PND93 First LINE Treatment with Natalizumab Reduces Healthcare Resource Use and Work Productivity and Activity Impairment in Relapsing-Remitting Multiple Sclerosis (RRMS) Patients Compared to Natalizumab Delayed Use

Natalizumab is a highly efficacious disease modifying treatment (DMT) for RRMS patients. Though mostly used as second-line, some evidence suggests that first-line (1L) Natalizumab treatment could be more beneficial compared to its delayed second-line use following platform DMTs (interferon beta-1a, interferon beta-1b or glatiramer acetate). This study compares healthcare resource use (HCRU) and work productivity and activity impairment (WPAI) in RRMS patients who received 1L Natalizumab treatment vs. patients who received 1L platform DMTs and later switched to Natalizumab (delayed). The sample was drawn from Adelphi MS Disease Specific ProgrammeTM, an international (France, Germany, Italy, Spain, UK, and USA) cross-sectional study of RRMS patients captured between 2014 and 2018. First-line patients were treated with Natalizumab for at least 24 months; delayed patients were treated with a minimum of 12 months of 1L platform DMT, followed by at least 12 months Natalizumab treatment. Regression analysis was used to compare 1L Natalizumab vs delayed Natalizumab treatment. Professional caregiver hours, MS related hospitalizations, MS related hospitalization days and daily WPAI were compared using (zero-inflated) negative binomial and linear regressions. Regressions were adjusted for time from diagnosis to 1L therapy, age, BMI, sex, EDSS at initial therapy initiation and time since Natalizumab initiation. The use of 1L Natalizumab (n=79) vs delayed (n=189) was significantly associated with fewer professional caregiver hours (0.00 vs 0.06 per week; p=0.001), fewer hospitalizations (5 vs. 38 among 100 person-years ; p=0.004), fewer hospitalization days (6 vs 16 among 100 person-years ; p=0.023). An exploratory analysis associated 1L Natalizumab (n=29) vs. delayed (n=101)with lower WPAI (25.3% vs 40.1%; p=0.003). Delayed Natalizumab use is associated with greater downstream HCRU use and WPAI. Therefore, starting 1L Natalizumab could offer benefits to both patients and healthcare systems. This analysis extends and updates current comparative evidence for 1L Natalizumab use.