The use of epidemiological multiple sclerosis registers in research: the Danish MS Registry

NARCOMS and Other Registries in Multiple Sclerosis: Issues and Insights

Observational studies and registries can play a critical role in elucidating the natural and treated history of multiple sclerosis (MS) and identifying factors associated with outcomes such as disability and health-related quality of life. The North American Research Committee on Multiple Sclerosis (NARCOMS) Registry is one of multiple registries worldwide that focuses on people with MS, but one of the very few patient-driven MS registries. On the 25th anniversary of the first data collection for the NARCOMS Registry, we discuss the importance of disease registries in the MS field, describe key concepts related to registry design and management, and highlight findings from MS registries relevant to clinical care or health policy.

Multiple sclerosis incidence rate in southern Iran: a Bayesian epidemiological study

Background

Multiple Sclerosis (MS) remains to be a public health challenge, due to its unknown biological mechanisms and clinical impacts on young people. The prevalence of this disease in Iran is reported to be 5.30 to 74.28 per 100,000-person. Because of high prevalence of this disease in Fars province, the purpose of this study was to assess the spatial pattern of MS incidence rate by modeling both the associations s of spatial dependence between neighboring regions and risk factors in a Bayesian Poisson model, which can lead to the improvement of health resource allocation decisions.

Method

Data from 5468 patients diagnosed with MS were collected, according to the McDonald’s criteria. New cases of MS were reported by the MS Society of Fars province from 1991 until 2016. The association between the percentage of people with low vitamin D intake, smoking, abnormal BMI and alcohol consumption in addition to spatial structure in a Bayesian spatio-temporal hierarchical model were used to determine the relative risk and trend of MS incidence rate in 29 counties of Fars province.

Results

County-level crude incidence rates ranged from 0.22 to 11.31 cases per 100,000-person population. The highest relative risk was estimated at 1.80 in the county of Shiraz, the capital of Fars province, while the lowest relative risk was estimated at 0.11 in Zarindasht county in southern of Fars. The percentages of vitamin D supplementation intake and smoking were significantly associated with the incidence rate of MS. The results showed that 1% increase in vitamin D supplementation intake is associated with 2% decrease in the risk of MS and 1% increase in smoking is associated with 16% increase in the risk of MS.

Conclusion

Bayesian spatio-temporal analysis of MS incidence rate revealed that the trend in the south and south east of Fars province is less steep than the mean trend of this disease. The lower incidence rate was associated with a higher percentage of vitamin D supplementation intake and a lower percentage of smoking. Previous studies have also shown that smoking and low vitamin D, among all covariates or risk factors, might be associated with high incidence of MS.

Obesity and multiple sclerosis: prevalence, susceptibility and progression in disability

Recent emerging data indicate that obesity is an important risk factor for multiple sclerosis (MS) susceptibility and may be associated with MS disability progression. Marked interactions between obesity and human leukocyte antigen (HLA) genotype with regard to the risk of MS have been reported. Evidence from Mendelian randomization studies also point to a causal relationship between obesity and MS risk. In this report, we aimed to analyze the current evidence of the relationship between obesity and risk of MS and disability progression, examine data on the interaction between obesity and HLA risk genes of MS and Mendelian randomization studies and to explore the plausible biological mechanisms that may underlie this relationship.

The Norwegian Multiple Sclerosis Registry and Biobank

Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system with unknown cause and various benefits from disease modifying therapies. Systematic recording of data into national MS registries is therefore needed to optimize treatment and define the pathogenesis of the disease. The Norwegian MS Registry and Biobank was established for systematic collection of clinical and epidemiological data, as well as biological samples. Data collection is based on informed consent from the individual patients and recordings by treating neurologists. All researchers have, by application, access to data and biological samples from the Norwegian Multiple Sclerosis Registry and Biobank. By this combined effort from both patients and healthcare personnel, the Registry and Biobank aims to facilitate research for improved understanding of disease mechanisms and improved health care in MS.

Register-based incidence of multiple sclerosis in Brittany (north-western France), 2000-2001

OBJECTIVES

To report on multiple sclerosis (MS) incidence in Brittany, north-western France.

MATERIALS & METHODS

From 2000, we set up a population-based register for patients presenting a putative incident MS (PIMS), that is first symptoms compatible with MS onset. We used 3 medical sources of case ascertainment (neurologists, CSF, regional MS-Clinic). Eligibility criteria required both clinical onset and being permanent resident of Brittany in 2000 or 2001. From 2010, all medical records were tracked, the 10-year follow-up allowing previously reported data to be updated.

RESULTS

Of 313 eligible PIMS, there were 208 definite MS (both McDonald and Poser criteria), 41 CIS-probable MS (Poser criteria), 32 CIS-possible MS and 32 non-MS. Our incident cohort of 249 MS cases with definite/probable MS (sex ratio 2.95) gave a crude annual incidence of 4.28 per 100,000 inhabitants (6.22 for women, 2.23 for men), and age-standardized rates (adjustment to the European population) of 4.41 [3.32-5.51], 6.68 [4.75-8.60], and 2.21 [1.12-3.31], respectively. Age-specific rates by gender and initial course showed that attack onset MS peaked at 25-29 years and progressive onset MS at 40-44 years in women (20-24 years and 45-49 years in men, respectively).

CONCLUSIONS

Brittany is confirmed a high-risk region for MS. Our data show marked differences in sex-specific pattern of MS incidence by clinical course and point out 25- to 29-year-old women as having the highest MS risk. While temporal variations cannot be excluded, comparison with overall French data suggests that other factors rather than latitude may influence the MS risk in France.

Bibliometric profile of the global scientific research on multiple sclerosis (2003-2012)

BACKGROUND AND OBJECTIVES

The aim of this paper is to analyse the scientific research on multiple sclerosis using a bibliographic analysis of articles published during the period 2003-2012.

METHODS

The items under study were obtained from the Science Citation Index-Expanded (SCI-E) database, which was accessed through the Web of Science (WOS) platform. All records with the term 'multiple sclerosis' in the title, plus all articles published in the journals Multiple Sclerosis and Multiple Sclerosis Journal, were analysed.

RESULTS

A total of 9778 articles, with 160,966 citations, were retrieved on multiple sclerosis, and the majority of the articles were published in Multiple Sclerosis Journal (n = 1511). The articles were published in journals belonging to 135 different subject areas, with the greatest number of papers falling under the category of clinical neurology. The countries that published the largest numbers of articles were the United States (US) (n = 2786), Italy (n = 1263), the United Kingdom (n = 1147) and Germany (n = 1018). International collaborations produced 20.4% of the papers.

CONCLUSIONS

We emphasise the progressive growth of publications worldwide, the publication of articles in a wide variety of journals covering numerous subject areas, and the research leadership of Western countries, most notably European countries, the US and Canada.

Pregnancy, sex and hormonal factors in multiple sclerosis

BACKGROUND

Multiple sclerosis (MS) is influenced by pregnancy, sex and hormonal factors.

OBJECTIVES

A comprehensive understanding of the role of pregnancy, sex and hormonal factors can provide insights into disease mechanisms, and new therapeutic developments and can provide improved patient care and treatment.

METHODS

Based on an international conference of experts and a comprehensive PubMed search for publications on these areas in MS, we provide a review of what is known about the impact of these factors on disease demographics, etiology, pathophysiology and clinical course and outcomes.

RESULTS AND CONCLUSIONS

Recommendations are provided for counseling and management of people with MS before conception, during pregnancy and after delivery. The use of disease-modifying and symptomatic therapies in pregnancy is problematic and such treatments are normally discontinued. Available knowledge about the impact of treatment on the mother, fetus and newborn is discussed. Recommendations for future research to fill knowledge gaps and clarify inconsistencies in available data are made.

Childhood body mass index and multiple sclerosis risk: a long-term cohort study

BACKGROUND

Obesity in late adolescence has been associated with an increased risk of multiple sclerosis (MS); however, it is not known if body size in childhood is associated with MS risk.

METHODS

Using a prospective design we examined whether body mass index (BMI) at ages 7-13 years was associated with MS risk among 302,043 individuals in the Copenhagen School Health Records Register (CSHRR). Linking the CSHRR with the Danish MS registry yielded 774 MS cases (501 girls, 273 boys). We used Cox proportional hazards models to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS

Among girls, at each age 7-13 years, a one-unit increase in BMI z-score was associated with an increased risk of MS (HR(age 7)=1.20, 95% CI: 1.10-1.30; HR(age 13)=1.18, 95% CI: 1.08-1.28). Girls who were ≥95(th) percentile for BMI had a 1.61-1.95-fold increased risk of MS as compared to girls <85(th) percentile. The associations were attenuated in boys. The pooled HR for a one-unit increase in BMI z-score at age 7 years was 1.17 (95% CI: 1.09-1.26) and at age 13 years was 1.15 (95% CI: 1.07-1.24).

CONCLUSION

Having a high BMI in early life is a risk factor for MS, but the mechanisms underlying the association remain to be elucidated.

A need for national registries and international collaborative research in multiple sclerosis

OBJECTIVE

There is a growing need to identify biomarkers for early diagnosis and treatment in multiple sclerosis (MS). Such markers may also be involved in the cause and pathogenesis of the disease.

METHODS

Established national MS registries have through several decades allowed data collection to facilitate MS research. The European MS Registry (EUReMS) is a recent international collaborative effort to ultimately promote MS research and quality in health care across European countries. International collaborations based on such initiatives can facilitate studies on new biomarkers in MS.

RESULTS

Important studies on data from MS registries, as well as national- and international collaboration networks have been conducted.

CONCLUSION

The symposium "National MS Registries--to improve health care and research in Multiple Sclerosis" held in Bergen, Norway, earlier this year aimed to highlight the need and benefit from national MS registries and promote international collaborative research in MS.

The Norwegian Multiple Sclerosis Registry and Biobank

OBJEVTIVES: Multiple sclerosis is a chronic inflammatory disease of the central nervous system with unknown cause and without any curable treatment. Research aiming at defining the pathogenesis of the disease is therefore needed.

METHODS

The Norwegian Multiple Sclerosis Registry and Biobank has been established for systematic collection of clinical and epidemiological data as well as biological samples. Data collection is based on informed consent from the individual patients and recordings by the treating neurologists.

RESULTS

All researchers have, by application, access to data and biological samples from the Norwegian Multiple Sclerosis Registry and Biobank.

CONCLUSION

By this combined effort from both patients and health care personnel, the Registry and Biobank aims to facilitate research for improved understanding of disease mechanisms and improved health care in multiple sclerosis.