Supplementary Material for: Real-world data on switches of the employment status in people with multiple sclerosis: a longitudinal observational study of the German MS Register

Introduction: Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system affecting 2.9 million people worldwide. MS symptom variety can have a significant impact on the economic and occupational participation of people with MS (pwMS). The objective of this study was to investigate the trends in the employment (EMP) status change of pwMS over a two-year period and to identify the associated sociodemographic, clinical and symptom-specific factors. Methods: The present longitudinal observational study analysed real-world registry data from pwMS characterised by ≥1 documented data set during 2014–2023, an age of 18–60 years, ≥2 data sets during a two-year period (±2 months) and a documented EMP status change. The transition from EMP to non-employment (NEMP) or vice versa within a two-year period was investigated during two visits: baseline (pre-transition) and follow-up (post-transition). Univariable and multivariable logistic regression models were utilised to identify associated variables. Results: The study population (N=940) was classified into NEMP-to-EMP patients (n=269) and EMP-to-NEMP patients (n=671). EMP-to-NEMP patients were found to be older in median (45.6 vs. 39.3 years) and more likely to have chronic progressive MS at baseline (14.2% vs. 4.8%) than NEMP-to-EMP patients. Moderate/severe disability level emerged as the most robust predictor of EMP-to-NEMP switches (odds ratio [OR]=1.89, p=0.005). Pain (baseline: OR=1.96, p=0.017; follow-up: OR=5.57, p=0.025) and cognitive impairment (baseline: OR=1.78, p=0.048; follow-up: OR=10.47, p=0.005) were significant symptomatic predictors of EMP-to-NEMP transitions. Conclusion: The results emphasise the particular importance of pain and cognitive impairment as independent symptomatic predictors, whose impact on work ability may be underestimated.