quality of life measures for the palliative care of people severely affected by multiple sclerosis: a systematic review. Mult Scler 2004; 10: 690–704

    Article  PubMed  CAS  Google Scholar 

  40. Parkin D, Jacoby A, McNamee P, et al. Treatment of multiple sclerosis with interferon β: an appraisal of cost-effectiveness and quality of life. J Neurol Neurosurg Psychiatry 2000; 68: 144–9

    Article  PubMed  CAS  Google Scholar 

  41. Rudick RA, Stuart WH, Calabresi PA, et al. Natalizumab plus interferon beta-1a for relapsing multiple sclerosis. N Engl J Med 2006; 354: 911–23

    Article  PubMed  CAS  Google Scholar 

  42. Nortvedt MW, Riise T, Myhr KM, et al. Type 1 interferons and the quality of life of multiple sclerosis patients: results from a clinical trial on interferon alfa-2a. Mult Scler 1999; 5: 317–22

    PubMed  CAS  Google Scholar 

  43. Vermersch P, de Seze J, Delisse B, et al. Quality of life in multiple sclerosis: influence of interferon-β1a (Avonex®) treatment. Mult Scler 2002; 8: 377–81

    Article  PubMed  CAS  Google Scholar 

  44. Zivadinov R, Zorzon M, Tommasi MA, et al. A longitudinal study of quality of life and side effects in patients with multiple sclerosis treated with interferon beta-1a. J Neurol Sci 2003; 216: 113–8

    Article  PubMed  CAS  Google Scholar 

  45. Arnoldus JHA, Killestein J, Pfennings LEMA, et al. Quality of life during the first 6 months of interferon-β treatment in patients with MS. Mult Scler 2000; 6: 338–42

    PubMed  CAS  Google Scholar 

  46. Freeman JA, Thompson AJ, Fitzpatrick R, et al. Interferon-β1b in the treatment of secondary progressive MS: impact of quality of life. Neurology 2001; 57: 1870–5

    Article  PubMed  CAS  Google Scholar 

  47. Cohen JA, Cutter GR, Fischer JS, et al. Benefit of interferon β-1a on MSFC progression in secondary progressive MS. Neurology 2002; 59: 679–87

    Article  PubMed  CAS  Google Scholar 

  48. Simone IL, Ceccarelli A, Tortorella C, et al. Influence of interferon beta treatment on quality of life in multiple sclerosis patients. Health Qual Life Outcomes 2006; 4: 96

    Article  PubMed  Google Scholar 

  49. Lily O, McFadden E, Hensor E, et al. Disease-specific quality of life in multiple sclerosis: the effect of disease modifying treatment. Mult Scler 2006; 12: 808–13

    Article  PubMed  CAS  Google Scholar 

  50. Rice GP, Oger J, Duquette P, et al. Treatment with interferon beta-1b improves quality of life in multiple sclerosis. Can J Neurol Sci 1999; 26: 276–82

    PubMed  CAS  Google Scholar 

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Acknowledgements

The authors wish to acknowledge Hema Gowda, PharmD, Matthew Hasson, BA, and Jillian Licata, PhD, of Scientific Connexions for their editorial assistance in the preparation of this manuscript; their activities were supported by funding from Biogen Idec, Inc.

Biogen Idec has provided research funds to the Cleveland Clinic for Tysabri® (natalizumab) clinical trials. Dr Rudick has received consulting fees in the past year from Biogen Idec, Elan, Millennium Pharmaceuticals, Novartis and Wyeth, and has received research grants from Biogen Idec, Elan, the National Institutes of Health, and the National Multiple Sclerosis Society. Dr Miller has received speaker fees from Biogen Idec, and consulting fees from GlaxoSmithKline and Novartis.

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Correspondence to Richard A. Rudick.

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Rudick, R.A., Miller, D.M. Health-Related Quality of Life in Multiple Sclerosis. CNS Drugs 22, 827–839 (2008). https://doi.org/10.2165/00023210-200822100-00004

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