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A Principal Component Analysis Approach to Estimate the Disability Status for Patients with Multiple Sclerosis Using Japanese Claims Data. Neurol Ther 2022; 11:385-396. [PMID: 35064908 PMCID: PMC8857383 DOI: 10.1007/s40120-022-00324-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/12/2022] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Claims databases are preferred for research on multiple sclerosis (MS) as this condition is characterized by low prevalence and long disease course. However, Japanese claims databases contain no information on disease severity or disability status of MS. Here, we aimed to explore the possibility of utilizing a principal component analysis (PCA) to estimate MS severity using a Japanese claims database. METHODS An MS severity score was developed using a PCA. Factors related to functional systems for Expanded Disability Status Scale (EDSS) and higher disease severity (74 diagnoses, 68 drug prescriptions, and 77 procedures) were extracted from the claims database (April 2008-August 2018). The score (PC1 score) was developed for each patient-year-each year from the first diagnosis (excluding the year of the first diagnosis), based on the first principal component of the included factors. Finally, the patient-years were classified into quartiles based on the PC1 score, and demographic information and medical status were analyzed. RESULTS The database contained 7067 patients with MS. The highest score group had a higher mean age (55.4 ± 0.2 [mean ± standard error] years), lower percentage of women (64.4 ± 0.7%), and longer mean disease duration from first diagnosis (8.1 ± 0.1 years) than the lowest score group (43.3 ± 0.2 years, 68.4 ± 0.8%, and 6.0 ± 0.1 years, respectively). In addition, the PC1 score of each patient positively correlated with disease duration from diagnosis. CONCLUSION We developed a PC1 score to indicate MS severity using information from a Japanese claims database. Since changes in demographic features we observed are consistent with findings of previous research, this score might represent MS severity to some extent. Further research is necessary to validate this score with clinical measurement of disability such as the EDSS.
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Ryerson LZ, Naismith RT, Krupp LB, Charvet LE, Liao S, Fisher E, de Moor C, Williams JR, Campbell N. No difference in radiologic outcomes for natalizumab patients treated with extended interval dosing compared with standard interval dosing: Real-world evidence from MS PATHS. Mult Scler Relat Disord 2022; 58:103480. [PMID: 35051898 DOI: 10.1016/j.msard.2021.103480] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 11/24/2021] [Accepted: 12/31/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Extended interval dosing (EID; average dosing interval approximately every 6 weeks) of natalizumab is associated with significantly lower risk of progressive multifocal leukoencephalopathy than standard interval dosing (SID; every 4 weeks) in patients with relapsing-remitting multiple sclerosis (MS). Real-world studies, though limited, suggest that natalizumab effectiveness is generally maintained in patients who switch to EID after initiation of stable treatment with SID. MS PATHS (Multiple Sclerosis Partners Advancing Technology and Health Solutions) is a collaborative, multicenter learning health system that generates real-world clinical and MRI data using highly standardized acquisition protocols. We compared MRI outcomes in MS PATHS patients treated with natalizumab EID versus SID. We also compared MRI outcomes in patients treated with natalizumab (EID and/or SID) versus injectable MS platform therapy. METHODS Natalizumab infusion data from the TOUCH Prescribing Program database and MS PATHS MRI assessment data from seven US sites as of July 23, 2020, were used to identify patients with relapsing-remitting MS who had received natalizumab EID or SID in the interval between two MRI scans (an MRI segment). Patients who received injectable platform MS therapy between two MRI scans were also identified. MRI data were used to determine the incidence rate and odds of developing new or enlarging T2 lesions, annualized percentage change in T2 lesion volume (T2LV), and annualized percentage change in brain parenchymal fraction (BPF). MRI outcomes were compared for 1) natalizumab EID treatment versus natalizumab SID treatment, 2) natalizumab treatment (EID + SID) versus platform therapy, and 3) natalizumab EID versus platform therapy. Propensity score-based weighting or matching were used to balance covariates at the start of MRI segments for all comparisons. RESULTS The MRI outcomes observed with natalizumab EID treatment did not differ significantly from those observed with natalizumab SID treatment. The odds ratio for any new or enlarging T2 lesion was 1.07 (95% confidence interval [CI]: 0.93, 1.24; p = 0.355), and the rate ratio (95% CI) for new or enlarging T2 lesions was 1.62 (0.93, 2.82; p = 0.090). Differences (95% CI) between EID and SID patients in mean annualized percentage change in T2LV and BPF were 1.56% (-3.77%, 6.90%; p = 0.566) and -0.11% (-0.25%, -0.10%; p = 0.096), respectively. Conversely, when MRI outcomes in natalizumab and platform therapy patients were compared, there were significant differences favoring natalizumab in all assessments: the odds of any new or enlarging T2 lesion (odds ratio: 0.69 [95% CI: 0.64, 0.75]; p<0.001), the incidence rate of new or enlarging T2 lesions (rate ratio: 0.47 [95% CI: 0.37, 0.61]; p<0.001), annualized percentage change (decrease) in T2LV (difference: -3.68% [95% CI: -7.06%, -0.30%]; p = 0.033), and annualized percentage change (increase) in BPF (difference: 0.22% [95% CI: 0.16%, 0.29%]; p<0.001). Results of the subgroup comparison of natalizumab EID patients with platform therapy patients were similar to those of the overall-natalizumab-group-versus-platform-therapy comparison. CONCLUSIONS The results indicate that natalizumab EID and SID provide comparable real-world effectiveness on quantitative MRI metrics. These data further demonstrate that natalizumab EID can provide superior real-world effectiveness to injectable platform therapy on quantitative MRI metrics.
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Affiliation(s)
- Lana Zhovtis Ryerson
- New York University Langone Multiple Sclerosis Comprehensive Care Center, 240 East 38th Street, New York, NY 10016, USA.
| | - Robert T Naismith
- Department of Neurology, Washington University, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - Lauren B Krupp
- New York University Langone Multiple Sclerosis Comprehensive Care Center, 240 East 38th Street, New York, NY 10016, USA; Perlmutter Cancer Center at NYU Langone Huntington Medical Group, 789 Park Ave, Huntington, NY 11743, USA
| | - Leigh E Charvet
- New York University Langone Multiple Sclerosis Comprehensive Care Center, 240 East 38th Street, New York, NY 10016, USA
| | - Shirley Liao
- Biogen, 225 Binney St., Cambridge, MA 02142, USA, at the time of this analysis
| | | | - Carl de Moor
- Biogen, 225 Binney St., Cambridge, MA 02142, USA
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Chisari CG, Grimaldi LM, Salemi G, Ragonese P, Iaffaldano P, Bonavita S, Sparaco M, Rovaris M, D'Arma A, Lugaresi A, Ferrò MT, Grossi P, Di Sapio A, Cocco E, Granella F, Curti E, Lepore V, Trojano M, Patti F. Clinical effectiveness of different natalizumab interval dosing schedules in a large Italian population of patients with multiple sclerosis. J Neurol Neurosurg Psychiatry 2020; 91:1297-1303. [PMID: 33055141 DOI: 10.1136/jnnp-2020-323472] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/16/2020] [Accepted: 07/07/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Natalizumab (NTZ) is one of the most effective treatment options for multiple sclerosis (MS) treatment. Our study aimed to evaluate the effectiveness of NTZ when administered according to the extended dosing strategy compared with standard 4-weekly administration in a large Italian MS population. MATERIALS AND METHODS This retrospective multicentre study included patients with relapsing-remitting MS (RR-MS) who received NTZ administrations between the 1 June 2012 and the 15 May 2018 and were followed by the 'Italian MS Register'. All patients with MS were stratified into two groups based on NTZ administration schedule: standard interval dosing (SID) patients who received infusions on average from 28 to 32 days (median 30) and extended interval dosing (EID) including patients who have been infused with interval between 33 and 49 days (median 43). Clinical data were assessed at baseline (before starting NTZ), after 12 (T1) and 24 months (T2) of treatment. RESULTS Out of 5231 patients with RR-MS screened, 2092 (mean age 43.2±12.0, 60.6% women) were enrolled. A total of 1254 (59.9%) received NTZ according to SID, and 838 (40.1%) according to EID. At 12 and 24 months, no differences in terms of annualised relapse rate and disability status were found between the two groups. Progression index and confirmed disability worsening were similar between the two groups. DISCUSSION The use of NTZ with an extended interval schedule showed similar effectiveness compared with SID. Unchanged clinical efficacy of EID schedule may raise the question of a possible advantage in terms of tolerability and safety.
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Affiliation(s)
- Clara Grazia Chisari
- Department of Surgical and Medical Sciences Advanced Technologies GF Ingrassia, University of Catania, Catania, Italy
| | - Luigi Maria Grimaldi
- Neurology Unit, Fondazione Istituto San Raffaele G. Giglio di Cefalù, Cefalu, Sicily, Italy
| | - Giuseppe Salemi
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, Università degli Studi di Palermo, Palermo, Sicilia, Italy
| | - Paolo Ragonese
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, Università degli Studi di Palermo, Palermo, Sicilia, Italy
| | - Pietro Iaffaldano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, Università degli Studi di Bari Aldo Moro, Bari, Puglia, Italy
| | - Simona Bonavita
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Napoli, Campania, Italy
| | - Maddalena Sparaco
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Napoli, Campania, Italy
| | - Marco Rovaris
- Multiple Sclerosis Center and Rehabilitation Unit, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Alessia D'Arma
- Multiple Sclerosis Center and Rehabilitation Unit, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Alessandra Lugaresi
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Emilia-Romagna, Italy.,Istituto delle Scienze Neurologiche di Bologna, Unità Operative Semplici d'Istituto (UOSI) Riabilitazione Sclerosi Multipla, Bologna, Italy
| | - Maria Teresa Ferrò
- Neurology Unit, Presidio Ospedale Maggiore di Crema, Crema, Lombardia, Italy
| | - Paola Grossi
- Neurology Unit, Presidio Ospedale Maggiore di Crema, Crema, Lombardia, Italy
| | - Alessia Di Sapio
- Department of Neurology, Ospedale Regina Montis Regalis-ASLCN1, Presidio di Mondovì Ceva, Mondovi, Piedmont, Italy
| | - Eleonora Cocco
- Multiple Sclerosis Centre Binaghi Hospital, ATS Sardegna, University of Cagliari, Cagliari, Sardegna, Italy
| | - Franco Granella
- Neurosciences Unit, Department of Medicine and Surgery, Università degli Studi di Parma, Parma, Emilia-Romagna, Italy
| | - Erica Curti
- Neurosciences Unit, Department of Medicine and Surgery, Università degli Studi di Parma, Parma, Emilia-Romagna, Italy
| | - Vito Lepore
- Istituto di Ricerche Farmacologiche Mario Negri Sede di Milano, Milano, Lombardia, Italy.,Coreserach Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, Università degli Studi di Bari Aldo Moro, Bari, Puglia, Italy
| | - Francesco Patti
- Department of Surgical and Medical Sciences Advanced Technologies GF Ingrassia, University of Catania, Catania, Italy
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Dekker I, Leurs C, Hagens M, van Kempen Z, Kleerekooper I, Lissenberg-Witte B, Barkhof F, Uitdehaag B, Balk L, Wattjes M, Killestein J. Long-term disease activity and disability progression in relapsing-remitting multiple sclerosis patients on natalizumab. Mult Scler Relat Disord 2019; 33:82-87. [DOI: 10.1016/j.msard.2019.05.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/13/2019] [Accepted: 05/24/2019] [Indexed: 12/11/2022]
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Comparative effectiveness of dimethyl fumarate versus fingolimod and teriflunomide among MS patients switching from first-generation platform therapies in the US. Mult Scler Relat Disord 2018; 27:101-111. [PMID: 30368221 DOI: 10.1016/j.msard.2018.09.038] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 09/28/2018] [Accepted: 09/29/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Previous real-world comparative research of MS disease modifying therapies (DMTs) in the overall population has suggested dimethyl fumarate (DMF) to be comparable to fingolimod (FTY) and more efficacious than teriflunomide (TERI) in reducing relapses. However, there is limited comparative evidence in patients switching from platform DMTs in the US. The objective of the study was to compare the annualized relapse rate (ARR) and risk of relapse in MS patients who have switched from a platform therapy to DMF, FTY, or TERI. METHODS MS patients (18-65 years old) initiating an oral DMT from June 2013 to March 2015 were identified from the Truven MarketScan® Commercial Claims Database. The index date was the date of first oral DMT fill. Patients were required to have: continuous enrollment in the database for 12 months pre-index date and ≥3 months post-index date; ≥1 MS diagnosis over the pre-index period; discontinuation of a platform DMT with no evidence of oral or infusion DMTs over the pre-index period; and adherence to the index drug for ≥90 days. DMF patients were propensity-score matched (PSM) 3:1 to FTY and to TERI based on age, gender, region, a claims-based MS severity measure, ARR, and number of hospitalizations over the pre-index period. Patients were censored when they dropped out of the database or at the end of the study period (March 31, 2016). Post-index relapses were annualized. RESULTS The database included 20,311 oral DMT users. After applying the study criteria, the PSM yielded 1602:534 switch patients for the DMF-FTY matched cohort. DMF-FTY patients were well-matched on all covariates: age (mean = 44 for both), gender (28% vs. 26% male, respectively), MS severity measure (0.99 vs. 1.08), and baseline ARR (0.40 vs. 0.44). PSM yielded 833:279 switch patients for the DMF-TERI match. DMF-TERI patients were well-matched on all covariates: age (mean = 50), gender (24% vs. 25% male), MS severity measure (0.86 vs. 0.99), and baseline ARR (0.23 vs. 0.30). The standardized differences confirmed balance across all covariates for matched cohorts. The matched DMF-FTY cohorts had comparable post-index ARR (Rate Ratio [RR] = 1.07 [95% Cl: 0.861, 1.328]) and risk of relapse (Hazard Ratio [HR ]= 0.996 [95% CI: 0.803, 1.236]). Post-index ARR was significantly lower with DMF in comparison to TERI (RR = 0.667 [0.486, 0.914]). The risk of relapse was also significantly lower when switching to DMF than TERI (HR = 0.679 [0.503, 0.917]). CONCLUSION In this analysis, the effectiveness profiles for those oral DMT users specifically switching from platform therapies are consistent with findings from previous research conducted among all oral DMT users, regardless of prior therapy.
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Houtchens MK, Edwards NC, Phillips AL. Relapses and disease-modifying drug treatment in pregnancy and live birth in US women with MS. Neurology 2018; 91:e1570-e1578. [PMID: 30266887 PMCID: PMC6205686 DOI: 10.1212/wnl.0000000000006382] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 07/16/2018] [Indexed: 11/17/2022] Open
Abstract
Objective To evaluate relapse rates and disease-modifying drug (DMD) treatment in US women with multiple sclerosis (MS) and a live birth. Methods This retrospective administrative claims database study used US commercial health plan data from women with MS and a live birth from January 1, 2006, to June 30, 2015. Relapses and DMD treatment were evaluated 1-year prepregnancy, during pregnancy, during puerperium (6 weeks postpregnancy), and 1-year postpregnancy. Relapse was defined as MS-related hospitalization, emergency room visit, or outpatient visit with corticosteroid prescription within 7 days. Generalized estimating equation models for longitudinal data tested for differences between prepregnancy vs the other time periods. Results A total of 2,158 patients were eligible. The odds of relapse declined during pregnancy (odds ratio [OR] 0.623, 95% confidence interval [CI] 0.521–0.744; p < 0.0001), increased during puerperium (OR 1.710, 95% CI 1.358–2.152; p < 0.0001), and ended at a higher level during the last 3 postpartum quarters (OR 1.216, 95% CI 1.052–1.406; p = 0.0081). The proportion of women with DMD treatment was rather low overall: approximately 20% prepregnancy, bottoming to 1.9% during the second trimester, and peaking at 25.5% 9 to 12 months postpartum. DMD treatment declined significantly during pregnancy (OR 0.171, 95% CI 0.144–0.203; p < 0.0001), remained lower during puerperium (OR 0.361, 95% CI 0.312–0.418; p < 0.0001), and ended at a higher level during the last 3 postpartum quarters (OR 1.259, 95% CI 1.156–1.371; p < 0.0001). Conclusions The rate of MS relapse decreased during pregnancy, increased 6 months postpartum, and decreased 6 to 12 months postpartum. DMD treatment was uncommon in the year before pregnancy, further decreased immediately prepregnancy and during pregnancy, and increased postpartum.
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Affiliation(s)
- Maria K Houtchens
- From the Partners MS Center (M.K.H.), Brigham and Women's Hospital, Harvard Medical School, Boston; Health Services Consulting Corporation (N.C.E.), Boxborough; and EMD Serono, Inc. (A.L.P.), Rockland, MA.
| | - Natalie C Edwards
- From the Partners MS Center (M.K.H.), Brigham and Women's Hospital, Harvard Medical School, Boston; Health Services Consulting Corporation (N.C.E.), Boxborough; and EMD Serono, Inc. (A.L.P.), Rockland, MA
| | - Amy L Phillips
- From the Partners MS Center (M.K.H.), Brigham and Women's Hospital, Harvard Medical School, Boston; Health Services Consulting Corporation (N.C.E.), Boxborough; and EMD Serono, Inc. (A.L.P.), Rockland, MA
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Groeneweg M, Forrester SH, Arnold B, Palazzo L, Zhu W, Yoon P, Scearce T. One-Year Outcomes of an Integrated Multiple Sclerosis Disease Management Program. J Manag Care Spec Pharm 2018; 24:458-463. [PMID: 29694287 PMCID: PMC10397632 DOI: 10.18553/jmcp.2018.24.5.458] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is associated with high total health care cost, the majority of which is attributable to medications. Patients with MS are less likely to experience relapses, emergency department (ED) visits, and hospitalizations when they are adherent to disease-modifying treatments. Disease management programs are hypothesized to improve medication adherence thereby improving clinical and economic outcomes. OBJECTIVE To evaluate the clinical and economic effects of a specialty pharmacy and chronic disease management program for patients with MS from a health plan perspective. METHODS This study was a retrospective analysis using prescription drug claims, medical claims, and electronic medical record information (2013-2015) 1 year before and after enrollment in the disease management program for members with 24 months of continuous health plan coverage. Medication adherence was calculated using proportion of days covered (PDC). Relapse rate was defined as an MS outpatient visit associated with a corticosteroid dispense within 7 days of the visit or an MS hospitalization. Disease progression was assessed using the Modified Expanded Disability Status Scale (mEDSS). Resource use included outpatient visits, ED visits, and hospitalizations. Cost information was collected as health plan-paid amount and was reported in 2013 U.S. dollars. RESULTS The analysis included 377 patients (mean age 55 years, 76.4% female). After enrollment in the program, 78.7% of the study group had a PDC of ≥ 0.80 compared with 70.0% before enrollment (P < 0.001). There was no difference in MS relapse rate (0.25 after vs. 0.45 before, P = 0.11) or mEDSS score (3.77 after vs. 3.76 before, P = 0.19). Health care resource utilization was minimal and did not change significantly throughout the study period: mean outpatient visits (13.09 after vs. 13.78 before, P = 0.69); mean ED visits (0.18 after vs. 0.16 before, P = 0.60); and mean hospitalizations (0.12 after vs. 0.12 before, P = 1.00). This nonsignificant finding remained when the analysis was limited to MS-related visits only. Average annual health plan spend per patient on MS medications significantly increased ($55,835 after vs. $40,883 before, P < 0.001). CONCLUSIONS Specialty pharmacy and chronic disease management for patients with MS can increase the proportion of patients adherent to medication. The increase in health plan spend on MS medications is not offset by savings in health care resource utilization. DISCLOSURES This study was funded by Kaiser Permanente Washington Health Research Institute and Kaiser Permanente Washington Pharmacy Administration. The authors have no disclosures to report.
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Affiliation(s)
| | | | | | - Lorella Palazzo
- 3 Kaiser Permanente Washington Health Research Institute, Seattle
| | - Weiwei Zhu
- 3 Kaiser Permanente Washington Health Research Institute, Seattle
| | - Paul Yoon
- 2 Kaiser Permanente Washington, Renton
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Abstract
PURPOSE OF REVIEW This review evaluates current and late-phase developing therapies for multiple sclerosis in regard to therapeutic efficacy and patient safety in light of recent published and presented observations from 2015. RECENT FINDINGS We describe data that provide supportive evidence for comparisons of therapeutic efficacy of multiple sclerosis therapies and review available data on rare but serious adverse events associated with these therapies. SUMMARY Serious adverse events that are sometimes rare and unpredictable may substantially alter current approaches to multiple sclerosis treatments. New therapies that have proved superior effects compared with older therapies will also impact multiple sclerosis treatment practice in the near future.
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Colais P, Agabiti N, Davoli M, Buttari F, Centonze D, De Fino C, Di Folco M, Filippini G, Francia A, Galgani S, Gasperini C, Giuliani M, Mirabella M, Nociti V, Pozzilli C, Bargagli A. Identifying Relapses in Multiple Sclerosis Patients through Administrative Data: A Validation Study in the Lazio Region, Italy. Neuroepidemiology 2017; 48:171-178. [PMID: 28793295 DOI: 10.1159/000479515] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 07/11/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Relapse is frequently considered an outcome measure of disease activity in relapsing-remitting multiple sclerosis (MS). The objectives of this study were to identify relapse episodes in patients with MS in the Lazio region using health administrative databases and to evaluate the validity of the algorithm using patients enrolled at MS treatment centers. METHODS MS cases were identified in the period between January 1, 2006 and December 31, 2009 using data from regional Health Information Systems (HIS). An algorithm based on HIS was used to identify relapse episodes, and patients recruited at MS centers were used to validate the algorithm. Positive and negative predictive values (PPV, NPV) and the Cohen's kappa coefficient were calculated. RESULTS The overall MS population identified through HIS consisted of 6,094 patients, of whom 67.1% were female and the mean age was 41.5. Among the MS patients identified by the algorithm, 2,242 attended the centers and 3,852 did not. The PPV was 58.9%, the NPV was 76.3%, and the kappa was 0.36. CONCLUSIONS The proposed algorithm based on health administrative databases does not seem to be able to reliably detect relapses; however, it may be a helpful tool to detect healthcare utilization, and therefore to identify the worsening condition of a patient's health.
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Affiliation(s)
- Paola Colais
- Department of Epidemiology, Regional Health Service, Lazio Region, Rome, Italy
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Munsell M, Frean M, Menzin J, Phillips AL. Development and validation of a claims-based measure as an indicator for disease status in patients with multiple sclerosis treated with disease-modifying drugs. BMC Neurol 2017; 17:106. [PMID: 28583104 PMCID: PMC5460356 DOI: 10.1186/s12883-017-0887-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 05/23/2017] [Indexed: 11/10/2022] Open
Abstract
Background Administrative healthcare claims data provide a mechanism for assessing and monitoring multiple sclerosis (MS) disease status across large, clinically representative “real-world” populations. The estimation of MS disease status using administrative claims can be a challenge, however, due to a lack of detailed clinical information. Retrospective claims analyses in MS have traditionally used rates of MS relapses to approximate disease status. Healthcare costs may be alternate, broader claims-based indicators of disease activity because costs reflect multiple facets of care of patients with MS, and there is a strong correlation between quality of life of patients with MS and costs of the disease. This study developed, tested, and validated a healthcare cost-based measure to serve as an indicator of overall disease status in patients with MS treated with disease-modifying drugs (DMDs) utilizing administrative claims. Methods Using IMS Health Real World Data Adjudicated Claims – US data (January 2006–June 2013), a negative binomial regression predicted annual all-cause medical costs. Coefficients reaching statistical significance (p < 0.05) and increasing costs by ≥5% were selected for inclusion into an MS-specific severity score (scale of 0 to 100). Components of the score included rehabilitation services, altered mental state, pain, disability, stiffness, balance disorder, urinary incontinence, numbness, malaise/fatigue, and infections. Coefficient weights represented each predictor’s contribution. The predictive model was derived using 50% of a random sample and tested/validated using the remaining 50%. Results Average overall predicted annual total medical cost was $11,134 (development sample, n = 11,384, vs. $10,528 actual) and $11,303 (validation sample, n = 11,385, vs. $10,620 actual). The model had consistent bias (approximately +$600 or +6% of actual costs) for both samples. In the validation sample, mean MS disease status scores were 0.24, 8.95, and 21.77 for low, medium, and high tertiles, respectively. Mean costs were most accurately predicted among less severe patients ($5243 predicted vs. $5233 actual cost for lowest tertile). Conclusion The algorithm developed in this study provides an initial step to helping understand and potentially predict cost changes for a commercially insured MS population. Electronic supplementary material The online version of this article (doi:10.1186/s12883-017-0887-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michael Munsell
- Boston Health Economics, Inc., 20 Fox Road, Waltham, MA, 02451, USA
| | - Molly Frean
- Boston Health Economics, Inc., 20 Fox Road, Waltham, MA, 02451, USA
| | - Joseph Menzin
- Boston Health Economics, Inc., 20 Fox Road, Waltham, MA, 02451, USA.
| | - Amy L Phillips
- Health Economics & Outcomes Research, EMD Serono, Inc., One Technology Place, Rockland, MA, 02370, USA
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Correia I, Batista S, Galego O, Marques IB, Jesus-Ribeiro J, Martins AI, Nunes C, Macário MC, Cunha L, Sousa L. Long-term effectiveness and safety of natalizumab in a Portuguese population. Int Immunopharmacol 2017; 46:105-111. [DOI: 10.1016/j.intimp.2017.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 03/02/2017] [Accepted: 03/04/2017] [Indexed: 11/27/2022]
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Kalincik T, Butzkueven H. Observational data: Understanding the real MS world. Mult Scler 2016; 22:1642-1648. [DOI: 10.1177/1352458516653667] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 05/16/2016] [Indexed: 11/16/2022]
Abstract
Randomised clinical trials are the primary source of evidence, guiding the use of disease-modifying drugs in multiple sclerosis. However, the spectrum of questions that can be answered in the trial setting is relatively narrow. ‘Real-world’ observational data analysis has always been the major source of evidence for epidemiology, aetiology, outcomes and prognostics, but is now also increasingly used to study treatment effectiveness. While analyses of observational cohorts typically offer superior power, generalisability and duration of follow-up relative to prospective randomised trials, they are also subject to multiple biases. It is the role of researchers to mitigate bias and to ensure the results of observational studies are robust and valid. In this review of observational data research, we provide an overview of the inherent biases, the available mitigation strategies, and the state and direction of contemporary treatment outcomes research. The review will help clinicians critically appraise published results of observational studies.
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Affiliation(s)
- Tomas Kalincik
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia/Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Helmut Butzkueven
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia/Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia/Box Hill Hospital, Monash University, Box Hill, VIC, Australia
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Macchi B, Marino-Merlo F, Nocentini U, Pisani V, Cuzzocrea S, Grelli S, Mastino A. Role of inflammation and apoptosis in multiple sclerosis: Comparative analysis between the periphery and the central nervous system. J Neuroimmunol 2015; 287:80-7. [PMID: 26439966 DOI: 10.1016/j.jneuroim.2015.08.016] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 08/19/2015] [Accepted: 08/24/2015] [Indexed: 01/23/2023]
Abstract
Multiple sclerosis (MS) is a complex, multifactorial disease associated with damage to the axonal myelin sheaths and neuronal degeneration. The pathognomonic event in MS is oligodendrocyte loss accompanied by axonal damage, blood-brain barrier leakage, inflammation and infiltration of immune cells. The etiopathogenesis of MS is far from being elucidated. However, increasing evidence suggests that the inflammatory and apoptotic responses, occurring in patients either at the peripheral level or the central nervous system (CNS), can play a role. In this review, we give a comprehensive picture of general aspects of inflammation and apoptosis in MS, with special emphasis on the until now not well highlighted possible links between phenomena relevant to these aspects occurring in either the periphery or in the CNS during MS.
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Affiliation(s)
- Beatrice Macchi
- Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133 Rome, Italy.
| | - Francesca Marino-Merlo
- Department of Biological and Environmental Sciences, University of Messina, Via F. Stagno d'Alcontres 31, 98166 Messina, Italy.
| | - Ugo Nocentini
- Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133 Rome, Italy; I.R.C.C.S. "Santa Lucia" Foundation, Via Ardeatina 306, 00179 Rome, Italy.
| | - Valerio Pisani
- I.R.C.C.S. "Santa Lucia" Foundation, Via Ardeatina 306, 00179 Rome, Italy.
| | - Salvatore Cuzzocrea
- Department of Biological and Environmental Sciences, University of Messina, Via F. Stagno d'Alcontres 31, 98166 Messina, Italy.
| | - Sandro Grelli
- Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata", Via Montpellier 1, 00133 Rome, Italy.
| | - Antonio Mastino
- Department of Biological and Environmental Sciences, University of Messina, Via F. Stagno d'Alcontres 31, 98166 Messina, Italy; The Institute of Translational Pharmacology, CNR, Via Fosso del Cavaliere 100, 00133 Rome, Italy.
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