The Impact of In-Hospital Disease Modifying Treatments on Mental and Physical Burden in Caregiver of Patients With MS

Objective: People with multiple sclerosis (pwMS) may require a high level of daily assistance both for indoor and outdoor activities. Usually, relatives or friends provide daily support to MS patients who have lost personal autonomy. Several factors such as disability level and disease duration may affect the burden of care in caregivers of pwMS; however, the relationship between disease-modifying therapies (DMTs) and caregiver burden has never been explored so far. The aim of this study is to explore the impact of hospital-based therapies on anxiety, depression, and burden of care in caregivers of pwMS. Methods: Hospital Anxiety and the Depression Scale (HADS) and Caregiver Burden Inventory (CBI) questionnaires were administered to caregivers of pwMS who performed planned visits in the outpatient setting. Multivariable regression models were built to evaluate the association between hospital-based therapies and depression (HADS-D > 7), anxiety (HADS-A > 7) and need to rest (CBI > 24). Results: Caregivers of pwMS receiving in-hospital therapies achieved higher scores in HADS and CBI questionnaires, resulting in a higher proportion of anxiety, depression, and need to rest among these. The multivariable models also showed that hospital-based therapies were positively associated with caregivers' depression (aOR = 2.38 [1.04-5.5; p = 0.04]), anxiety (aOR = 2.36 [1.03-5.4; p = 0.043]) and need to rest (aOR = 2.06 [0.8-5.29]; p = 0.13). Interpretation: Hospital-based therapies in pwMS negatively affect the burden of care and mental health of their own caregivers. The availability of home-based highly effective DMTs may contribute to reducing the outdoor caregiver burden without renouncing highly effective treatments.