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. 2025 Jun;14(3):895-909.
doi: 10.1007/s40120-025-00725-x. Epub 2025 Apr 10.

Impact of Natalizumab on Productivity and Ability to Work in Patients with Multiple Sclerosis in France: The TITAN Study

Patrick Vermersch  1 , Arnaud Kwiatkowski  2 , Jérôme de Sèze  3 , Alain Créange  4 , Nathalie Texier  5 , Sophie Fantoni-Quinton  6 , Marilyn Gros  7 , Marta Ruiz  7 , Christine Lebrun-Frenay  8 ; TITAN Investigators
Affiliations

Impact of Natalizumab on Productivity and Ability to Work in Patients with Multiple Sclerosis in France: The TITAN Study

Patrick Vermersch et al. Neurol Ther. 2025 Jun.

Abstract

Introduction: The TITAN study examined changes in productivity, ability to work, and quality of life (QoL) before and after treatment with the high-efficacy therapy natalizumab (TYSABRI®) in patients with multiple sclerosis (MS) in France.

Methods: Patients, aged ≥ 18 and < 65 years with relapsing-remitting MS, either naïve to natalizumab or with ≤ 1 prior natalizumab infusion, with paid employment, were evaluated for productivity (number of working hours) in the 12 months prior to and after natalizumab initiation. Changes in annualized relapse rate and Expanded Disability Status Scale (EDSS) score were assessed. Changes in work status, working ability, physical and psychologic functioning, and QoL were also evaluated.

Results: Of 185 enrolled patients, the primary analysis population comprised 162 patients with a mean (SD) age of 36.8 (9.6) years and a baseline mean (SD) EDSS score of 1.9 (1.4). Annual mean (SD) productivity (n = 160) decreased from 1284.4 (503.3) h before natalizumab to 1208.0 (575.3) h (p = 0.05) in the year after natalizumab initiation. Significant improvement was seen in overall activity impairment at 6, 12, and 18 months of natalizumab treatment (p < 0.001). Decreases in annualized relapse rate (p < 0.0001) and EDSS score (p < 0.05) were observed during this period. In addition, treatment-related improvements were observed in presenteeism (reduced work efficiency), overall work impairment, and absenteeism (p < 0.05); significant improvements in psychological and physical impact (p ≤ 0.01) of MS were reported.

Conclusions: These findings suggest that early treatment with natalizumab may improve the work function of patients with MS, thereby decreasing the economic burden of the disease and improving patient quality of life.

Keywords: COVID-19; MSIS-29; Relapsing-remitting multiple sclerosis; WPAI-MS; Work productivity.

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Conflict of interest statement

Declarations. Conflict of Interest: Patrick Vermersch: personal compensation for consulting from AB Science, Biogen, BMS-Celgene, Imcyse, Merck, Novartis, Roche, Sanofi, and Teva. Honoraria and support for meetings from Biogen, Janssen, Merck, Novartis, Roche, and Sanofi. Research grants from Merck, Sanofi, and Roche. Arnaud Kwiatkowski: personal compensation for consulting from Biogen, Merck, Novartis. Honoraria from Biogen, Merck, Novartis, Roche, and Sanofi; for meetings from Biogen, Janssen, Novartis, Roche, and Sanofi; for participation in advisory board from Novartis. Alain Créange: grants or contracts from Alexion, Biogen, BMS, Merck, Novartis, and Roche. Honoraria and support for meetings from Alexion, Biogen, and Novartis. Payment for expert testimony from Merck. Marilyn Gros and Marta Ruiz: employees of and may hold stock and/or stock options in Biogen. Nathalie Texier, Jérôme de Sèze, Christine Lebrun-Frenay and Sophie Fantoni-Quinton have nothing to disclose. Ethical Approval: The TITAN study was approved by the French Consultative Committee on Data Processing in Health Research; approved by the French Expert Committee on Health Research, Studies, and Evaluations (Comité Consultatif sur le Traitement de l’Information en matière de Recherche dans le domaine de la Santé [CCTIRS]); and authorized by the French Data Protection Commission. The study was conducted in accordance with local French laws, including the French Data Protection Act (Informatique et Libertés) and French Expert Committee on Health Research, Studies, and Evaluations (Comité d’Expertise pour les Recherches, les Etudes et les Evaluations dans le domaine de la Santé [CEREES]).

Figures

Fig. 1
Fig. 1
Work productivity 12 months before and after natalizumab initiation. A Twelve months before and 12 months after natalizumab initiation and B mean annual productivity before natalizumab initiation (n = 160), after natalizumab initiation in the pre-COVID-19 period (n = 160), and after natalizumab initiation during the COVID-19 period (n = 49). COVID-19 coronavirus disease 2019
Fig. 2
Fig. 2
WPAI-reported changes in work impairment before and after natalizumab treatment. p values calculated using Student’s t-tests for paired series. WPAI-MS Work Productivity and Activity Impairment-Multiple Sclerosis
Fig. 3
Fig. 3
Change in physical and psychologic impact of MS after treatment with natalizumab (MSIS-29). MS multiple sclerosis, MSIS-29 Multiple Sclerosis Impact Scale
Fig. 4
Fig. 4
Change in ARR before and after natalizumab treatment. Baseline ARR was calculated for the 12 months prior to natalizumab initiation. ARR at month 6 and month 18 were adjusted to annual rates. ARR annualized relapse rate
See this image and copyright information in PMC

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