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A systematic review and meta-analysis exploring the efficacy of mindfulness-based interventions on quality of life in people with multiple sclerosis. J Neurol 2023; 270:726-745. [PMID: 36348069 PMCID: PMC9643979 DOI: 10.1007/s00415-022-11451-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/20/2022] [Accepted: 10/21/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Quality of life (QoL) is commonly impaired among people with multiple sclerosis (PwMS). The aim of this study was to evaluate via meta-analysis the efficacy of Mindfulness-based interventions (MBIs) for improving QoL in PwMS. METHODS Eligible randomized controlled trials (RCTs) were identified via searching six major electronic databases (MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, AMED, and PsycINFO) in April 2022. The primary outcome was QoL. Study quality was determined using the Cochrane Collaboration risk of bias tool. Meta-analysis using a random effects model was undertaken. Effect sizes are reported as Standardized Mean Difference (SMD). Prospero ID: 139835. RESULTS From a total of 1312 individual studies, 14 RCTs were eligible for inclusion in the meta-analysis, total participant n = 937. Most studies included PwMS who remained ambulatory. Cognitively impaired PwMS were largely excluded. Comorbidities were inconsistently reported. Most MBIs were delivered face-to face in group format, but five were online. Eight studies (n = 8) measured MS-specific QoL. In meta-analysis, overall effect size (SMD) for any QoL measure (n = 14) was 0.40 (0.18-0.61), p = 0.0003, I2 = 52%. SMD for MS-specific QoL measures (n = 8) was 0.39 (0.21-0.57), p < 0.0001, I2 = 0%. MBI effect was largest on subscale measures of mental QoL (n = 8), SMD 0.70 (0.33-1.06), p = 0.0002, I2 = 63%. Adverse events were infrequently reported. CONCLUSIONS MBIs effectively improve QoL in PwMS. The greatest benefits are on mental health-related QoL. However, more research is needed to characterize optimal formatting, mechanisms of action, and effects in PwMS with more diverse social, educational, and clinical backgrounds.
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Knapp R, Hardtstock F, Krieger J, Wilke T, Maywald U, Chognot C, Muros-Le Rouzic E, Craveiro L. Serious infections in patients with relapsing and progressive forms of multiple sclerosis: A German claims data study. Mult Scler Relat Disord 2022; 68:104245. [PMID: 36306609 DOI: 10.1016/j.msard.2022.104245] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/22/2022] [Accepted: 10/14/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND People with multiple sclerosis (pwMS) have a higher risk of serious infection (i.e., infection-related hospitalizations) than people without MS. Few studies have explored the risk of serious infections by MS phenotype in a real-world setting. This retrospective study compared the incidence of serious infections among people with relapse remitting MS (RRMS), primary progressive MS (PPMS), and secondary progressive MS (SPMS). METHODS Adult pwMS were selected from a German claims database, based on one inpatient or two outpatient diagnoses of MS (ICD-10 G35) by a neurologist from 01/01/2016 to 12/31/2018. Three cohorts (RRMS, PPMS, SPMS) were identified based on codes for MS subtypes included in the German Modification of the ICD-10 system. A fourth cohort of unspecified MS patients combined those with conflicting MS subtype diagnoses and multiple unspecified codes for MS. Serious infections were defined as hospitalizations for which infections were selected as the primary inpatient diagnosis. Infections were identified from a basket of ICD-10 codes distributed across 11 main categories, according to possible pathogen (e.g., other bacterial diseases [A30-A49]) or anatomical location (e.g., urinary tract infection [N39.0]). Multiple infections were counted if an interval of at least 60 days was recorded between episodes. Serious infections were counted from index (i.e., first recorded MS code) until the end of the study period or death. Incidence rates (IRs) were reported per 100 patient years (PY). RESULTS A total of 4,250 pwMS (RRMS: 2,307, PPMS: 282, SPMS: 558, unspecified MS: 1,135) were included; 32 patients progressed from RRMS to SPMS during the follow-up period. Mean (SD) age at baseline was 46.6 (13.6), 61.9 (12.4), and 62.5 (11.8) years in patients with RRMS, PPMS, and SPMS, respectively. Most pwMS were female (RRMS 74.8%, PPMS 62.1%, SPMS 67.4%). Progressive pwMS were more likely to have at least 1 comorbidity (PPMS 87.2%, SPMS 87.5%) compared to those with relapsing MS (61.9%). Most RRMS patients received disease-modifying therapy during follow-up (82.1%), while less than half of progressive MS patients did (PPMS 23.8%, SPMS 31.4%). Over a mean (SD) follow-up period of 3.5 (0.8) years, the IR of serious infections per 100 PY was higher in progressive MS cohorts (PPMS 13.5 [11.3-16.1], SPMS 13.6 [12.0-15.3]) than in the RRMS group (3.4 [3.0-3.7]). Yearly IRs remained stable over time in each cohort. Where anatomical location was specified, respiratory (2.0 per 100 PY) and genitourinary (1.9 per 100 PY) infections were most common. Across all subtypes, higher rates of serious infections were observed in men and older patients. CONCLUSION Progressive MS, older age and male sex are associated with an increased risk of serious infections. Overall, respiratory and genitourinary infections were the most commonly reported serious infections.
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Affiliation(s)
- Rachel Knapp
- Cytel, Potsdamer Straße 58, 10785 Berlin, Germany
| | | | | | - Thomas Wilke
- IPAM e.V., Alter Holzhafen 19, 23966 Wismar, Germany
| | - Ulf Maywald
- AOK PLUS, Sternplatz 7, 01067 Dresden, Germany
| | - Cathy Chognot
- F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070 Basel, Switzerland
| | | | - Licinio Craveiro
- F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070 Basel, Switzerland.
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Dai D, Sharma A, Phillips AL, Lobo C. Patterns of Comorbidity and Multimorbidity Among Patients With Multiple Sclerosis in a Large US Commercially Insured and Medicare Advantage Population. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2022; 9:125-133. [PMID: 36475279 PMCID: PMC9684016 DOI: 10.36469/001c.38669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 09/30/2022] [Indexed: 06/17/2023]
Abstract
Background: Comorbidities are common in patients with multiple sclerosis (MS), thus increasing the complexity of disease management and economic burden and worsening their prognosis and quality of life. Real-world evidence comparing comorbidities and multimorbidity patterns of commercially insured vs Medicare enrollees with MS is lacking. Objective: To evaluate the patterns of comorbidity and multimorbidity among patients with MS in a US commercially insured and Medicare Advantage population. Methods: This retrospective observational cohort study was conducted using Aetna health claims data from January 1, 2015, to October 31, 2019. Eligibility criteria were (1) at least 3 MS-related inpatient/outpatient (ICD-10-CM: G35), or disease-modifying therapy claims within 1 year (date of first claim = index date); (2) Aetna commercial health plan or Medicare Advantage medical and pharmacy benefits at least 12 months pre-/post-index; and (3) age 18 and older. Commercially insured patients, Medicare Advantage patients younger than 65 years of age, and Medicare Advantage patients 65 years and older were compared. Results: Among 5000 patients (mean [SD] age, 52.6 [12.9]; 75.2% female), 53% had commercial insurance and 47% had Medicare Advantage (59.2% disabled age <65). Medicare Advantage patients were older (age <65: 53.3 [7.9]; age ≥65: 70.8 [5.2]) vs commercial (age, 45.7 [10.2]), had greater comorbidity burden (Charlson Comorbidity Index; age <65: 1.17 [1.64], age ≥65: 1.65 [1.95]) vs commercial (0.53 [1.02]) (all P < .0001). Symptoms specific to MS (ie, malaise, fatigue, depression, spasms, fibromyalgia, convulsions) were more common among patients younger than 65 (all P < .0001). Age-related and other comorbidities (ie, hypertension, hyperlipidemia, dyspepsia, osteoarthritis, osteoporosis, glaucoma, diabetes, cerebrovascular, cancer) were more common among patients 65 years and older Medicare Advantage (all P < .0001). Multiple comorbidities were highly prevalent (median, 4 comorbidities), particularly among Medicare Advantage patients younger than 65 (median, 6) and Medicare Advantage patients 65 and older (median, 7). Conclusions: Comorbidities and multimorbidity patterns differed between patients with MS with commercial insurance and patients with Medicare Advantage. Multimorbidity was highly prevalent among patients with MS and should be considered in the context of clinical decision making to ensure comprehensive MS management and improve outcomes.
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Affiliation(s)
- Dingwei Dai
- CVS Health Clinical Trial Services LLC, Woonsocket, Rhode Island, USA
| | - Ajay Sharma
- CVS Health Clinical Trial Services LLC, Woonsocket, Rhode Island, USA
| | - Amy L Phillips
- Health Economics & Outcomes Research, EMD Serono, Rockland, Massachusetts, USA
| | - Carroline Lobo
- Health Economics & Outcomes Research, EMD Serono, Rockland, Massachusetts, USA
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Lai QL, Zhang YX, Wang JJ, Mo YJ, Zhuang LY, Cheng L, Weng ST, Qiao S, Liu L. Occurrence of Intracranial Hemorrhage and Associated Risk Factors in Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy: A Systematic Review and Meta-Analysis. J Clin Neurol 2022; 18:499-506. [PMID: 36062766 PMCID: PMC9444563 DOI: 10.3988/jcn.2022.18.5.499] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/17/2022] [Accepted: 02/17/2022] [Indexed: 11/18/2022] Open
Abstract
Background and Purpose Intracranial hemorrhage (ICH) is thought to be a rare but probably underestimated presentation of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). We conducted a systematic review and meta-analysis with the aim of comprehensively revealing the occurrence of ICH in patients with CADASIL. Methods English-language studies published up to September 30, 2021 were searched for in the MEDLINE (PubMed), Web of Science, and Cochrane Library databases. The design, patient characteristics, occurrence rate of ICH, and associated risk factors were retrieved for each identified relevant study. Results We enrolled 13 studies in the final meta-analysis, which included 1,310 patients with CADASIL. The probability of ICH occurrence in patients with CADASIL was 10.1% (95% confidence interval [CI]=5.6%–18.0%, I2=85.1%). When stratified by geographic region, the occurrence rate of ICH was much higher in Asians (17.7%; 95% CI=11.0%–28.5%, I2=76.3%) than in Europeans (2.0%; 95% CI=0.4%–10.8%, I2=82.8%). A higher burden of cerebral microbleeds (CMBs) and a history of hypertension were the most commonly recorded risk factors for ICH, which were available for three and two of the included studies, respectively. Conclusions Our study suggests that ICH is an important clinical manifestation of CADASIL, especially in Asians. A higher burden of CMBs and the existence of hypertension were found to be associated with a higher probability of ICH occurrence in patients with CADASIL.
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Affiliation(s)
- Qi-Lun Lai
- Department of Neurology, Zhejiang Hospital, Hangzhou, China
| | - Yin-Xi Zhang
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jun-Jun Wang
- Department of Neurology, Zhejiang Hospital, Hangzhou, China
| | - Ye-Jia Mo
- Department of Neurology, Zhejiang Hospital, Hangzhou, China
| | - Li-Ying Zhuang
- Department of Neurology, Zhejiang Hospital, Hangzhou, China
| | - Lin Cheng
- Department of Neurology, Zhejiang Hospital, Hangzhou, China
| | - Shi-Ting Weng
- The Second Clinical Medical College, Zhejiang Chinese Medicine University, Hangzhou, China
| | - Song Qiao
- Department of Neurology, Zhejiang Hospital, Hangzhou, China.
| | - Lu Liu
- Department of Neurology, Zhejiang Hospital, Hangzhou, China.
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Maric G, Pekmezovic T, Mesaros S, Tamas O, Veselinovic N, Budimkic Stefanovic M, Jovanovic A, Drulovic J. Occurrence of malignant diseases in patients with multiple sclerosis: population-based MS Registry data. Neurol Sci 2022; 43:6839-6846. [DOI: 10.1007/s10072-022-06362-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 08/20/2022] [Indexed: 10/14/2022]
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Bezzini D, Gualdani E, Razzanelli M, Battaglia MA, Cortese R, Francesconi P, Ulivelli M. Prevalence of chronic comorbidities in people with multiple sclerosis: descriptive study based on administrative data in Tuscany (Central Italy). Neurol Sci 2022; 43:6407-6414. [PMID: 35978257 PMCID: PMC9616752 DOI: 10.1007/s10072-022-06345-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/11/2022] [Indexed: 11/29/2022]
Abstract
Objective Chronic comorbidities are common in people with multiple sclerosis (PwMS), thus worsening their prognosis and quality of life, and increasing disease burden. The aim of the present study was to evaluate the prevalence of common comorbidities in PwMS in Tuscany (Central Italy) and to compare it with the general population. Methods The prevalence of comorbidities, including diabetes, chronic obstructive pulmonary disease (COPD), hypertension, stroke, heart failure (HF), cardiac infarction and ischemic heart disease (IHD), was assessed in PwMS and in general population resident in Tuscany, aged > 20 years, using administrative data. Results In total, we identified 8,274 PwMS. Among them, 34% had at least one comorbidity, with hypertension being the most common (28.5%). Comparing PwMS with the general population, PwMS had a higher frequency of hypertension and stroke when considering the whole group, and of diabetes, COPD, and IHD when considering sex and age subgroups. This increased risk was especially evident in the young and intermediate age groups, where multiple sclerosis may play an important role as risk factor for some comorbidities. In PwMS, as well as in the general population, prevalence of chronic diseases was higher in males and increased with age. Conclusions Comorbidities frequently coexist with multiple sclerosis and they may have an impact on this complex disease, from the health, clinical, and socioeconomic points of view. Therefore, a routine screening of chronic comorbidities should be a crucial step in clinical practice, as well as the promotion of healthy lifestyles to prevent the onset and to reduce their burden.
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Affiliation(s)
- Daiana Bezzini
- Department of Life Sciences, University of Siena, Siena, Italy.
| | - Elisa Gualdani
- Agenzia Regionale Di Sanità Della Toscana, Florence, Italy
| | | | - Mario Alberto Battaglia
- Department of Life Sciences, University of Siena, Siena, Italy
- Research Department, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Rosa Cortese
- Department of Medicine, Surgery and Neuroscience, Policlinico Le Scotte, University of Siena, Siena, Italy
| | | | - Monica Ulivelli
- Department of Medicine, Surgery and Neuroscience, Policlinico Le Scotte, University of Siena, Siena, Italy
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Kuiper JG, Overbeek JA, Foch C, Boutmy E, Sabidó M. Incidence of malignancies in patients with multiple sclerosis versus a healthy matched cohort: A population-based cohort study in the Netherlands using the PHARMO Database Network. J Clin Neurosci 2022; 103:49-55. [PMID: 35810606 DOI: 10.1016/j.jocn.2022.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 06/07/2022] [Accepted: 06/28/2022] [Indexed: 11/18/2022]
Abstract
This study estimated the incidence of malignancy in patients with multiple sclerosis (MS) versus a matched general population cohort in the Netherlands. Adults with a diagnosis of MS between 2006 and 2014 in the General Practitioner (GP) Database of the PHARMO Database Network with ≥ 1 year of patient history were matched to four non-MS individuals based on year of birth, sex, and GP practice. Patients were followed-up until the earliest malignancy diagnosis, death, or end of data collection. Age-adjusted incidence rates (IR) were measured overall and by cancer type. Standardized incidence ratios (SIR) were calculated as the ratio of stratification-specific IRs in the MS and non-MS cohorts. A total of 1,692 MS patients were matched to 6,768 non-MS patients. Age-adjusted IR of any malignancy, excluding non-melanoma skin cancer (n = 27), in the MS cohort was 48.3 (95%CI:30.1-66.5) per 10,000 PY. An increased incidence of any malignancy was observed in the MS cohort versus the non-MS cohort (SIR 1.8 [95%CI:1.1-2.5]). The most commonly observed malignancies in the MS cohort were breast cancer (n = 8; IR 20.4 [95%CI:6.3-34.5] per 10,000 PY) and melanoma (n = 6; IR 14.8 [95%CI:3.0-26.7] per 10,000 PY). The corresponding SIR observed between cohorts was 1.4 (95%CI:0.4-2.4) and 3.4 (95%CI:0.7-6.2), respectively. While the small increased incidence of malignancy in the MS cohort could be an artefact created by a different distribution of risk factors, an increased incidence of malignancy in MS patients in the Netherlands cannot be excluded.
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Affiliation(s)
- Josephina G Kuiper
- Research, PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands.
| | - Jetty A Overbeek
- Research, PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - Caroline Foch
- R&D Global Epidemiology, Merck Healthcare KGaA, Darmstadt, Germany
| | | | - Meritxell Sabidó
- R&D Global Epidemiology, Merck Healthcare KGaA, Darmstadt, Germany
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Association of age and disease duration with comorbidities and disability: a study of the Swiss Multiple Sclerosis Registry. Mult Scler Relat Disord 2022; 67:104084. [DOI: 10.1016/j.msard.2022.104084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/06/2022] [Accepted: 07/29/2022] [Indexed: 11/23/2022]
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Felicetti F, Tommasin S, Petracca M, De Giglio L, Gurreri F, Ianniello A, Nistri R, Pozzilli C, Ruggieri S. Eating Hubs in Multiple Sclerosis: Exploring the Relationship Between Mediterranean Diet and Disability Status in Italy. Front Nutr 2022; 9:882426. [PMID: 35782931 PMCID: PMC9244404 DOI: 10.3389/fnut.2022.882426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/25/2022] [Indexed: 11/23/2022] Open
Abstract
Background Multiple Sclerosis (MS) is a complex disease in which multiple factors contribute to disability accrual. Mediterranean Diet (MeDi) has shown beneficial effects across neurodegenerative diseases. We hypothesize that specific food habits, rather than global adherence to MeDi, might impact on MS. We aimed to (i) evaluate differences in adherence to MeDi between people living with MS (PwMS) and healthy controls (HC); (ii) characterize eating patterns in PwMS and HC, identifying the most influential MeDi items for each group by the use of network analysis; (iii) explore the relationship between patients' eating habits and disability. Materials and Methods In this cross-sectional study, we consecutively recruited 424 PwMS and 165 matched HC. Data were obtained through the administration of self-reported questionnaires. Expanded Disability Status Scale (EDSS) and Fatigue Severity Scale (FSS) were evaluated in the MS population. We performed between-groups comparisons via unpaired two-sample t-test and X2 test as appropriate. We calculated food networks in both MS cases and HC using and tested the association between hub nodes and disability. Finally, we conducted a post-hoc analysis, investigating the relationship between food items, lifestyle factors (smoking, exercise) and clinical outcomes. Results Most participants adhered sufficiently to MeDi. Exploring each group separately, fruit, vegetables, cereal, and fish were identified as hubs in PwMS, while meat and alcohol were identified as hubs in HC. Hubs were all inter-correlated, indicating that eating habits of PwMS include a large intake of all the foods identified as hubs. EDSS was predicted by the intake of vegetables (beta = −0.36, p < 0.03) and fish (beta = −0.34, p < 0.02). The model including smoking pack/year, International Physical Activity Questionnaire (IPAQ) score and intake of “negative foods” predicted 6% of the variance in EDSS (p < 0.001), while the model including smoking pack/year and IPAQ score predicted 4% of the variance in FSS (p < 0.001). Conclusions We identified a sufficient adherence to MeDi in our population. PwMS showed overall a healthier dietary pattern than HC. Vegetables and fish intake were associated with disability outcomes. Future longitudinal studies applying integrated approaches are needed to understand lifestyle added value to the use of standard pharmacological therapies.
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Affiliation(s)
| | - Silvia Tommasin
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- Neuroimmunology Unit, IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Maria Petracca
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Laura De Giglio
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Flavia Gurreri
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Antonio Ianniello
- MS Center, Sant'Andrea Hospital, Rome, Italy
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | - Carlo Pozzilli
- MS Center, Sant'Andrea Hospital, Rome, Italy
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Serena Ruggieri
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- Neuroimmunology Unit, IRCSS Fondazione Santa Lucia, Rome, Italy
- *Correspondence: Serena Ruggieri
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Ketogenic and Modified Mediterranean Diet as a Tool to Counteract Neuroinflammation in Multiple Sclerosis: Nutritional Suggestions. Nutrients 2022; 14:nu14122384. [PMID: 35745113 PMCID: PMC9229939 DOI: 10.3390/nu14122384] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/26/2022] [Accepted: 05/30/2022] [Indexed: 12/13/2022] Open
Abstract
Ketogenic Diet is a nutritional pattern often used as dietotherapy in inflammatory diseases, including neurological disorders. Applied on epileptic children since 1920, in recent years it has been taken into account again as a tool to both reduce inflammatory burdens and ameliorate the nutritional status of patients affected by different pathologies. Multiple sclerosis (MS) is considered an immune-mediated neuro-inflammatory disease and diet is a possible factor in its pathogenesis. The aim of this work is to investigate the main potential targets of MS-related impairments, in particular the cognitive deficits, focusing on the alteration of biomarkers such as the Brain Derived-Neurotrophic Factor and the Tryptophan/Kynurenine ratio that could play a role on neuroprotection and thus on MS progression. Furthermore, we here propose nutritional suggestions which are useful in the development of a ketogenic diet protocol that takes advantage of the anti-inflammatory properties of low-carbohydrate foods from the Mediterranean diet to be applied to subjects with MS. In conclusion, this approach will allow one to develop the ketogenic diet combined with a modified Mediterranean diet as a possible tool to improve neuroinflammation in multiple sclerosis.
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Cognitive Decline in Older People with Multiple Sclerosis—A Narrative Review of the Literature. Geriatrics (Basel) 2022; 7:geriatrics7030061. [PMID: 35735766 PMCID: PMC9223056 DOI: 10.3390/geriatrics7030061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/02/2022] [Accepted: 06/02/2022] [Indexed: 12/04/2022] Open
Abstract
Several important questions regarding cognitive aging and dementia in older people with multiple sclerosis (PwMS) are the focus of this narrative review: Do older PwMS have worse cognitive decline compared to older people without MS? Can older PwMS develop dementia or other neurodegenerative diseases such as Alzheimer’s disease (AD) that may be accelerated due to MS? Are there any potential biomarkers that can help to determine the etiology of cognitive decline in older PwMS? What are the neural and cellular bases of cognitive aging and neurodegeneration in MS? Current evidence suggests that cognitive impairment in MS is distinguishable from that due to other neurodegenerative diseases, although older PwMS may present with accelerated cognitive decline. While dementia is prevalent in PwMS, there is currently no consensus on defining it. Cerebrospinal fluid and imaging biomarkers have the potential to identify disease processes linked to MS and other comorbidities—such as AD and vascular disease—in older PwMS, although more research is required. In conclusion, one should be aware that multiple underlying pathologies can coexist in older PwMS and cause cognitive decline. Future basic and clinical research will need to consider these complex factors to better understand the underlying pathophysiology, and to improve diagnostic accuracy.
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Lind J, Persson S, Vincent J, Lindenfalk B, Oliver BJ, Smith AD, Andersson Gäre B. Contact patterns and costs of multiple sclerosis in the Swedish healthcare system-A population-based quantitative study. Brain Behav 2022; 12:e2582. [PMID: 35511113 PMCID: PMC9226803 DOI: 10.1002/brb3.2582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/11/2022] [Accepted: 03/25/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The burden of disease for persons with multiple sclerosis (MS) and society is changing due to new treatments. Knowledge about the total need for care is necessary in relation to changing needs and new service models. OBJECTIVE The aim of this study was to describe the contact patterns for MS patients, calculate costs in health care, and create meaningful subgroups to analyze contact patterns. METHODS All patients diagnosed with MS at Ryhov Hospital were included. All contacts in the region from January 1, 2018, until September 30, 2019, were retrieved from the hospital administrative system. Data about age, sex, contacts, and diagnosis were registered. The cost was calculated using case costing, and costs for prescriptions were calculated from medical files. RESULTS During the 21-month period, patients (n = 305) had 9628 contacts and 7471 physical visits, with a total cost of $7,766,109. Seventeen percent of the patients accounted for 48% of the visits. The median annual cost was $7386 in the group with 10 or fewer visits, compared to $22,491 in patients with more than 50 visits. CONCLUSION There are considerable differences in the utilization of care and cost between patients with MS in an unselected population, meaning that the care needs to be better customized to each patient's demands.
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Affiliation(s)
- Jonas Lind
- Section of Neurology, Department of Internal Medicine, County Hospital Ryhov, Jönköping, Sweden.,Division of Neurobiology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Sofia Persson
- Department of Public Health and Health Care, Region Jönköping County, Jönköping, Sweden.,Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Jonatan Vincent
- Department of Public Health and Health Care, Region Jönköping County, Jönköping, Sweden
| | - Bertil Lindenfalk
- Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Brant J Oliver
- Departments of Community and Family Medicine, Psychiatry, and the Dartmouth Institute for Health Policy and Clinical Practice at the Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire, USA
| | - Andrew D Smith
- Multiple Sclerosis Center, Dartmouth-Hitchcock Medical Center and Geisel School of Medicine Dartmouth College, Lebanon, New Hampshire, USA
| | - Boel Andersson Gäre
- Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping and Futurum, Region Jönköping County, Sweden
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Titcomb TJ, Bao W, Du Y, Liu B, Snetselaar LG, Wahls TL. Association of multiple sclerosis with risk of mortality among a nationally representative sample of adults in the United States. Mult Scler J Exp Transl Clin 2022; 8:20552173221104009. [PMID: 35665135 PMCID: PMC9158421 DOI: 10.1177/20552173221104009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/12/2022] [Indexed: 11/16/2022] Open
Abstract
Background Multiple sclerosis (MS) has been associated with increased mortality ratios, but few studies have investigated the independent association of MS with mortality. Objective To examine the prospective association of MS with risk of mortality in a nationally representative sample of U.S. adults. Methods This prospective study included 23,053 adults aged 45–79 years who participated in the National Health Interview Survey in 2002 and 2008. Physician-diagnosed MS was reported by participants during household interviews. These participants were linked to death records from survey date through December 31, 2015. Results Among the 23,053 participants included in this study, 120 reported a physician’s diagnosis of MS, with a higher prevalence in females (0.85%) than in males (0.31%). During on average 9.4 years (maximum 13.8 years) of observation, 4208 deaths occurred. After adjustment for age, sex, race/ethnicity, socioeconomic factors, lifestyle factors, and BMI, participants with MS had an 80% higher risk of mortality (HR 1.80; 95% CI, 1.11–2.92), compared with those without MS. The association remained significant (HR 1.75; 95% CI, 1.07–2.87) after further adjustment for baseline diabetes, cardiovascular disease, chronic lung disease, and cancer. Conclusion In this nationally representative sample of U.S. adults, MS was associated with an increased risk of mortality.
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Affiliation(s)
- Tyler J. Titcomb
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Wei Bao
- Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Yang Du
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Buyun Liu
- Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Linda G. Snetselaar
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Terry L. Wahls
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
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Marrie RA, Patel R, Figley CR, Kornelsen J, Bolton JM, Graff LA, Mazerolle EL, Helmick C, Uddin MN, Figley TD, Marriott JJ, Bernstein CN, Fisk JD. Effects of Vascular Comorbidity on Cognition in Multiple Sclerosis Are Partially Mediated by Changes in Brain Structure. Front Neurol 2022; 13:910014. [PMID: 35685743 PMCID: PMC9170886 DOI: 10.3389/fneur.2022.910014] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/03/2022] [Indexed: 01/09/2023] Open
Abstract
ObjectiveVascular comorbidities are associated with reduced cognitive performance and with changes in brain structure in people with multiple sclerosis (MS). Understanding causal pathways is necessary to support the design of interventions to mitigate the impacts of comorbidities, and to monitor their effectiveness. We assessed the inter-relationships among vascular comorbidity, cognition and brain structure in people with MS.MethodsAdults with neurologist-confirmed MS reported comorbidities, and underwent assessment of their blood pressure, HbA1c, and cognitive functioning (i.e., Symbol Digit Modalities Test, California Verbal Learning Test, Brief Visuospatial Memory Test-Revised, and verbal fluency). Test scores were converted to age-, sex-, and education-adjusted z-scores. Whole brain magnetic resonance imaging (MRI) was completed, from which measures of thalamic and hippocampal volumes, and mean diffusivity of gray matter and normal-appearing white matter were converted to age and sex-adjusted z-scores. Canonical correlation analysis was used to identify linear combinations of cognitive measures (cognitive variate) and MRI measures (MRI variate) that accounted for the most correlation between the cognitive and MRI measures. Regression analyses were used to test whether MRI measures mediated the relationships between the number of vascular comorbidities and cognition measures.ResultsOf 105 participants, most were women (84.8%) with a mean (SD) age of 51.8 (12.8) years and age of symptom onset of 29.4 (10.5) years. Vascular comorbidity was common, with 35.2% of participants reporting one, 15.2% reporting two, and 8.6% reporting three or more. Canonical correlation analysis of the cognitive and MRI variables identified one pair of variates (Pillai's trace = 0.45, p = 0.0035). The biggest contributors to the cognitive variate were the SDMT and CVLT-II, and to the MRI variate were gray matter MD and thalamic volume. The correlation between cognitive and MRI variates was 0.50; these variates were used in regression analyses. On regression analysis, vascular comorbidity was associated with the MRI variate, and with the cognitive variate. After adjusting for the MRI variate, vascular comorbidity was not associated with the cognitive variate.ConclusionVascular comorbidity is associated with lower cognitive function in people with MS and this association is partially mediated via changes in brain macrostructure and microstructure.
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Affiliation(s)
- Ruth Ann Marrie
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- *Correspondence: Ruth Ann Marrie
| | - Ronak Patel
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Chase R. Figley
- Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Division of Diagnostic Imaging, Winnipeg Health Sciences Centre, Winnipeg, MB, Canada
- Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Winnipeg Health Sciences Centre, Winnipeg, MB, Canada
| | - Jennifer Kornelsen
- Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Division of Diagnostic Imaging, Winnipeg Health Sciences Centre, Winnipeg, MB, Canada
- Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Winnipeg Health Sciences Centre, Winnipeg, MB, Canada
| | - James M. Bolton
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Lesley A. Graff
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Erin L. Mazerolle
- Department of Psychology, St. Francis Xavier University, Antigonish, NS, Canada
| | - Carl Helmick
- Department of Psychiatry and Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
| | - Md Nasir Uddin
- Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Neurology, University of Rochester, Rochester, New York, NY, United States
| | - Teresa D. Figley
- Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - James J. Marriott
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Charles N. Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - John D. Fisk
- Nova Scotia Health and the Departments of Psychiatry, Psychology & Neuroscience, and Medicine, Dalhousie University, Halifax, NS, Canada
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Dietary Patterns and Metabolic Disorders in Polish Adults with Multiple Sclerosis. Nutrients 2022; 14:nu14091927. [PMID: 35565893 PMCID: PMC9104558 DOI: 10.3390/nu14091927] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 04/30/2022] [Accepted: 04/30/2022] [Indexed: 02/04/2023] Open
Abstract
Diet plays a major role in the aetiopathogenesis of many neurological diseases and may exacerbate their symptoms by inducing the occurrence of metabolic disorders. The results of research on the role of diet in the course of multiple sclerosis (MS) are ambiguous, and there is still no consensus concerning dietary recommendations for patients with MS. The aim of this study was to analyse the dietary patterns (DPs) of patients with MS and to assess the relationships between these DPs and the metabolic disorders. The study participants were comprised of 330 patients aged 41.9 ± 10.8 years. A survey questionnaire was used to collect data related to diet, lifestyle and health. The DPs were identified using a principal component analysis (PCA). Three DPs were identified: Traditional Polish, Prudent and Fast Food & Convenience Food. An analysis of the odds ratios adjusted for age, gender, smoking and education showed that a patient’s adherence to the Traditional Polish and the Fast Food & Convenience Food DPs increased the likelihood of abdominal obesity and low HDL-cholesterol concentration. Conversely, adherence to the Prudent DP was not significantly associated with any metabolic disorder. The results of this study confirmed that an unhealthy diet in patients with MS is connected with the presence of some metabolic risk factors. There is also an urgent need to educate patients with MS on healthy eating, because the appropriate modifications to their diet may improve their metabolic profile and clinical outcomes.
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Mirabella M, Annovazzi P, Brownlee W, Cohen JA, Kleinschnitz C, Wolf C. Treatment Challenges in Multiple Sclerosis – A Continued Role for Glatiramer Acetate? Front Neurol 2022; 13:844873. [PMID: 35493825 PMCID: PMC9051342 DOI: 10.3389/fneur.2022.844873] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/09/2022] [Indexed: 12/14/2022] Open
Abstract
Earlier diagnosis, access to disease-modifying therapies (DMTs), and improved supportive care have favorably altered the disease course of multiple sclerosis (MS), leading to an improvement in long-term outcomes for people with MS (PwMS). This success has changed the medical characteristics of the population seen in MS clinics. Comorbidities and the accompanying polypharmacy, immune senescence, and the growing number of approved DMTs make selecting the optimal agent for an individual patient more challenging. Glatiramer acetate (GA), a moderately effective DMT, interacts only minimally with comorbidities, other medications, or immune senescence. We describe here several populations in which GA may represent a useful treatment option to overcome challenges due to advanced age or comorbidities (e.g., hepatic or renal disease, cancer). Further, we weigh GA's potential merits in other settings where PwMS and their neurologists must base treatment decisions on factors other than selecting the most effective DMT, e.g., family planning, conception and pregnancy, or the need for vaccination.
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Affiliation(s)
- Massimiliano Mirabella
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
- Centro di Ricerca Sclerosi Multipla (CERSM), Università Cattolica, Rome, Italy
- *Correspondence: Massimiliano Mirabella ; orcid.org/0000-0002-7783-114X
| | - Pietro Annovazzi
- MS Center, ASST Valle Olona, Gallarate Hospital, Gallarate, Italy
| | - Wallace Brownlee
- Queen Square MS Centre, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Jeffrey A. Cohen
- Department of Neurology, Mellen Center, Neurologic Institute, Cleveland Clinic, Cleveland, OH, United States
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Russell RD, Black LJ, Begley A. Nutrition Education Programs for Adults with Neurological Diseases Are Lacking: A Scoping Review. Nutrients 2022; 14:nu14081577. [PMID: 35458139 PMCID: PMC9030740 DOI: 10.3390/nu14081577] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/05/2022] [Accepted: 04/08/2022] [Indexed: 12/04/2022] Open
Abstract
The nutrition recommendation for most common neurological diseases is to follow national dietary guidelines. This is to mitigate malnutrition, reduce the risk of diet-related diseases, and to help manage some common symptoms, including constipation. Nutrition education programs can support people in adhering to guidelines; hence the aim of this scoping review was to explore what programs have been implemented for adults with neurological diseases. We conducted this review according to a published a priori protocol. From 2555 articles screened, 13 were included (dementia n = 6; multiple sclerosis n = 4; stroke survivors n = 2; Parkinson’s n = 1). There were no programs for epilepsy, Huntington’s, and motor neurone disease. Program duration and number of sessions varied widely; however, weekly delivery was most common. Just over half were delivered by dietitians. Most did not report using a behavior change theory. Commonly used behavior change techniques were instruction on how to perform a behavior, credible source, and behavioral practice/rehearsal. Evidence of nutrition education programs for adults with neurological diseases is lacking. Of those that are published, many do not meet best practice principles for nutrition education regarding delivery, educator characteristics, and evaluation. More programs aligning with best practice principles are needed to assess characteristics that lead to behavior change.
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Affiliation(s)
- Rebecca D. Russell
- Curtin School of Population Health, Curtin University, Perth, WA 6102, Australia; (R.D.R.); (L.J.B.)
| | - Lucinda J. Black
- Curtin School of Population Health, Curtin University, Perth, WA 6102, Australia; (R.D.R.); (L.J.B.)
- Curtin Health Innovation Research Institute, Curtin University, Perth, WA 6102, Australia
| | - Andrea Begley
- Curtin School of Population Health, Curtin University, Perth, WA 6102, Australia; (R.D.R.); (L.J.B.)
- Correspondence: ; Tel.: +61-8-9266-2773
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Barbieri MA, Sorbara EE, Battaglia A, Cicala G, Rizzo V, Spina E, Cutroneo PM. Adverse Drug Reactions with Drugs Used in Multiple Sclerosis: An Analysis from the Italian Pharmacovigilance Database. Front Pharmacol 2022; 13:808370. [PMID: 35281926 PMCID: PMC8904918 DOI: 10.3389/fphar.2022.808370] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/10/2022] [Indexed: 12/14/2022] Open
Abstract
Given the importance of inflammation at the onset of multiple sclerosis (MS), therapy is mainly based on the use of anti-inflammatory drugs including disease modifying therapies (DMTs). Considering the recent approval of some DMTs, pharmacovigilance becomes a fundamental tool for the acquisition of new safety data. The aim of the study was to analyze adverse drug reactions (ADRs) related to the use of drugs approved for MS. All national publicly-available aggregated ADR reports recorded from 2002 to 2020 into the Reports of Adverse Reactions of Medicines (RAM) system and all complete Sicilian data reported into the Italian spontaneous reporting system (SRS) database having as suspected drugs interferon β-1a (IFN β-1a), interferon β-1b (IFN β-1b), peginterferon β-1a (PEG-IFN β-1a), glatiramer acetate (GA), natalizumab (NTZ), fingolimod (FNG), teriflunomide (TRF), dimethyl fumarate (DMF), alemtuzumab (Alem), ocrelizumab (OCZ), or cladribine (Cladr), were collected. Descriptive analyses of national, publicly-available aggregated data and full-access regional data were performed to assess demographic characteristics and drug-related variables followed by a more in-depth analysis of all Sicilian ADRs with a case-by-case assessment and a disproportionality analysis of unexpected ADRs. A total of 13,880 national reports have been collected from 2002 to 2020: they were mainly not serious ADRs (67.9% vs. 26.1%) and related to females (71.7% vs. 26.3%) in the age group 18–65 years (76.5%). The most reported ADRs were general and administration site conditions (n = 6,565; 47.3%), followed by nervous (n = 3,090; 22.3%), skin (n = 2,763; 19.9%) and blood disorders (n = 2,180; 15.7%). Some unexpected Sicilian ADRs were shown, including dyslipidemia for FNG (n = 10; ROR 28.5, CI 14.3–59.6), NTZ (n = 5; 10.3, 4.1–25.8), and IFN β-1a (n = 4; 8.7, 3.1–24.1), abortion and alopecia for NTZ (n = 9; 208.1, 73.4–590.1; n = 3; 4.9, 1.5–15.7), and vitamin D deficiency for GA (n = 3; 121.2, 30.9–475.3). Moreover, breast cancer with DMF (n = 4, 62.8, 20.5–191.9) and hypothyroidism with Cladr (n = 3; 89.2, 25.9–307.5) were also unexpected. The reporting of drugs-related ADRs in MS were mostly reported in the literature, but some unknown ADRs were also found. However, further studies are necessary to increase the awareness about the safety profiles of new drugs on the market.
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Affiliation(s)
| | | | - Alessandro Battaglia
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giuseppe Cicala
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Vincenzo Rizzo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Edoardo Spina
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Paola Maria Cutroneo
- Sicilian Regional Pharmacovigilance Centre, University Hospital of Messina, Messina, Italy
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Buscarinu MC, Reniè R, Morena E, Romano C, Bellucci G, Marrone A, Bigi R, Salvetti M, Ristori G. Late-Onset MS: Disease Course and Safety-Efficacy of DMTS. Front Neurol 2022; 13:829331. [PMID: 35356454 PMCID: PMC8960027 DOI: 10.3389/fneur.2022.829331] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 01/24/2022] [Indexed: 11/13/2022] Open
Abstract
Multiple sclerosis (MS), an inflammatory demyelinating and neurodegenerative disease of the central nervous system, usually begins between the ages of 20 and 49 years, though in rare cases it is diagnosed in childhood and adolescence before the age of 18 years, or at the age of 50 years and later. When the onset of the disease occurs at 50 years or older it is conventionally defined as late onset MS (LOMS). Compared to classical MS, the LOMS is characterized by progressive course, a greater delay in diagnosis and a higher prevalence of motor disability. The older the patients, the greater is the risk of comorbidities that can negatively influence the course of the disease and can limit therapeutic strategies. To date, there is no study focused on the efficacy of Disease Modifying Therapies (DMT) in older patients with MS. The only data available are retrievable from subgroup analysis from phase-3 trials of DMT efficacy. In this work, we discuss how the aging process influences the onset, the clinical course and the therapeutic approach in LOMS.
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Affiliation(s)
- Maria Chiara Buscarinu
- Department of Neuroscience, Mental Health, and Sensory Organs, Sapienza University, Rome, Italy
- Neuroimmunology Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Roberta Reniè
- Department of Clinical-Experimental Neuroscience and Psychiatry, Sapienza University, Rome, Italy
| | - Emanuele Morena
- Department of Neuroscience, Mental Health, and Sensory Organs, Sapienza University, Rome, Italy
| | - Carmela Romano
- Department of Clinical-Experimental Neuroscience and Psychiatry, Sapienza University, Rome, Italy
| | - Gianmarco Bellucci
- Department of Neuroscience, Mental Health, and Sensory Organs, Sapienza University, Rome, Italy
| | - Antonio Marrone
- Department of Neuroscience, Mental Health, and Sensory Organs, Sapienza University, Rome, Italy
| | - Rachele Bigi
- Department of Neuroscience, Mental Health, and Sensory Organs, Sapienza University, Rome, Italy
| | - Marco Salvetti
- Department of Neuroscience, Mental Health, and Sensory Organs, Sapienza University, Rome, Italy
- IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed, Pozzilli, Italy
- *Correspondence: Marco Salvetti
| | - Giovanni Ristori
- Department of Neuroscience, Mental Health, and Sensory Organs, Sapienza University, Rome, Italy
- Neuroimmunology Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
- Giovanni Ristori
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Bachmann P, Frahm N, Debus JL, Mashhadiakbar P, Langhorst SE, Streckenbach B, Baldt J, Heidler F, Hecker M, Zettl UK. Prevalence and Severity of Potential Drug–Drug Interactions in Patients with Multiple Sclerosis with and without Polypharmacy. Pharmaceutics 2022; 14:pharmaceutics14030592. [PMID: 35335968 PMCID: PMC8949310 DOI: 10.3390/pharmaceutics14030592] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/01/2022] [Accepted: 03/04/2022] [Indexed: 02/01/2023] Open
Abstract
Polypharmacy (PP) is a common problem in modern medicine, especially known to affect patients with chronic diseases such as multiple sclerosis (MS). With an increasing number of drugs taken, the risk of potential drug–drug interactions (pDDIs) is rising. This study aims to assess the prevalence and clinical relevance of polypharmacy and pDDIs in patients with MS. Pharmacological data of 627 patients with MS were entered into two drug–drug-interaction databases to determine the number and severity of pDDIs for each patient. The patients were divided into those with and without PP (total PP and prescription medication PP (Rx PP)). Of the 627 patients included, 53.3% and 38.6% had total PP and Rx PP, respectively. On average, every patient took 5.3 drugs. Of all patients, 63.8% had at least one pDDI with a mean of 4.6 pDDIs per patient. Less than 4% of all pDDIs were moderately severe or severe. Medication schedules should be checked for inappropriate medication and for possible interacting drugs to prevent pDDIs. Physicians as well as pharmacists should be more sensitive towards the relevance of pDDIs and know how they can be detected and avoided.
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Affiliation(s)
- Paula Bachmann
- Section of Neuroimmunology, Department of Neurology, Rostock University Medical Center, Gehlsheimer Str. 20, 18147 Rostock, Germany; (N.F.); (J.L.D.); (P.M.); (S.E.L.); (B.S.); (J.B.); (M.H.); (U.K.Z.)
- Correspondence: ; Tel.: +49-3814949517
| | - Niklas Frahm
- Section of Neuroimmunology, Department of Neurology, Rostock University Medical Center, Gehlsheimer Str. 20, 18147 Rostock, Germany; (N.F.); (J.L.D.); (P.M.); (S.E.L.); (B.S.); (J.B.); (M.H.); (U.K.Z.)
| | - Jane Louisa Debus
- Section of Neuroimmunology, Department of Neurology, Rostock University Medical Center, Gehlsheimer Str. 20, 18147 Rostock, Germany; (N.F.); (J.L.D.); (P.M.); (S.E.L.); (B.S.); (J.B.); (M.H.); (U.K.Z.)
| | - Pegah Mashhadiakbar
- Section of Neuroimmunology, Department of Neurology, Rostock University Medical Center, Gehlsheimer Str. 20, 18147 Rostock, Germany; (N.F.); (J.L.D.); (P.M.); (S.E.L.); (B.S.); (J.B.); (M.H.); (U.K.Z.)
| | - Silvan Elias Langhorst
- Section of Neuroimmunology, Department of Neurology, Rostock University Medical Center, Gehlsheimer Str. 20, 18147 Rostock, Germany; (N.F.); (J.L.D.); (P.M.); (S.E.L.); (B.S.); (J.B.); (M.H.); (U.K.Z.)
| | - Barbara Streckenbach
- Section of Neuroimmunology, Department of Neurology, Rostock University Medical Center, Gehlsheimer Str. 20, 18147 Rostock, Germany; (N.F.); (J.L.D.); (P.M.); (S.E.L.); (B.S.); (J.B.); (M.H.); (U.K.Z.)
- Ecumenic Hainich Hospital Mühlhausen, Pfafferode 102, 99974 Mühlhausen, Germany;
| | - Julia Baldt
- Section of Neuroimmunology, Department of Neurology, Rostock University Medical Center, Gehlsheimer Str. 20, 18147 Rostock, Germany; (N.F.); (J.L.D.); (P.M.); (S.E.L.); (B.S.); (J.B.); (M.H.); (U.K.Z.)
- Ecumenic Hainich Hospital Mühlhausen, Pfafferode 102, 99974 Mühlhausen, Germany;
| | - Felicita Heidler
- Ecumenic Hainich Hospital Mühlhausen, Pfafferode 102, 99974 Mühlhausen, Germany;
| | - Michael Hecker
- Section of Neuroimmunology, Department of Neurology, Rostock University Medical Center, Gehlsheimer Str. 20, 18147 Rostock, Germany; (N.F.); (J.L.D.); (P.M.); (S.E.L.); (B.S.); (J.B.); (M.H.); (U.K.Z.)
| | - Uwe Klaus Zettl
- Section of Neuroimmunology, Department of Neurology, Rostock University Medical Center, Gehlsheimer Str. 20, 18147 Rostock, Germany; (N.F.); (J.L.D.); (P.M.); (S.E.L.); (B.S.); (J.B.); (M.H.); (U.K.Z.)
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Huynh T, Jeng B, Motl RW. Physical activity and vascular comorbidity in black and white persons with multiple sclerosis: A cross-sectional study. Disabil Health J 2022; 15:101314. [DOI: 10.1016/j.dhjo.2022.101314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 11/29/2022]
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Kołtuniuk A, Chojdak-Łukasiewicz J. Adherence to Therapy in Patients with Multiple Sclerosis-Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042203. [PMID: 35206387 PMCID: PMC8872308 DOI: 10.3390/ijerph19042203] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/27/2022] [Accepted: 02/12/2022] [Indexed: 12/04/2022]
Abstract
Multiple sclerosis (MS) is a chronic, autoimmune, demyelinating disease of the central nervous system (CNS). MS is an incurable disease. The goal of disease-modifying therapies (DMT) is to slow the progression of the disease, prevent relapses and increase the patient’s overall quality of life. According to the World Health Organisation definition, adherence means the extent to which a person’s medication-taking behaviour corresponds with the agreed upon treatment recommendations from a healthcare provider. Accurate adherence is necessary for efficient treatment. Non-adherence is related to unsuccessful treatments, the risk of relapses and increased healthcare costs. The aim of this study is to present the main factors relating to non-adherence in MS patients.
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Affiliation(s)
- Aleksandra Kołtuniuk
- Division of Internal Medicine Nursing, Faculty of Health Sciences, Wroclaw Medical University, Bartla 5, 51-618 Wroclaw, Poland;
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Peterson MD, Lin P, Kamdar N, Marsack-Topolewski CN, Mahmoudi E. Physical and Mental Health Comorbidities Among Adults With Multiple Sclerosis. Mayo Clin Proc Innov Qual Outcomes 2022; 6:55-68. [PMID: 35005438 PMCID: PMC8715377 DOI: 10.1016/j.mayocpiqo.2021.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To compare the incidence of and adjusted hazard ratios for common cardiometabolic diseases, musculoskeletal disorders, and psychological morbidities among adults with and without multiple sclerosis (MS). PATIENTS AND METHODS Beneficiaries were included if they had an International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic code for MS (n=9815) from a national private insurance claims database (Clinformatics Data Mart; OptumInsight). Adults without MS were also included (n=1,474,232) as a control group. Incidence estimates of common cardiometabolic diseases, musculoskeletal disorders, and psychological morbidities were compared at 5 years of continuous enrollment. Survival models were used to quantify unadjusted and adjusted hazard ratios for incident morbidities. RESULTS Adults with MS had a higher incidence of any common cardiometabolic disease (51.6% [2663 of 5164] vs 36.4% [328,690 of 904,227]), musculoskeletal disorder (68.8% [3411 of 4959] vs 47.5% [512,422 of 1,077,737]), and psychological morbidity (49.4% [3305 of 6691] vs 30.8% [380,893 of 1,235,388]) than adults without MS, and differences were clinically meaningful (all P<.001). Fully adjusted survival models revealed that adults with MS had a greater risk for any (hazard ratio [HR], 1.37; 95% CI, 1.32 to 1.43) and all (HR, 1.19 to 1.48) common cardiometabolic diseases, any (HR, 1.59; 95% CI, 1.53 to 1.64) and all (HR, 1.22 to 2.77) musculoskeletal disorders, and any (HR, 1.57; 95% CI, 1.51 to 1.62) and all (HR, 1.20 to 2.51) but one (impulse control disorders) psychological morbidity. CONCLUSION Adults with MS have a significantly higher risk for development of common cardiometabolic diseases, musculoskeletal disorders, and psychological morbidities (all P<.001) than adults without MS. Efforts are needed to facilitate the development of improved clinical screening algorithms and early interventions to reduce risk of chronic physical and mental disease onset/progression in this higher risk population.
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Affiliation(s)
- Mark D. Peterson
- Department of Physical Medicine and Rehabilitation
- Institute for Healthcare Policy and Innovation
| | - Paul Lin
- Institute for Healthcare Policy and Innovation
| | - Neil Kamdar
- Institute for Healthcare Policy and Innovation
- Department of Obstetrics and Gynecology
- Department of Emergency Medicine
- Department of Surgery
| | | | - Elham Mahmoudi
- Institute for Healthcare Policy and Innovation
- Department of Family Medicine, Michigan Medicine, University of Michigan, Ann Arbor
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Schoedel KA, Kolly C, Gardin A, Neelakantham S, Shakeri-Nejad K. Abuse and dependence potential of sphingosine-1-phosphate (S1P) receptor modulators used in the treatment of multiple sclerosis: a review of literature and public data. Psychopharmacology (Berl) 2022; 239:1-13. [PMID: 34773483 PMCID: PMC8770388 DOI: 10.1007/s00213-021-06011-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 10/18/2021] [Indexed: 12/05/2022]
Abstract
Abuse and misuse of prescription drugs remains an ongoing concern in the USA and worldwide; thus, all centrally active new drugs must be assessed for abuse and dependence potential. Sphingosine-1-phosphate (S1P) receptor modulators are used primarily in the treatment of multiple sclerosis. Among the new S1P receptor modulators, siponimod, ozanimod, and ponesimod have recently been approved in the USA, European Union (EU), and other countries. This review of literature and other public data has been undertaken to assess the potential for abuse of S1P receptor modulators, including ozanimod, siponimod, ponesimod, and fingolimod, as well as several similar compounds in development. The S1P receptor modulators have not shown chemical or pharmacological similarity to known drugs of abuse; have not shown abuse or dependence potential in animal models for subjective effects, reinforcement, or physical dependence; and do not have adverse event profiles demonstrating effects of interest to individuals who abuse drugs (such as sedative, stimulant, mood-elevating, or hallucinogenic effects). In addition, no reports of actual abuse, misuse, or dependence were identified in the scientific literature for fingolimod, which has been on the market since 2010 (USA) and 2011 (EU). Overall, the data suggest that S1P receptor modulators are not associated with significant potential for abuse or dependence, consistent with their unscheduled status in the USA and internationally.
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Affiliation(s)
| | - Carine Kolly
- grid.419481.10000 0001 1515 9979Novartis Institutes for Biomedical Research, Novartis Pharma AG, Basel, Switzerland
| | - Anne Gardin
- grid.419481.10000 0001 1515 9979Novartis Institutes for Biomedical Research, Novartis Pharma AG, Basel, Switzerland
| | - Srikanth Neelakantham
- grid.464975.d0000 0004 0405 8189Novartis Institutes for Biomedical Research, Novartis Healthcare Pvt Ltd, Hyderabad, India
| | - Kasra Shakeri-Nejad
- grid.419481.10000 0001 1515 9979Novartis Institutes for Biomedical Research, Novartis Pharma AG, Basel, Switzerland
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75
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Diržiuvienė B, Mickevičienė D. Comorbidity in Multiple Sclerosis: Emphasis on Patient-Reported Outcomes. Mult Scler Relat Disord 2022; 59:103558. [DOI: 10.1016/j.msard.2022.103558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/12/2022] [Accepted: 01/22/2022] [Indexed: 11/28/2022]
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Hynes SM, O'Keeffe F, Bane E, Oglesby MH, Dwyer CP, Joyce R, Klein OA. Assessment and Management of Cognitive and Psychosocial Difficulties for People with Multiple Sclerosis in Ireland: A National Survey of Clinical Practice. Int J Clin Pract 2022; 2022:3232076. [PMID: 36340964 PMCID: PMC9616662 DOI: 10.1155/2022/3232076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/28/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND A recent survey of 109 healthcare professionals explored how UK healthcare professionals typically assess and treat multiple sclerosis (MS)-related cognitive impairment. Little is currently known about what constitutes usual care for cognitive impairment and psychosocial care for people with MS in Ireland. AIM The aim of the current research was to survey healthcare professionals (HCPs) who work with people with MS, to understand current assessment and management of cognition and psychosocial care in people with MS in the Republic of Ireland. METHODS A cross-sectional survey design was used. Data were collected online through Microsoft forms and through postal responses. The original UK questionnaire was adapted, piloted, and distributed to Irish HCPs. Participants were qualified HCPs who work clinically with people with MS in the Republic of Ireland. RESULTS Ninety-eight HCPs completed the survey. Only 34% of those surveyed reported routine screening of cognition for people with MS within their services; approximately, 36% HCPs reported that they did not provide information or services in relation to cognition to people with MS and 39% reported not referring elsewhere when cognitive difficulties were suspected. Out of the 98 HCPs, 47% reported assessing mood difficulties as part of their services, with 14% unsure. In total, 70% of participants reported onward referral took place if mood difficulties were identified. The Montreal Cognitive Assessment was the most commonly administrated cognitive assessment. Cognitive intervention choices were found to be guided by clinical judgement in 75.5% of cases. Discussion. Despite the high importance placed on cognitive and psychosocial care, there is very little consistency in treatment and assessment across services for people with MS in Ireland.
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Affiliation(s)
- Sinéad M. Hynes
- Discipline of Occupational Therapy, School of Health Sciences, National University of Ireland Galway, Galway, Ireland
| | | | - Eimear Bane
- Discipline of Occupational Therapy, School of Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Megan H. Oglesby
- Discipline of Occupational Therapy, School of Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Christopher P. Dwyer
- School of Social Science, Technological University of the Shannon IE, Athlone, Ireland
| | - Robert Joyce
- Discipline of Occupational Therapy, School of Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Olga A. Klein
- German Center for Neurodegenerative Diseases, Rostock, DE, Germany
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77
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Maric G, Pekmezovic T, Tamas O, Veselinovic N, Jovanovic A, Lalic K, Mesaros S, Drulovic J. Impact of comorbidities on the disability progression in multiple sclerosis. Acta Neurol Scand 2022; 145:24-29. [PMID: 34414566 DOI: 10.1111/ane.13516] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/23/2021] [Accepted: 08/05/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Investigation of the comorbidity burden in persons with multiple sclerosis (PwMS) has become increasingly important. The aim of this study was to investigate the relationships of cardiovascular disease (CVD) comorbidities and type 2 diabetes with the disability progression. MATERIALS & METHODS The retrospective cohort study was conducted at the Clinic of Neurology, Belgrade. The Belgrade MS population Registry, which comprises 2725 active MS cases, was used as the source of data. The mean duration of the disease was 21.6 ± 12.5 years. Expanded Disability Status Scale (EDSS) was followed in all PwMS in the Registry. In the statistical analysis, the Cox proportional hazard regression analysis and Kaplan-Meier curve were performed. RESULTS Hypertension statistically significantly contributed to more rapid reaching investigated levels of irreversible disability (EDSS 4.0, 6.0, and 7.0), while the presence of any of the investigated CVD comorbidities and type 2 diabetes significantly contributed to faster reaching EDSS 4.0 and EDSS 6.0. In a multivariable model, progression index (PI) was singled out (HR = 3.171, p < .001), indicating that higher progression index (PI) was an independent predictor of CVD occurrence in MS patients. In the case of type 2 diabetes, PI (p < .001) and MS phenotype (p = .015) were statistically significant in multivariable Cox regression analysis. CONCLUSIONS Our study confirms the impact of CVD comorbidities and type 2 diabetes in MS on the progression of disability as measured by EDSS in the large cohort of PwMS from the population Registry.
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Affiliation(s)
- Gorica Maric
- Faculty of Medicine Institute of Epidemiology University of Belgrade Belgrade Serbia
| | - Tatjana Pekmezovic
- Faculty of Medicine Institute of Epidemiology University of Belgrade Belgrade Serbia
| | - Olivera Tamas
- Faculty of Medicine University of Belgrade Belgrade Serbia
- Clinic of Neurology Clinical Center of Serbia Belgrade Serbia
| | - Nikola Veselinovic
- Faculty of Medicine University of Belgrade Belgrade Serbia
- Clinic of Neurology Clinical Center of Serbia Belgrade Serbia
| | - Aleksa Jovanovic
- Faculty of Medicine Institute of Epidemiology University of Belgrade Belgrade Serbia
| | - Katarina Lalic
- Faculty of Medicine University of Belgrade Belgrade Serbia
- Clinic of Endocrinology, Diabetes and Metabolic Diseases Clinical Center of Serbia Belgrade Serbia
| | - Sarlota Mesaros
- Faculty of Medicine University of Belgrade Belgrade Serbia
- Clinic of Neurology Clinical Center of Serbia Belgrade Serbia
| | - Jelena Drulovic
- Faculty of Medicine University of Belgrade Belgrade Serbia
- Clinic of Neurology Clinical Center of Serbia Belgrade Serbia
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78
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Tremlett H, Zhu F, Arnold D, Bar-Or A, Bernstein CN, Bonner C, Forbes JD, Graham M, Hart J, Knox NC, Marrie RA, Mirza AI, O'Mahony J, Van Domselaar G, Yeh EA, Zhao Y, Banwell B, Waubant E. The gut microbiota in pediatric multiple sclerosis and demyelinating syndromes. Ann Clin Transl Neurol 2021; 8:2252-2269. [PMID: 34889081 PMCID: PMC8670321 DOI: 10.1002/acn3.51476] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 10/22/2021] [Indexed: 12/15/2022] Open
Abstract
Objective To examine the gut microbiota in individuals with and without pediatric‐onset multiple sclerosis (MS). Methods We compared stool‐derived microbiota of Canadian Pediatric Demyelinating Disease Network study participants ≤21 years old, with MS (disease‐modifying drug [DMD] exposed and naïve) or monophasic acquired demyelinating syndrome [monoADS] (symptom onset <18 years), and unaffected controls. All were ≥30 days without antibiotics or corticosteroids. V4 region 16S RNA gene‐derived amplicon sequence variants (Illumina MiSeq) were assessed using negative binomial regression and network analyses; rate ratios were age‐ and sex‐adjusted (aRR). Results Thirty‐two MS, 41 monoADS (symptom onset [mean] = 14.0 and 6.9 years) and 36 control participants were included; 75%/56%/58% were female, with mean ages at stool sample = 16.5/13.8/15.1 years, respectively. Nine MS cases (28%) were DMD‐naïve. Although microbiota diversity (alpha, beta) did not differ between participants (p > 0.1), taxa‐level and gut community networks did. MS (vs. monoADS) exhibited > fourfold higher relative abundance of the superphylum Patescibacteria (aRR = 4.2;95%CI:1.6–11.2, p = 0.004, Q = 0.01), and lower abundances of short‐chain fatty acid (SCFA)‐producing Lachnospiraceae (Anaerosporobacter) and Ruminococcaceae (p, Q < 0.05). DMD‐naïve MS cases were depleted for Clostridiales vadin‐BB60 (unnamed species) versus either DMD‐exposed, controls (p, Q < 0.01), or monoADS (p = 0.001, Q = 0.06) and exhibited altered community connectedness (p < 10−9 Kruskal–Wallis), with SCFA‐producing taxa underrepresented. Consistent taxa‐level findings from an independent US Network of Pediatric MS Centers case/control (n = 51/42) cohort included >eightfold higher abundance for Candidatus Stoquefichus and Tyzzerella (aRR = 8.8–12.8, p < 0.05) in MS cases and 72%–80% lower abundance of SCFA‐producing Ruminococcaceae‐NK4A214 (aRR = 0.38–0.2, p ≤ 0.01). Interpretation Gut microbiota community structure, function and connectivity, and not just individual taxa, are of likely importance in MS.
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Affiliation(s)
- Helen Tremlett
- Medicine (Neurology), University of British Columbia and The Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, V6T 1Z3, Canada
| | - Feng Zhu
- Medicine (Neurology), University of British Columbia and The Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, V6T 1Z3, Canada
| | - Douglas Arnold
- The Montreal Neurological Institute, McGill University, Montreal, Quebec, H3A 2B4, Canada
| | - Amit Bar-Or
- Center for Neuroinflammation and Experimental Therapeutics and Department of Neurology, Perleman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, 19104, USA
| | - Charles N Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba Inflammatory Bowel Disease Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, R3E 3P4, Canada
| | - Christine Bonner
- National Microbiology Laboratory, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, R3E 3R2, Canada
| | - Jessica D Forbes
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, M5S 1A8, Canada
| | - Morag Graham
- National Microbiology Laboratory, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, R3E 3R2, Canada.,Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, Rady Faculty of Health Sciences, Winnipeg, Manitoba, R3E 0J9, Canada
| | - Janace Hart
- Department of Neurology, University of California San Francisco, San Francisco, California, 94158, USA
| | - Natalie C Knox
- National Microbiology Laboratory, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, R3E 3R2, Canada.,Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, Rady Faculty of Health Sciences, Winnipeg, Manitoba, R3E 0J9, Canada
| | - Ruth Ann Marrie
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, Winnipeg, Manitoba, R3A 1R9, Canada
| | - Ali I Mirza
- Medicine (Neurology), University of British Columbia and The Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, V6T 1Z3, Canada
| | - Julia O'Mahony
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, M5G 1X8, Canada
| | - Gary Van Domselaar
- National Microbiology Laboratory, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, R3E 3R2, Canada.,Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, Rady Faculty of Health Sciences, Winnipeg, Manitoba, R3E 0J9, Canada
| | - E Ann Yeh
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, M5G 1X8, Canada
| | - Yinshan Zhao
- Medicine (Neurology), University of British Columbia and The Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, V6T 1Z3, Canada
| | - Brenda Banwell
- Division of Neurology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, 19104, USA
| | - Emmanuelle Waubant
- Department of Neurology, University of California San Francisco, San Francisco, California, 94158, USA
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79
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Yalachkov Y, Anschuetz V, Jakob J, Schaller-Paule MA, Schaefer JH, Reilaender A, Friedauer L, Behrens M, Foerch C. C-Reactive Protein Levels and Gadolinium-Enhancing Lesions Are Associated With the Degree of Depressive Symptoms in Newly Diagnosed Multiple Sclerosis. Front Neurol 2021; 12:719088. [PMID: 34764926 PMCID: PMC8575739 DOI: 10.3389/fneur.2021.719088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/27/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Inflammation is essential for the pathogenesis of multiple sclerosis (MS). While the immune system contribution to the development of neurological symptoms has been intensively studied, inflammatory biomarkers for mental symptoms such as depression are poorly understood in the context of MS. Here, we test if depression correlates with peripheral and central inflammation markers in MS patients as soon as the diagnosis is established. Methods: Forty-four patients were newly diagnosed with relapsing-remitting MS, primary progressive MS or clinically isolated syndrome. Age, gender, EDSS, C-reactive protein (CRP), albumin, white blood cells count in cerebrospinal fluid (CSF WBC), presence of gadolinium enhanced lesions (GE) on T1-weighted images and total number of typical MS lesion locations were included in linear regression models to predict Beck Depression Inventory (BDI) score and the depression dimension of the Symptoms Checklist 90-Revised (SCL90RD). Results: CRP elevation and GE predicted significantly BDI (CRP: p = 0.007; GE: p = 0.019) and SCL90RD (CRP: p = 0.004; GE: p = 0.049). The combination of both factors resulted in more pronounced depressive symptoms (p = 0.04). CSF WBC and EDSS as well as the other variables were not correlated with depressive symptoms. Conclusions: CRP elevation and GE are associated with depressive symptoms in newly diagnosed MS patients. These markers can be used to identify MS patients exhibiting a high risk for the development of depressive symptoms in early phases of the disease.
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Affiliation(s)
- Yavor Yalachkov
- Department of Neurology, University Hospital Frankfurt, Frankfurt, Germany
| | - Victoria Anschuetz
- Department of Neurology, University Hospital Frankfurt, Frankfurt, Germany
| | - Jasmin Jakob
- Department of Neurology, University Hospital Frankfurt, Frankfurt, Germany.,Department of Neurology, Universitätsmedizin Mainz, Mainz, Germany
| | | | | | | | - Lucie Friedauer
- Department of Neurology, University Hospital Frankfurt, Frankfurt, Germany
| | - Marion Behrens
- Department of Neurology, University Hospital Frankfurt, Frankfurt, Germany
| | - Christian Foerch
- Department of Neurology, University Hospital Frankfurt, Frankfurt, Germany
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80
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Smyth P, Watson KE, Tsuyuki RT. Measuring the effects of nurse practitioner (NP)-led care on depression and anxiety levels in people with multiple sclerosis: a study protocol for a randomized controlled trial. Trials 2021; 22:785. [PMID: 34749784 PMCID: PMC8577034 DOI: 10.1186/s13063-021-05726-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 10/18/2021] [Indexed: 12/14/2022] Open
Abstract
Background Canada has one of the highest rates of multiple sclerosis (MS) in the world. Treatments and supports for people with MS (PwMS) have become increasingly complex, requiring individualized and adaptive care. Specialized NPs provide advanced skills to those with complex medical conditions, with potential to enhance the health, functioning, and quality of life for PwMS. This study aims to determine the effect of a Nurse Practitioner (NP) on depression and anxiety levels in PwMS. Methods We will perform a parallel randomized controlled trial. PwMS who are followed by general private-practice neurologists will be randomly assigned to the intervention group (NP-led care) or the ‘usual care’ control group (general neurologist or family physician and registered nurse support). In the intervention group, the NP will assess and provide care to the MS patient and their caregiver at a baseline visit, with 3-month and 6-month follow-up visits. PwMS in the control group will receive usual care provided by their community neurologists or family physicians with the standard assistance provided by registered nurses experienced in MS care. The primary outcome will be the difference in change in the patient’s anxiety and depression scores as measured by the validated Hospital Anxiety and Depression Scale (HADS) questionnaire at 3 months. Secondary outcomes will include difference in change in HADS at 6 months; Modified Fatigue Impact Scale scores (MSIF) at 3 and 6 months; EQ-5D scores at 3 and 6 months; caregiver health-related quality of life in MS measures (CAREQOL-MS) at 3 and 6 months; number of visits and phone calls to healthcare professionals recorded by patient, and satisfaction with NP-led care vs usual care measured by the validated Consultant Satisfaction Questionnaire. Discussion Findings from this study will contribute to exploring benefits of advanced nursing practitioner interventions for PwMS followed by general neurologists and family physicians in a community setting. It will provide evidence of the benefits of NP-led care for PwMS and offer an alternative healthcare resource for management of MS. Trial registration ClinicalTrials.govPro00069595. Retrospectively registered on June 26, 2020. Protocol version: January 2017, version 1. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05726-3.
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Affiliation(s)
- Penelope Smyth
- Department of Medicine (Neurology), University of Alberta, Edmonton, AB, Canada.
| | - Kaitlyn E Watson
- EPICORE Centre, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Ross T Tsuyuki
- EPICORE Centre, Department of Medicine, University of Alberta, Edmonton, AB, Canada.,Department of Pharmacology, University of Alberta, Edmonton, AB, Canada
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81
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Palukuru S, Patil SS, Nagarathna R, Singh A, Nibedita KS. Content Validity of an Integrated Yoga Module for Practice During Remission in Relapsing-Remitting Multiple Sclerosis Patients. Ann Neurosci 2021; 28:29-38. [PMID: 34733052 PMCID: PMC8558981 DOI: 10.1177/09727531211023754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/25/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Some investigations point to the beneficial effects of yoga in alleviating
the motor and cognitive dysfunctions in multiple sclerosis (MS) patients by
using varying combinations of physical, breathing, and meditative practices
of yoga. There is a need for a validated yoga module with a holistic
approach that can be used as a standardized protocol by researchers and
therapists. Purpose: To develop and validate an integrated yoga module for practice in
relapsing–remitting MS patients to improve their quality of life. Methods: We did a thorough review of the literature for the development of the yoga
module. We formed an expert group with 24 experts and a neurologist and used
two rounds of interactive Delphi method to combine their opinion to obtain
content validity of the module through online structured questionnaire
prepared for the purpose on a Google Form. We incorporated all suggestions
obtained by the experts. The final module (60 min per session, twice a day,
five days per week) included warm-up exercises, customized asanas,
relaxation techniques, and OM meditation. Advice on yogic diet and
discussion using yogic concepts for stress management also form a part of
the holistic approach to yoga lifestyle modification. Results: Analysis divulged that 30 out of 39 practices exhibited a content validity
ratio value greater than or equal to 0.42. Conclusion: The study has shown good content validity of the integrated yoga module.
Future clinical studies are being planned to rule the feasibility and
reliability of this module.
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Affiliation(s)
- Sreedhar Palukuru
- Department of Yoga and Life Sciences, S-VYASA Yoga University, Bengaluru, Karnataka, India
| | - Suchitra S Patil
- Department of Yoga and Life Sciences, S-VYASA Yoga University, Bengaluru, Karnataka, India
| | - R Nagarathna
- Department of Yoga and Life Sciences, S-VYASA Yoga University, Bengaluru, Karnataka, India
| | - Amit Singh
- Department of Yoga and Life Sciences, S-VYASA Yoga University, Bengaluru, Karnataka, India
| | - K S Nibedita
- Department of Yoga and Life Sciences, S-VYASA Yoga University, Bengaluru, Karnataka, India
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The Role of Nutritional Lifestyle and Physical Activity in Multiple Sclerosis Pathogenesis and Management: A Narrative Review. Nutrients 2021; 13:nu13113774. [PMID: 34836032 PMCID: PMC8620342 DOI: 10.3390/nu13113774] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/20/2021] [Accepted: 10/21/2021] [Indexed: 12/18/2022] Open
Abstract
Studies on the role of nutritional factors and physical activity (PA) in the pathogenesis of multiple sclerosis (MS) go back a long time. Despite the intrinsic difficulty of studying their positive or negative role in MS, the interest of researchers on these topics increased during the last few decades, since the role of diet has been investigated with the perspective of the association with disease-modifying drugs (DMD). The association of DMD, diets, and PA might have an additive effect in modifying disease severity. Among the various diets investigated (low-carbohydrate, gluten-free, Mediterranean, low-fat, fasting-mimicking, and Western diets) only low-carbohydrate, Mediterranean, and fast-mimicking diets have shown both in animal models and in humans a positive effect on MS course and in patient-reported outcomes (PROs). However, the Mediterranean diet is easier to be maintained compared to fast-mimicking and low-carbohydrate diets, which may lead to detrimental side effects requiring careful clinical monitoring. Conversely, the Western diet, which is characterized by a high intake of highly saturated fats and carbohydrates, may lead to the activation of pro-inflammatory immune pathways and is therefore not recommended. PA showed a positive effect both in animal models as well as on disease course and PROs in humans. Training with combined exercises is considered the more effective approach.
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83
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Prakash RS. Mindfulness Meditation: Impact on Attentional Control and Emotion Dysregulation. ARCHIVES OF CLINICAL NEUROPSYCHOLOGY : THE OFFICIAL JOURNAL OF THE NATIONAL ACADEMY OF NEUROPSYCHOLOGISTS 2021; 36:1283-1290. [PMID: 34651648 DOI: 10.1093/arclin/acab053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 06/16/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Theoretical models of mindfulness meditation conceptualize the cultivation of focused attention and regulation of emotional states, with the attitudinal foundations that promote nonjudgment and acceptance, to facilitate cognitive and affective processing resulting in improved brain health. Within the scientific study of mindfulness meditation, outcomes assessing behavioral and neural correlates of attentional control and emotion regulation have been examined for their malleability as a function of engagement in mindfulness practices. This review synthesizes the results of our pilot trials examining the preliminary effects of mindfulness meditation on metrics of cognitive, affective, and brain health in older adults and in individuals with multiple sclerosis. CONCLUSIONS There is promising support for mindfulness meditation to enhance attentional control, reduce mind-wandering, and reduce emotion dysregulation. However, well-powered efficacy trials, with an objective assessment of mindfulness practice data are needed to further provide causal and comprehensive evidence supporting the efficacy of mindfulness meditation for brain health. Inclusion of independently derived and validated brain-based signatures of cognitive and affective functioning can additionally enable a parsimonious understanding of how mindfulness meditation can causally impact metrics of functional and structural integrity of the human brain.
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Affiliation(s)
- Ruchika Shaurya Prakash
- The Ohio State University, Department of Psychology, 1835 Neil Ave Columbus, OH 43210 USA.,The Ohio State University, Center for Cognitive and Behavioral Brain Imaging, 1835 Neil Ave Columbus, OH 43210 USA
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84
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Zanga G, Drzewiscki E, Tagliani P, Smietniansky M, Esnaola Y Rojas MM, Caruso D. Predictors of adherence and persistence to disease-modifying therapies in Multiple Sclerosis. Ther Adv Neurol Disord 2021; 14:17562864211031099. [PMID: 34630632 PMCID: PMC8495537 DOI: 10.1177/17562864211031099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 06/21/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND AND AIMS In multiple sclerosis (MS), non-adherence/non-persistence is related to suboptimal response to treatment, including disease relapses and the need for more expensive healthcare. The aim of this study was to identify predictors related to adherence to disease modifying therapies (DMTs) in a cohort of Argentinian MS patients. METHODS We conducted a cross-sectional study at the National Medical Care Program from Argentina. MS patients with at least one claim for a DMT from 1 January 2017 to 1 October 2017 were identified. A telephone survey was performed to assess clinical and demographic factors. The medication possession ratio (MPR) was used to estimate adherence; MPR <80% defined non-adherence. Associations were studied using a logistic regression model. RESULTS Our database included 648 MS patients. A total of 360 patients (60% females, mean age 55.3 years) accepted to participate. Of these, 308 (85.5%) patients were receiving DMT at the time of the survey. Some 198 (63.7%) were receiving injectable therapies. Optimal adherence was 47.7%. Adherence was associated with oral medication [odds ratio (OR) 1.83 95% confidence interval (CI) 1.13-3.00, p = 0.014]. A factor related to oral drugs was higher educational level (OR 2.86 95%CI 1.41-5.81, p = 0.004). CONCLUSION This real-world study showed better adherence and persistence on treatment with oral therapies in MS patients in Argentina.
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Affiliation(s)
- Gisela Zanga
- Department of Neurology, César Milstein Hospital, associated with University of Buenos Aires, La Rioja 951, Buenos Aires, C1221ACI, Argentina
| | - Estefania Drzewiscki
- Department of Neurology, César Milstein Hospital, associated with University of Buenos Aires, Buenos Aires, Argentina
| | - Paula Tagliani
- Servei de Neurologia-Neuroinmunologia, Centre d'Esclerosi Multiple de Catalunya, (CEMCAT), Vall d'Hebron Hospital Universitari, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Maximiliano Smietniansky
- Department of Internal Medicine Interna, Programa de Medicine Geriatric Program, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Maria M Esnaola Y Rojas
- Department of Neurology, César Milstein Hospital, associated with University of Buenos Aires, Buenos Aires, Argentina
| | - Diego Caruso
- Department of Internal Medicine, César Milstein Hospital, associated with University of Buenos Aires, Buenos Aires, Argentina
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85
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Simpson R, Simpson S, Wasilewski M, Mercer S, Lawrence M. Mindfulness-based interventions for people with multiple sclerosis: a systematic review and meta-aggregation of qualitative research studies. Disabil Rehabil 2021; 44:6179-6193. [PMID: 34498997 DOI: 10.1080/09638288.2021.1964622] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Mindfulness-based interventions (MBIs) are effective treatments for stress, anxiety, and depression in PwMS. However, low adherence and high attrition may limit effectiveness. Qualitative research can provide important insights into MBI acceptability, accessibility, and implementation. This systematic review and meta-aggregation evaluated qualitative research findings on the use of MBIs for PwMS. METHODS Systematic searches were undertaken in six major electronic databases. Studies using qualitative or mixed methods were included. Two reviewers screened, data extracted, and critically appraised studies. Meta-aggregation was performed following the Joanna Briggs Institute approach, extracting findings, developing categories, and synthesizing findings. RESULTS Six eligible papers, including 136 PwMS were included in meta-aggregation. 136 findings were extracted, grouped into 17 categories, with four synthesized findings: (1) "accessing mindfulness," (2) "a sense of belonging," (3) "experiencing mindfulness," and (4) "making mindfulness more relevant and sustainable for PwMS." CONCLUSIONS MBIs for PwMS need to take into consideration disability which can limit accessibility. Online MBIs (synchronous and asynchronous) appear acceptable alternatives to traditional face-to-face courses. However, PwMS benefit from shared (mindful) experiencing and highlight MBI instructors as crucial in helping them understand and practice mindfulness. Involving PwMS in design, delivery, and iterative refinement would make MBIs more relevant to those taking part.IMPLICATIONS FOR REHABILITATIONBoth face-to-face and online Mindfulness-based interventions (MBIs) appear acceptable to PwMS and, ideally, people should be offered a choice in training modality.PwMS derive benefit from undertaking MBIs with their peers, where a sense of camaraderie and belonging develop through shared (mindful) experiences.Instructors delivering MBIs for PwMS should be knowledgeable about the condition; participants describe how the instructor has a key role in helping them practice mindfulness effectively in the context of unpleasant experiences associated with MS.MBIs tailored for PwMS should include a pre-course orientation session, clearly articulate how mindfulness practices can help with MS, provide well-organized course materials in large font size, and deliver individual mindfulness practices flexibly depending on participant need.
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Affiliation(s)
- Robert Simpson
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Toronto, Canada.,Institute of Health and Wellbeing, University of Glasgow, Scotland, UK
| | - Sharon Simpson
- Institute of Health and Wellbeing, University of Glasgow, Scotland, UK
| | - Marina Wasilewski
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Toronto, Canada
| | | | - Maggie Lawrence
- School of Health and Life Sciences, Glasgow Caledonian University, Scotland, UK
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86
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Parks NE, Andreou P, Marrie RA, Fisk JD, Bhan V, Kirkland SA. Comorbidity and persistence of disease-modifying therapy use in relapsing remitting multiple sclerosis. Mult Scler Relat Disord 2021; 56:103249. [PMID: 34517192 DOI: 10.1016/j.msard.2021.103249] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 07/29/2021] [Accepted: 09/01/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Comorbidity decreases the likelihood of initiating disease-modifying therapy (DMT) for multiple sclerosis (MS). Our objective was to characterize the relationship between comorbidity and initial DMT persistence along with reasons for DMT discontinuation. METHODS We identified individuals with relapsing remitting MS or clinically isolated syndrome starting a platform DMT (interferon-β, glatiramer acetate, dimethyl fumarate, teriflunomide) as initial therapy in the Canadian province of Nova Scotia from 2001 to 2016. Cases were identified using a clinic database for the only clinic providing specialty MS care in a province with universal publicly-funded health care. Comorbidity was determined by linkage of MS cases to provincial health administrative data using validated case definitions for mental health disorder, hypertension, hyperlipidemia, diabetes, chronic lung disease, ischemic heart disease, epilepsy, and inflammatory bowel disease. Cox proportional hazards models explored the relationship between comorbidity, as a count or individual comorbidities, and time to discontinuation of initial DMT. Logistic regression models explored reasons for DMT discontinuation. RESULTS Among 1464 individuals starting platform therapy as initial DMT, the median duration on first DMT was 4 years (95% CI 4 - 4). Comorbidity count (0, 1, ≥2) was not associated with time to discontinuation of initial DMT. However, the presence of a mental health disorder was associated with an increased hazard of discontinuing DMT (hazard ratio 1.22, 95% CI 1.03-1.44). Comorbidity count was not associated with discontinuation for lack of efficacy or lack of tolerability after adjusting for covariates. CONCLUSION Individuals with mental health comorbidity may have unique challenges that affect persistence on DMT after treatment initiation.
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Affiliation(s)
- Natalie E Parks
- Division of Neurology, Halifax Infirmary, Dalhousie University, 1796 Summer St, Room 3832, Halifax, NS B3H 3A7, Canada; Department of Community Health and Epidemiology, Dalhousie University, 5790 University Ave, Halifax, NS B3H 1V7, Canada.
| | - Pantelis Andreou
- Department of Community Health and Epidemiology, Dalhousie University, 5790 University Ave, Halifax, NS B3H 1V7, Canada
| | - Ruth Ann Marrie
- Department of Internal Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, Health Sciences Centre, University of Manitoba, GF 543-820 Sherbrook St, Winnipeg, MB R3A 1R9, Canada
| | - John D Fisk
- Nova Scotia Health Authority and the Departments of Psychiatry, Psychology and Neuroscience and Medicine, Dalhousie University, 5909 Veterans' Memorial Lane, Halifax, NS B3H 2E2, Canada
| | - Virender Bhan
- Division of Neurology, University of British Columbia, 3935 Kincaid St, Burnaby, BC V5G 2J6, Canada
| | - Susan A Kirkland
- Department of Community Health and Epidemiology, Dalhousie University, 5790 University Ave, Halifax, NS B3H 1V7, Canada
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87
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Hoang PD, Lord S, Gandevia S, Menant J. Exercise and Sports Science Australia (ESSA) position statement on exercise for people with mild to moderate multiple sclerosis. J Sci Med Sport 2021; 25:146-154. [PMID: 34538565 DOI: 10.1016/j.jsams.2021.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 07/28/2021] [Accepted: 08/17/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Multiple sclerosis (MS), the most common chronic and progressive neurological condition of the central nervous system, affects 26,000 Australian adults. Exercise training has beneficial effects on MS-related impairments including reduced muscular strength, poor aerobic capacity and impaired mobility, and in consequence can improve quality of life. This Position Statement provides evidence-based recommendations for exercise prescription and delivery of exercise training for people with MS with mild to moderate disability. DESIGN AND METHODS Synthesis of published works within the field of exercise training in MS. RESULTS Exercise provides many benefits to people with MS. There is strong evidence that resistance and aerobic training, performed 2 to 3 times per week at a moderate intensity, are safe and can improve muscle strength, cardiorespiratory fitness, balance, fatigue, functional capacity, mobility and quality of life in people with MS with mild to moderate disability (Expanded Disease Severity Scale (EDSS) ≤ 6.5). However, the evidence for those with severe disability (EDSS >6.5) is less clear. The effects of exercise on MS pathogenesis, central nervous structures and other outcomes such as depression and cognitive impairment, have not been adequately investigated. Effective exercise interventions to improve balance, joint contractures and reduce falls in people with MS are also urgently needed as well as investigations of long-term (≥1 year) effects of exercise training. CONCLUSIONS Resistance and aerobic training exercises are effective to alleviate some characteristic signs and symptoms in MS and should be supplemented by balance exercise to prevent falls. Exercise training programs should be prescribed and delivered by qualified exercise professionals. It is important to recognise and accommodate exercise-associated complications such as fatigue and heat sensitivity.
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Affiliation(s)
- Phu D Hoang
- Neuroscience Research Australia (NeuRA), Australia; Australian Catholic University, Australia; Multiple Sclerosis Limited, Australia; School of Population Health, University of New South Wales, Australia.
| | - Stephen Lord
- Neuroscience Research Australia (NeuRA), Australia; School of Population Health, University of New South Wales, Australia
| | | | - Jasmine Menant
- Neuroscience Research Australia (NeuRA), Australia; School of Population Health, University of New South Wales, Australia
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88
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Chen Y, Xu S, Shen J, Yang H, Xu W, Shao M, Pan F. Effect of Exercise on Fatigue in Multiple Sclerosis Patients: A Network Meta-analysis. Int J Sports Med 2021; 42:1250-1259. [PMID: 34375988 DOI: 10.1055/a-1524-1935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Few studies have directly compared the effects of different exercise therapies on reducing fatigue in patients with multiple sclerosis. Thus, we conducted a Frequentist network meta-analysis to analyze and compare the effectiveness of different types of exercise on reducing multiple sclerosis-related fatigue. Relevant randomized controlled trials were searched in PubMed, Web of Science and Cochrane Library databases from the date of their inception up to April 1, 2021. In total, 27 articles involving 1470 participants and 10 types of interventions met the inclusion criteria. The results indicated that aquatic exercise ranked as the most effective among these interventions, and aerobic exercise had small-to-moderate effect sizes. Most of the interventions were shown to be better than the control group, except for climbing. Climbing was the only intervention that ranked worse than the controls. All of these findings merit further investigation in future clinical trials.
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Affiliation(s)
- Yuting Chen
- Department of Epidemiology and Biostatistics, Anhui Medical University, Hefei, Anhui, China.,The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, Hefei, Anhui, China
| | - Shanshan Xu
- Department of Epidemiology and Biostatistics, Anhui Medical University, Hefei, Anhui, China.,The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, Hefei, Anhui, China
| | - Jiran Shen
- Department of Internal Medicine, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.,The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, Hefei, Anhui, China
| | - Hui Yang
- Department of Epidemiology and Biostatistics, Anhui Medical University, Hefei, Anhui, China.,The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, Hefei, Anhui, China
| | - Wei Xu
- Department of Epidemiology and Biostatistics, Anhui Medical University, Hefei, Anhui, China.,The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, Hefei, Anhui, China
| | - Ming Shao
- Department of Epidemiology and Biostatistics, Anhui Medical University, Hefei, Anhui, China.,The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, Hefei, Anhui, China
| | - Faming Pan
- Department of Epidemiology and Biostatistics, Anhui Medical University, Hefei, Anhui, China.,The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, Hefei, Anhui, China
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ShahAli S, Choobsaz H, Ebrahimi R. COVID-19 related knowledge, anxiety, depression and physical activity among Iranian people with relapsing-remitting multiple sclerosis during COVID-19 pandemic: an online cross-sectional survey. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2021. [DOI: 10.1080/21679169.2021.1958055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Shabnam ShahAli
- Department of Physiotherapy, School of Rehabilitation Sciences, Rehabilitation Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Haniyeh Choobsaz
- Department of Physical Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Reyhane Ebrahimi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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90
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Rotstein D, Maxwell C, Tu K, Gatley J, Pequeno P, Kopp A, Marrie RA. High prevalence of comorbidities at diagnosis in immigrants with multiple sclerosis. Mult Scler 2021; 27:1902-1913. [PMID: 34328821 PMCID: PMC8521357 DOI: 10.1177/13524585211031791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Multiple sclerosis (MS) has been associated with certain comorbidities in general population studies, but it is unknown how comorbidity may affect immigrants with MS. Objective: To compare prevalence of comorbidities in immigrants and long-term residents at MS diagnosis, and in matched control populations without MS. Methods: We identified incident MS cases using a validated definition applied to health administrative data in Ontario, Canada, from 1994 to 2017, and categorized them as immigrants or long-term residents. Immigrants and long-term residents without MS (controls) were matched to MS cases 3:1 on sex, age, and geography. Results: There were 1534 immigrants and 23,731 long-term residents with MS matched with 4585 and 71,193 controls, respectively. Chronic obstructive pulmonary disease (COPD), diabetes, hypertension, ischemic heart disease, migraine, epilepsy, mood/anxiety disorders, schizophrenia, inflammatory bowel disease (IBD), and rheumatoid arthritis were significantly more prevalent among immigrants with MS compared to their controls. Prevalence of these conditions was generally similar comparing immigrants to long-term residents with MS, although COPD, epilepsy, IBD, and mood/anxiety disorders were less prevalent in immigrants. Conclusion: Immigrants have a high prevalence of multiple comorbidities at MS diagnosis despite the “healthy immigrant effect.” Clinicians should pay close attention to identification and management of comorbidity in immigrants with MS.
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Affiliation(s)
- Dalia Rotstein
- Department of Medicine, University of Toronto, Toronto, ON, Canada/St. Michael's Hospital, Toronto, ON, Canada
| | - Colleen Maxwell
- Schools of Pharmacy and Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada/ICES, Toronto, ON, Canada
| | - Karen Tu
- North York General Hospital, Toronto, ON, Canada/Department of Family and Community Medicine and Institute for Health Policy and Management, University of Toronto, Toronto, ON, Canada/Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | | | | | | | - Ruth Ann Marrie
- Departments of Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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91
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Francalancia J, Mavrogiorgou P, Juckel G, Mitrovic T, Kuhle J, Naegelin Y, Kappos L, Calabrese P. Death Anxiety and Attitudes towards Death in Patients with Multiple Sclerosis: An Exploratory Study. Brain Sci 2021; 11:brainsci11080964. [PMID: 34439584 PMCID: PMC8391402 DOI: 10.3390/brainsci11080964] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Death and the anxiety of it becomes more apparent when confronted with a chronic disease. Even though multiple sclerosis (MS) is a treatable condition today, it is still accompanied by a multitude of impairments, which in turn may intensify of death anxiety. Objective: The aim of this study is to explore the relationship between depression, anxiety and death anxiety in individuals with MS. Methods: Fifty-six MS patients were recruited at the Department of Neurology of the University Clinic in Basel. Death anxiety was assessed using the Bochumer Questionnaire on attitude to death and death anxiety 2.0 (BOFRETTA 2.0). Results: Scores of death anxiety towards it in MS patients were low. Only disability (EDSS) was moderately correlated with death anxiety. Depression in MS was significantly correlated with fatigue and disability, but not with the BOFRETTA 2.0. Conclusion: Scores of death anxiety and the attitude towards death are low in this MS cohort. It was shown that both psychopathological and neurological deficits impact the subject of death with respect to multiple sclerosis.
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Affiliation(s)
- Jara Francalancia
- Neuropsychology and Behavioral Neurology Unit, Division of Molecular and Cognitive Neuroscience, Department of Psychology, University of Basel, Birmannsgasse 8, 4055 Basel, Switzerland; (J.F.); (T.M.)
| | - Paraskevi Mavrogiorgou
- Department of Psychiatry, Ruhr University Bochum, Alexandrinenstr. 1, 44791 Bochum, Germany; (P.M.); (G.J.)
| | - Georg Juckel
- Department of Psychiatry, Ruhr University Bochum, Alexandrinenstr. 1, 44791 Bochum, Germany; (P.M.); (G.J.)
| | - Tina Mitrovic
- Neuropsychology and Behavioral Neurology Unit, Division of Molecular and Cognitive Neuroscience, Department of Psychology, University of Basel, Birmannsgasse 8, 4055 Basel, Switzerland; (J.F.); (T.M.)
- Department of Neurology, University Clinic Basel, Petersgraben 4, 4031 Basel, Switzerland; (J.K.); (Y.N.); (L.K.)
| | - Jens Kuhle
- Department of Neurology, University Clinic Basel, Petersgraben 4, 4031 Basel, Switzerland; (J.K.); (Y.N.); (L.K.)
| | - Yvonne Naegelin
- Department of Neurology, University Clinic Basel, Petersgraben 4, 4031 Basel, Switzerland; (J.K.); (Y.N.); (L.K.)
| | - Ludwig Kappos
- Department of Neurology, University Clinic Basel, Petersgraben 4, 4031 Basel, Switzerland; (J.K.); (Y.N.); (L.K.)
| | - Pasquale Calabrese
- Neuropsychology and Behavioral Neurology Unit, Division of Molecular and Cognitive Neuroscience, Department of Psychology, University of Basel, Birmannsgasse 8, 4055 Basel, Switzerland; (J.F.); (T.M.)
- Department of Neurology, University Clinic Basel, Petersgraben 4, 4031 Basel, Switzerland; (J.K.); (Y.N.); (L.K.)
- Correspondence:
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92
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Robers MV, Chan C, Vajdi B, Chiong-Rivero H, Martinez A, Burnett ME, Ramanathan M, Amezcua L. Hypertension and hypertension severity in Hispanics/Latinx with MS. Mult Scler 2021; 27:1894-1901. [PMID: 34197237 DOI: 10.1177/13524585211019243] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Vascular comorbidities (VCs) including hypertension (HTN) are associated with worse multiple sclerosis (MS) outcomes. HTN is common in Latinx, but the prevalence and relationship with disability are unknown in Latinx with MS. METHODS Latinx (n = 451) from the Alliance for Research in Hispanic MS (ARHMS) seen between 2007 and 2019 were included. HTN, diabetes (DM), hyperlipidemia (HLD), ischemic events, and smoking were considered VC. Blood pressures (BPs) were classified using the American Heart Association (AHA) criteria. Logistic regression determined associations between VC and ambulatory disability accounting for age, sex, and disease duration. RESULTS Medical comorbidities were found in 41.9% and VC in 24.2%. Smoking (13.6%) and HTN (7.3%) were the most common. HTN was the most common over the age of 40 (12.6%). The odds of having severe disability were three times higher for those with HTN (odds ratio [OR], 3.12; 95% confidence interval (CI), 1.37-7.12). Stage II HTN according to AHA also tripled the odds (OR, 2.89; 95%CI, 1.11-7.55). AHA BP confirmed HTN in 27.5% (compared to 7.3% with established diagnosis). CONCLUSION HTN diagnosis and stage II HTN defined by AHA were independently associated with severe ambulatory disability in Latinx with MS. HTN was underdiagnosed. Future studies should assess whether HTN treatment control would prevent disability in MS.
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Affiliation(s)
- Michael V Robers
- Department of Neurology, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA/Department of Neurology, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Chan Chan
- Department of Neurology, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Borna Vajdi
- Department of Neurology, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Horacio Chiong-Rivero
- Department of Neurology, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Andrea Martinez
- Department of Neurology, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Margaret E Burnett
- Department of Neurology, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Murali Ramanathan
- Departments of Pharmaceutical Sciences and Neurology, State University of New York, Buffalo, NY, USA
| | - Lilyana Amezcua
- Department of Neurology, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
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Burt RK, Muraro PA, Farge D, Oliveira MC, Snowden JA, Saccardi R, Han X, Quigley K, Bueno V, Frasca D, Fedorenko D, Burman J. New autoimmune diseases after autologous hematopoietic stem cell transplantation for multiple sclerosis. Bone Marrow Transplant 2021; 56:1509-1517. [PMID: 33911200 DOI: 10.1038/s41409-021-01277-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/01/2021] [Accepted: 03/19/2021] [Indexed: 02/02/2023]
Abstract
Secondary autoimmune diseases (2ndADs), most frequently autoimmune cytopenias (AICs), were first described after allogeneic hematopoietic stem cell transplantation (HSCT) undertaken for malignant and hematological indications, occurred at a prevalence of ~5-6.5%, and were attributed to allogeneic immune imbalances in the context of graft versus host disease, viral infections, and chronic immunosuppression. Subsequently, 2ndADs were reported to complicate roughly 2-14% of autologous HSCTs performed for an autoimmune disease. Alemtuzumab in the conditioning regimen has been identified as a risk for development of 2ndADs after either allogeneic or autologous HSCT and is consistent with the high rates of 2ndADs when using alemtuzumab as monotherapy. Due to the significant consequences but variable incidence, depending on conditioning regimen, of 2ndADs and similarity in known immune reconstitution kinetics after autologous HSCT for autoimmune diseases and after alemtuzumab monotherapy, we propose that an imbalance between B and T lineage regeneration early after HSCT may underlie the pathogenesis of 2ndADs.
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Affiliation(s)
- Richard K Burt
- Division of Immunotherapy, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Paolo A Muraro
- Neuroimmunology and Immunotherapy, Department of Brain Sciences, Imperial College London, London, UK
| | - Dominique Farge
- Unité de Médecine Interne: Maladies Auto-immunes et Pathologie Vasculaire (UF 04), IRSL, EA-3518, Université de Paris, MATHEC, Centre de Référence des Maladies auto-immunes systémiques Rares d'Ile-de-France, Filière FAI2R, Hôpital St-Louis, AP-HP, Paris, France
| | - Maria Carolina Oliveira
- Divisão de Imunologia Clínica, Departamento de Clínica Médica, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - John A Snowden
- Department of Haematology, Sheffield Teaching Hospitals, NHS Foundation Trust and the University of Sheffield, Sheffield, UK
| | - Riccardo Saccardi
- Department of Hematology, Careggi University Hospital, Florence, Italy
| | - Xiaoqiang Han
- Division of Immunotherapy, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kathleen Quigley
- Division of Immunotherapy, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Valquiria Bueno
- Department of Microbiology, Immunology and Parasitology DMIP Federal University of São Paulo UNIFESP, São Paulo, Brasil
| | - Daniela Frasca
- Department of Microbiology and Immunology, and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Denis Fedorenko
- The A.A. Maximov Department of Hematology and Cellular Therapy, National Pirogov Medical Surgical Center, Moscow, Russian Federation
| | - Joachim Burman
- Department of Neurology, Uppsala University, Uppsala, Sweden
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94
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Jamal I, Shah J, Mativo P, Hooker J, Wallin M, Sokhi DS. Multiple sclerosis in Kenya: Demographic and clinical characteristics of a registry cohort. Mult Scler J Exp Transl Clin 2021; 7:20552173211022782. [PMID: 34188951 PMCID: PMC8209835 DOI: 10.1177/20552173211022782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/17/2021] [Indexed: 11/16/2022] Open
Abstract
Background Multiple Sclerosis (MS) is the leading cause of non-traumatic neurological disability in young adults. There is limited literature regarding the burden of MS in sub-Saharan Africa (SSA). Objective To describe the demographic and clinical characteristics of patients with MS (PwMS) presenting to a tertiary referral hospital in Nairobi. Methods We conducted a retrospective descriptive study for PwMS presenting to Aga Khan University Hospital, Nairobi from 2008–2018. Results 99 cases met the diagnostic criteria for MS with a male to female ratio of 1:4. Majority (68.7%) of PwMS were indigenous Africans with a mean age of onset of 30.7 years. Mean duration from symptom onset to first neuro-imaging was 5.04 years. Only 33% of patients had sensory symptoms at onset whereas 54.5% had vitamin D deficiency/insufficiency. Majority (79.5%) had relapsing remitting MS (RRMS) and 56.6% were initiated on disease modifying therapy (DMT). Only 21.2% of patients on DMT were non-compliant. Patients with RRMS were more likely to be initiated on DMT at our hospital (p < 0.001). Conclusion Clinical characteristics of these patients largely resemble those of other SSA cohorts and African American patients. There was a delay between symptom onset and neuroimaging. There were also issues with DMT compliance.
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Affiliation(s)
- Imran Jamal
- Aga Khan University Medical College of East Africa, Faculty of Health Sciences, The Aga Khan University Hospital, Nairobi, Kenya
| | - Jasmit Shah
- Aga Khan University Medical College of East Africa, Faculty of Health Sciences, The Aga Khan University Hospital, Nairobi, Kenya
| | - Peter Mativo
- Aga Khan University Medical College of East Africa, Faculty of Health Sciences, The Aga Khan University Hospital, Nairobi, Kenya
| | - Juzar Hooker
- Aga Khan University Medical College of East Africa, Faculty of Health Sciences, The Aga Khan University Hospital, Nairobi, Kenya
| | - Mitchell Wallin
- Department of Veterans Affairs Multiple Sclerosis Centre of Excellence - East, Washington, DC, USA
| | - Dilraj Singh Sokhi
- Aga Khan University Medical College of East Africa, Faculty of Health Sciences, The Aga Khan University Hospital, Nairobi, Kenya
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95
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Gasperi C, Hapfelmeier A, Daltrozzo T, Schneider A, Donnachie E, Hemmer B. Systematic Assessment of Medical Diagnoses Preceding the First Diagnosis of Multiple Sclerosis. Neurology 2021; 96:e2977-e2988. [PMID: 33903190 DOI: 10.1212/wnl.0000000000012074] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 03/15/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To explore the occurrence of diseases and symptoms in the 5 years before diagnosis in patients with multiple sclerosis (MS) in a case-control study. METHODS Using ambulatory claims data, we systematically assessed differences in the occurrence of diseases and symptoms in the 5 years before first diagnosis in patients with MS (n = 10,262) compared to patients with 2 other autoimmune diseases, Crohn disease (n = 15,502) and psoriasis (n = 98,432), and individuals without these diseases (n = 73,430). RESULTS Forty-three ICD-10 codes were recorded more frequently for patients with MS before diagnosis compared to controls without autoimmune disease. Many of these findings were confirmed in a comparison to the other control groups. A high proportion of these ICD-10 codes represent symptoms suggestive of demyelinating events or other neurologic diagnoses. In a sensitivity analysis excluding patients with such recordings before first diagnosis, no association remained significant. Seven ICD-10 codes were associated with lower odds ratios of MS, 4 of which represent upper respiratory tract infections. Here, the relations with MS were even more pronounced in the sensitivity analysis. CONCLUSIONS Our analyses suggest that patients with MS are frequently not diagnosed at their first demyelinating event but often years later. Symptoms and physician encounters before MS diagnosis seem to be related to already ongoing disease rather than a prodrome. The observed association of upper respiratory tract infections with lower odds ratios of MS diagnosis suggests a link between protection from infection and MS that, however, needs to be validated and further investigated.
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Affiliation(s)
- Christiane Gasperi
- From the Department of Neurology (C.G., B.H.), Klinikum rechts der Isar, Institute of Medical Informatics, Statistics and Epidemiology (A.H.), Department of Psychosomatic Medicine and Psychotherapy (T.D.), Klinikum rechts der Isar, and Institute of General Practice and Health Services Research (A.H., A.S.), TUM School of Medicine, Technical University of Munich; Bavarian Association of Statutory Health Insurance Physicians (E.D.); and Munich Cluster for Systems Neurology (SyNergy) (B.H.), Germany
| | - Alexander Hapfelmeier
- From the Department of Neurology (C.G., B.H.), Klinikum rechts der Isar, Institute of Medical Informatics, Statistics and Epidemiology (A.H.), Department of Psychosomatic Medicine and Psychotherapy (T.D.), Klinikum rechts der Isar, and Institute of General Practice and Health Services Research (A.H., A.S.), TUM School of Medicine, Technical University of Munich; Bavarian Association of Statutory Health Insurance Physicians (E.D.); and Munich Cluster for Systems Neurology (SyNergy) (B.H.), Germany
| | - Tanja Daltrozzo
- From the Department of Neurology (C.G., B.H.), Klinikum rechts der Isar, Institute of Medical Informatics, Statistics and Epidemiology (A.H.), Department of Psychosomatic Medicine and Psychotherapy (T.D.), Klinikum rechts der Isar, and Institute of General Practice and Health Services Research (A.H., A.S.), TUM School of Medicine, Technical University of Munich; Bavarian Association of Statutory Health Insurance Physicians (E.D.); and Munich Cluster for Systems Neurology (SyNergy) (B.H.), Germany
| | - Antonius Schneider
- From the Department of Neurology (C.G., B.H.), Klinikum rechts der Isar, Institute of Medical Informatics, Statistics and Epidemiology (A.H.), Department of Psychosomatic Medicine and Psychotherapy (T.D.), Klinikum rechts der Isar, and Institute of General Practice and Health Services Research (A.H., A.S.), TUM School of Medicine, Technical University of Munich; Bavarian Association of Statutory Health Insurance Physicians (E.D.); and Munich Cluster for Systems Neurology (SyNergy) (B.H.), Germany
| | - Ewan Donnachie
- From the Department of Neurology (C.G., B.H.), Klinikum rechts der Isar, Institute of Medical Informatics, Statistics and Epidemiology (A.H.), Department of Psychosomatic Medicine and Psychotherapy (T.D.), Klinikum rechts der Isar, and Institute of General Practice and Health Services Research (A.H., A.S.), TUM School of Medicine, Technical University of Munich; Bavarian Association of Statutory Health Insurance Physicians (E.D.); and Munich Cluster for Systems Neurology (SyNergy) (B.H.), Germany
| | - Bernhard Hemmer
- From the Department of Neurology (C.G., B.H.), Klinikum rechts der Isar, Institute of Medical Informatics, Statistics and Epidemiology (A.H.), Department of Psychosomatic Medicine and Psychotherapy (T.D.), Klinikum rechts der Isar, and Institute of General Practice and Health Services Research (A.H., A.S.), TUM School of Medicine, Technical University of Munich; Bavarian Association of Statutory Health Insurance Physicians (E.D.); and Munich Cluster for Systems Neurology (SyNergy) (B.H.), Germany.
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96
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Kalra RS, Dhanjal JK, Meena AS, Kalel VC, Dahiya S, Singh B, Dewanjee S, Kandimalla R. COVID-19, Neuropathology, and Aging: SARS-CoV-2 Neurological Infection, Mechanism, and Associated Complications. Front Aging Neurosci 2021; 13:662786. [PMID: 34149397 PMCID: PMC8209245 DOI: 10.3389/fnagi.2021.662786] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/05/2021] [Indexed: 01/08/2023] Open
Abstract
The spectrum of health complications instigated by coronavirus disease 2019 (COVID-19, caused by the novel severe acute respiratory syndrome coronavirus 2 or SARS-CoV-2) pandemic has been diverse and complex. Besides the evident pulmonary and cardiovascular threats, accumulating clinical data points to several neurological complications, which are more common in elderly COVID-19 patients. Recent pieces of evidence have marked events of neuro infection and neuroinvasion, producing several neurological complications in COVID-19 patients; however, a systematic understanding of neuro-pathophysiology and manifested neurological complications, more specifically in elderly COVID-19 patients is largely elusive. Since the elderly population gradually develops neurological disorders with aging, COVID-19 inevitably poses a higher risk of neurological manifestations to the aged patients. In this report, we reviewed SARS-CoV-2 infection and its role in neurological manifestations with an emphasis on the elderly population. We reviewed neuropathological events including neuroinfection, neuroinvasion, and their underlying mechanisms affecting neuromuscular, central- and peripheral- nervous systems. We further assessed the imminent neurological challenges in the COVID-19 exposed population, post-SARS-CoV-2-infection. Given the present state of clinical preparedness, the emerging role of AI and machine learning was also discussed concerning COVID-19 diagnostics and its management. Taken together, the present review summarizes neurological outcomes of SARS-CoV-2 infection and associated complications, specifically in elderly patients, and underlines the need for their clinical management in advance.
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Affiliation(s)
- Rajkumar Singh Kalra
- AIST-INDIA DAILAB, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Japan
| | - Jaspreet Kaur Dhanjal
- Department of Computational Biology, Indraprastha Institute of Information Technology Delhi, Okhla Industrial Estate, New Delhi, India
| | - Avtar Singh Meena
- CSIR-Centre for Cellular and Molecular Biology (CCMB), Hyderabad, India
| | - Vishal C. Kalel
- Department of Systems Biochemistry, Institute of Biochemistry and Pathobiochemistry, Faculty of Medicine, Ruhr-University Bochum, Bochum, Germany
| | - Surya Dahiya
- Conservative Dentistry and Endodontics, Maharishi Markandeshwar College of Dental Sciences and Research, Ambala, India
| | - Birbal Singh
- ICAR-Indian Veterinary Research Institute (IVRI), Regional Station, Palampur, India
| | - Saikat Dewanjee
- Advanced Pharmacognosy Research Laboratory, Department of Pharmaceutical Technology, Jadavpur University, Kolkata, India
| | - Ramesh Kandimalla
- Applied Biology, CSIR-Indian Institute of Chemical Technology (IICT), Hyderabad, India
- Department of Biochemistry, Kakatiya Medical College, Warangal, India
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97
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Roux J, Kingwell E, Zhu F, Tremlett H, Leray E. Care consumption of people with multiple sclerosis: A multichannel sequence analysis in a population-based setting in British Columbia, Canada. Mult Scler 2021; 28:309-322. [PMID: 34048293 DOI: 10.1177/13524585211016726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Persons with multiple sclerosis (PwMS) typically require complex multidisciplinary care, which is rarely formally assessed. OBJECTIVES We applied multichannel sequence analysis (MCSA) to identify care consumption patterns by PwMS in British Columbia, Canada. METHODS We created two cohorts, comprising incident and prevalent MS cases, using linked clinical and administrative data. We applied MCSA to quantify and compare the care pathways of PwMS, based on all-cause hospitalizations and physician visits (divided into five specialities). Care consumption clusters were characterized using demographic and clinical features. RESULTS From 1048 incident and 3180 prevalent PwMS, the MCSA identified 12 and 6 distinct care consumption clusters over a median follow-up of 9.6 and 13.0 years, respectively. Large disparities between clusters were observed; the median number of annual consultations ranged from 5.6 to 21.3 for general practitioners, 1.2 to 4.6 for neurologists and 0 to 5.3 for psychiatrists in the incident cohort. Characteristics at MS symptom onset associated with the highest care consumption included high comorbidity burden and older age. There were similar disparities and associations for prevalent PwMS. CONCLUSION The distinct patterns of care consumption, which were reminiscent of the heterogeneity of MS itself, may facilitate health service planning and evaluation, and provide a novel outcome measure in health research.
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Affiliation(s)
- Jonathan Roux
- Univ Rennes, EHESP, REPERES (Pharmacoepidemiology and Health Services Research), Rennes, France/Inserm CIC-P 1414, CHU of Rennes, Rennes, France
| | - Elaine Kingwell
- Faculty of Medicine (Neurology), University of British Columbia and The Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, Canada/Research Department of Primary Care & Population Health, University College London, London, UK
| | - Feng Zhu
- Faculty of Medicine (Neurology), University of British Columbia and The Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, Canada
| | - Helen Tremlett
- Faculty of Medicine (Neurology), University of British Columbia and The Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, Canada
| | - Emmanuelle Leray
- Univ Rennes, EHESP, REPERES (Pharmacoepidemiology and Health Services Research), Rennes, France/Inserm CIC-P 1414, CHU of Rennes, Rennes, France
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98
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Lo LMP, Taylor BV, Winzenberg T, Palmer AJ, Blizzard L, Hussain MA, van der Mei I. Comorbidity patterns in people with multiple sclerosis: A latent class analysis of the Australian Multiple Sclerosis Longitudinal Study. Eur J Neurol 2021; 28:2269-2279. [PMID: 33931923 DOI: 10.1111/ene.14887] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 03/19/2021] [Accepted: 04/22/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND PURPOSE This study was undertaken to identify clinically meaningful comorbidity patterns and their associations with the demographic/clinical characteristics of people with multiple sclerosis (MS). METHODS We conducted latent class analysis to identify clinically distinct comorbidity patterns in MS using the 15 most common comorbidities among 1518 Australian Multiple Sclerosis Longitudinal Study participants. The associations between demographic/clinical characteristics and comorbidity patterns were examined using log-binomial and multinomial logistic regression. RESULTS Five distinct comorbidity patterns were identified: "minimally diseased class" (30.8%), consisting of participants with no or one comorbidity; "metabolic class" (22.7%); "mental health-allergy class" (21.7%); "nonmetabolic class" (7.6%); and "severely diseased class" (7.0%), consisting of participants with higher prevalence of these comorbidities. The relative probabilities of being assigned to comorbidity classes compared to the minimally diseased class were significantly increased for participants who were older (metabolic: relative risk ratio [RRR] = 1.09, 95% confidence interval [CI] = 1.06-1.11; nonmetabolic: RRR = 1.07, 95% CI = 1.04-1.11; severely diseased: RRR = 1.04, 95% CI = 1.01-1.08), female (nonmetabolic: RRR = 5.35, 95% CI = 1.98-14.42; severely diseased: RRR = 2.21, 95% CI = 1.02-4.77), and obese (metabolic: RRR = 4.06, 95% CI = 2.45-6.72; mental health-allergy: RRR = 1.57, 95% CI = 1.00-2.46; severely diseased: RRR = 4.53, 95% CI = 2.21-9.29) and who had moderate disability (mental health-allergy: RRR = 2.32, 95% CI = 1.47-3.64; severely diseased: RRR = 2.65, 95% CI = 1.16-6.04). CONCLUSIONS Comorbidity patterns exist in MS. Women, people who were older, people who were obese, and people who had higher disability levels were more likely to be in classes with higher levels of comorbidity. These findings may offer opportunities for designing more personalised approaches to comorbidity prevention and treatment.
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Affiliation(s)
- Lara Marie Pangan Lo
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Bruce V Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Tania Winzenberg
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Andrew J Palmer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.,Centre for Health Policy, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Leigh Blizzard
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | | | - Ingrid van der Mei
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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99
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Bhattacharjee S, Yegezu Z, Kollecas K, Duhrkopf K, Hashemi L, Greene N. Influence of Comorbidities on Healthcare Expenditures and Perceived Physical and Mental Health Status Among Adults with Multiple Sclerosis: A Propensity Score-Matched US National-Level Study. CLINICOECONOMICS AND OUTCOMES RESEARCH 2021; 13:377-394. [PMID: 34017188 PMCID: PMC8129918 DOI: 10.2147/ceor.s305154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/30/2021] [Indexed: 12/04/2022] Open
Abstract
Objective To evaluate the effect of comorbidities on healthcare expenditures and perceived physical and mental health status among adults with multiple sclerosis (MS) compared to propensity score-matched non-MS controls. Methods A retrospective, cross-sectional, matched cohort study was conducted using Medical Expenditure Panel Survey (2005–2015) data. The base study sample consisted of adults (age ≥18 years) who were alive and had positive total healthcare expenditures during the survey calendar year. Adults with MS were propensity-matched (1:1) to non-MS controls based on age, gender, and race/ethnicity using greedy matching algorithm. Healthcare expenditures consisted of total and subtypes of expenditures. Health status consisted of perceived physical and mental health status. Comorbidities were identified using ICD-9-CM and Clinical Classification System codes. Ordinary least squares regression and multinomial logistic regression were used to analyze the healthcare expenditures and health status variables, respectively. Results Final study sample consisted of 541 adults in each MS and non-MS control groups after propensity score matching. After adjusting for potential confounders, individuals with MS had greater total and subtypes of expenditures compared to non-MS controls, and several comorbidities (eg, depression, hypertension) were significantly associated with increased healthcare expenditures. Yearly average total expenditures (expressed in 2018 US$) were significantly (p<0.001) higher for adults with MS ($29,396) than propensity score-matched non-MS adults ($7875). Moreover, after adjusting for all individual-level factors, adults with MS experienced 363% (p<0.001) higher total expenditures compared to propensity score-matched non-MS controls. Individuals with MS were more likely to report poorer physical and good mental health status compared to propensity score-matched non-MS controls, and several comorbidities (eg, anxiety, depression) were significant independent predictors of poorer health status. For example, adults with MS were four times more likely (OR: 4.10, 95% CI: 2.42–6.96) to report fair/poor physical health status compared to excellent/very good physical health status compared with non-MS controls. Adults with MS were 42% (OR: 1.42, 95% CI: 1.01–1.99) more likely than propensity score-matched non-MS controls to report good rather than very good or excellent mental health status. However, there was no difference between adults with MS and propensity score-matched non-MS controls in terms of reporting fair or poor than very good or excellent mental health status. Conclusion Findings from this study indicate substantial economic and health status burdens among adults with MS at the US national-level that are significantly influenced by comorbidities.
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Affiliation(s)
- Sandipan Bhattacharjee
- Health Outcomes Division, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Zufan Yegezu
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, Tucson, AZ, USA
| | - Kristin Kollecas
- Neurology, Immunology, & Inflammation, Sanofi Genzyme, Cambridge, MA, USA
| | - Kevin Duhrkopf
- Neurology, Immunology, & Inflammation, Sanofi Genzyme, Cambridge, MA, USA
| | - Lobat Hashemi
- Neurology, Immunology, & Inflammation, Sanofi Genzyme, Cambridge, MA, USA
| | - Nupur Greene
- Neurology, Immunology, & Inflammation, Sanofi Genzyme, Cambridge, MA, USA
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100
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Joseph B, Nandakumar AL, Ahmed AT, Gopal N, Murad MH, Frye MA, Tobin WO, Singh B. Prevalence of bipolar disorder in multiple sclerosis: a systematic review and meta-analysis. EVIDENCE-BASED MENTAL HEALTH 2021; 24:88-94. [PMID: 33328183 PMCID: PMC10231514 DOI: 10.1136/ebmental-2020-300207] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 11/09/2020] [Accepted: 11/30/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic disabling, demyelinating disease of the central nervous system and is often associated with psychiatric comorbidities. Some studies suggest increased prevalence of bipolar disorder (BD) in MS. OBJECTIVE To conduct a systematic review and meta-analysis assessing the prevalence of BD in adults with MS. METHODS We registered this review with PROSPERO and searched electronic databases (Ovid MEDLINE, Central, Embase, PsycINFO and Scopus) for eligible studies from earliest inception to October 2020. Prevalence data of BD in adult patients with MS were extracted. Meta-analysis was conducted using random-effects model. FINDINGS Of the 802 articles that were screened, 23 studies enrolling a total of 68 796 patients were included in the systematic review and meta-analysis. The pooled prevalence rate of BD in patients with MS was 2.95% (95% CI 2.12% to 4.09%) with higher prevalence in the Americas versus Europe. The lifetime prevalence of BD was 8.4% in patients with MS. Subgroup analysis showed a higher prevalence of BD in MS in females (7.03%) than in males (5.64%), which did not reach statistical significance (p=0.53). CONCLUSIONS This meta-analysis suggests a high lifetime prevalence of BD in patients with MS. Patients with MS should be routinely screened for BD. Further assessment of bipolar comorbidity in MS through prospective studies may help in developing effective management strategies and may improve treatment outcomes in patients with MS.
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Affiliation(s)
- Boney Joseph
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Ahmed T Ahmed
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Clinical and Translational Science Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, Minnesota, USA
| | - Neethu Gopal
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | - M Hassan Murad
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota, USA
- Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark A Frye
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - W Oliver Tobin
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Balwinder Singh
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
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