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Lancia S, Marrie RA, Cutter G, Fox RJ, Salter A. Association of patient-reported cognitive impairment with quality of life and employment in multiple sclerosis. Mult Scler Relat Disord 2024; 87:105675. [PMID: 38763037 DOI: 10.1016/j.msard.2024.105675] [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: 09/01/2023] [Revised: 12/20/2023] [Accepted: 05/06/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND Cognition is frequently affected in persons with multiple sclerosis (MS). Cognitive impairment (CI) is associated with decreased quality of life (QOL) and employment status. Yet, CI assessed using patient-reported outcome measures is not as well studied and is thought to be influenced by other symptoms. Health Utilities Index 3 (HUI3) is a multi-attribute health-status classification system that assesses 8 different single attributes, including cognition. METHODS The North American Consortium of Multiple Sclerosis (NARCOMS) Registry, a voluntary, self-report registry for persons with MS, Spring 2019 survey collected the HUI3 and self-reported assessment of health-related QOL (RAND-12), cognitive status, depression, fatigue, disability, employment, disease-modifying therapy use, and sociodemographic data. We assessed the relationship between patient-reported cognitive CI from the HUI3 (HUI-C), QOL, and employment while adjusting for factors previously associated with the outcomes. For employment outcomes, the cohort was limited to participants 65 years of age or younger. RESULTS Of the 6,227 respondents, 56.4 % reported cognitive difficulty with the HUI-C. After adjusting for multiple covariates, cognitive difficulty was associated with 1.2 point lower physical QOL for each 0.1 decrease in HUI-C (p < 0.0001). Mental QOL decreased by 2 points for each 0.1 decrease in HUI-C (p < 0.0001). Cognitive difficulty was associated with a 10 % decreased odds of employment in the multivariable model (p < 0.0001). DISCUSSION Patient-reported CI was associated with lower health-related and vocational outcomes for MS patients, even after accounting for age, income, depression, fatigue, and disability associated with cognition. The HUI-C is a single attribute score derived from the HUI3 that may facilitate the evaluation of CI in MS.
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Affiliation(s)
- Samantha Lancia
- UT Southwestern Medical Center, Neurology, Section on Statistical Planning and Analysis, Dallas, TX, USA.
| | - Ruth Ann Marrie
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
| | - Gary Cutter
- University of Alabama Birmingham, Department of Biostatistics, Birmingham, AL, USA.
| | - Robert J Fox
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Amber Salter
- UT Southwestern Medical Center, Neurology, Section on Statistical Planning and Analysis, Dallas, TX, USA.
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2
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McKay KA, Wijnands JMA, Manouchehrinia A, Zhu F, Sereda P, Li J, Ye M, Trigg J, Kooij K, Ekström AM, Gisslén M, Hillert J, Hogg RS, Tremlett H, Kingwell E. Risk of Multiple Sclerosis in People Living with HIV: An International Cohort Study. Ann Neurol 2024; 95:487-494. [PMID: 38098141 DOI: 10.1002/ana.26840] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/31/2023] [Accepted: 11/10/2023] [Indexed: 03/01/2024]
Abstract
OBJECTIVE There has been interest in a possible negative association between HIV and multiple sclerosis (MS). We aimed to compare the risk of MS in a cohort of individuals living with HIV to that in the general population. METHODS Population-based health data were accessed for 2 cohorts of HIV-positive persons from Sweden and British Columbia, Canada. Incident MS was identified using MS registries or a validated algorithm applied to administrative data. Individuals with HIV were followed from 1 year after the first clinical evidence of HIV or the first date of complete administrative health data (Canada = April 1, 1992 and Sweden = January 1, 2001) until the earliest of incident MS, emigration, death, or study end (Canada = March 31, 2020 and Sweden = December 31, 2018). The observed MS incidence rate in the HIV-positive cohort was compared to the expected age-, sex-, calendar year-, income-specific, and region of birth-specific rates in a randomly selected sample of >20% of each general population. The standardized incidence ratio (SIR) for MS following the first antiretroviral therapy exposure ("ART-exposed") was also calculated. RESULTS The combined Sweden-Canada cohort included 29,163 (75% men) HIV-positive persons. During 242,248 person-years of follow-up, 14 incident MS cases were observed in the HIV-positive cohort, whereas 26.19 cases were expected. The SIR for MS in the HIV-positive population was 0.53 (95% confidence interval [CI] = 0.32-0.90). The SIR for MS following the first ART exposure was 0.55 (95% CI = 0.31-0.96). INTERPRETATION This international population-based study demonstrated a lower risk of MS among HIV-positive individuals, and HIV-positive ART-exposed individuals. These findings provide support for further exploration into the relationship among HIV, ART, and MS. ANN NEUROL 2024;95:487-494.
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Affiliation(s)
- Kyla A McKay
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - José M A Wijnands
- Medicine (Neurology), The Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ali Manouchehrinia
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Feng Zhu
- Medicine (Neurology), The Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Paul Sereda
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Jenny Li
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Monica Ye
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Jason Trigg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Katherine Kooij
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Anna Mia Ekström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases (Venhälsan), South General Hospital, Stockholm, Sweden
| | - Magnus Gisslén
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden
- Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Robert S Hogg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Helen Tremlett
- Medicine (Neurology), The Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Elaine Kingwell
- Research Department of Primary Care and Population Health, University College London, Royal Free Hospital, London, UK
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3
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Yusuf FLA, Zhu F, Evans C, Fisk JD, Zhao Y, Marrie RA, Tremlett H. Gastrointestinal conditions in the multiple sclerosis prodrome. Ann Clin Transl Neurol 2024; 11:185-193. [PMID: 38115680 PMCID: PMC10791028 DOI: 10.1002/acn3.51945] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 10/26/2023] [Accepted: 10/28/2023] [Indexed: 12/21/2023] Open
Abstract
OBJECTIVE To investigate gastrointestinal (GI)-related physician visits and drug dispensations in the 5 years preceding a first recorded demyelinating event or multiple sclerosis (MS) onset. METHODS Using linked administrative and clinical data from British Columbia (1996-2013), Canada, we identified an administrative cohort via a validated algorithm (n = 6863), a clinical cohort diagnosed at a MS clinic (n = 966), and matched controls (administrative cohort: n = 31,865; clinical cohort: n = 4534). In each cohort, the 5 years before a first demyelinating event or MS symptom onset (i.e., index date) were examined. We compared rates of GI-related physician visits and risk of ≥1 GI-related dispensation between MS cases and controls using negative binomial and robust Poisson models. Sex differences were tested using interaction terms. RESULTS The administrative cohort MS cases had higher rates of physician visits related to gastritis and duodenitis (adjusted rate/risk ratio (aRR):1.42, 95% CI: 1.10-1.83) and diseases of the esophagus (aRR: 1.46, 95% CI: 1.06-2.02) prior to the index date. MS cases also had greater risk of at least one dispensation for several drug classes, including constipation-related (aRR: 1.82, 95% CI: 1.50-2.22), antiemetics/antinauseants (aRR: 1.64, 95% CI: 1.43-1.89), and propulsives (promotility drugs; aRR: 1.62, 95% CI: 1.47-1.79). Men had a disproportionally higher relative risk for propulsives than women (aRR: men = 2.32, 95% CI: 1.79-3.00; women = 1.54, 95% CI: 1.36-1.72). Several findings were similar in the smaller clinical cohort though none reached statistical significance. INTERPRETATION GI-related physician visits and drug dispensations were more common in the 5 years before the first demyelinating event versus matched controls. GI symptoms are a measurable feature of the prodromal or early phase of MS, with a sex difference evident.
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Affiliation(s)
- Fardowsa L. A. Yusuf
- Medicine (Neurology), the Djavad Mowafaghian Centre for Brain HealthUniversity of British Columbia2211 Wesbrook MallVancouverBritish ColumbiaV6T 2B5Canada
- School of Population and Public Health, University of British Columbia2206 East MallVancouverBritish ColumbiaV6T 1Z3Canada
| | - Feng Zhu
- Medicine (Neurology), the Djavad Mowafaghian Centre for Brain HealthUniversity of British Columbia2211 Wesbrook MallVancouverBritish ColumbiaV6T 2B5Canada
| | - Charity Evans
- College of Pharmacy and Nutrition, University of Saskatchewan2A20.4 Health Sciences Bldg, 107 Wiggins AveSaskatoonSaskatchewanS7N 5E5Canada
| | - John D. Fisk
- Nova Scotia Health and the Departments of Psychiatry, Psychology & Neuroscience, and MedicineDalhousie University4066 A.J. Lane Memorial Building, 5909 Veterans' Memorial LaneHalifaxNova ScotiaB3H 2E2Canada
| | - Yinshan Zhao
- Medicine (Neurology), the Djavad Mowafaghian Centre for Brain HealthUniversity of British Columbia2211 Wesbrook MallVancouverBritish ColumbiaV6T 2B5Canada
| | - Ruth A. Marrie
- Departments of Internal Medicine and Community Health Sciences, Rady Faculty of Health Sciences, Health Sciences CentreMax Rady College of Medicine, University of ManitobaGF543, 820 Sherbrook StreetWinnipegManitobaR3A 1R9Canada
| | - Helen Tremlett
- Medicine (Neurology), the Djavad Mowafaghian Centre for Brain HealthUniversity of British Columbia2211 Wesbrook MallVancouverBritish ColumbiaV6T 2B5Canada
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Giacomini PS, Oh J, Morrow SA, Beauchemin P, Clift F, Devonshire V, Smyth P. Virtual Management of Multiple Sclerosis: Providing Access or Just Phoning it in? Can J Neurol Sci 2024; 51:113-116. [PMID: 37066757 DOI: 10.1017/cjn.2023.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Affiliation(s)
- Paul S Giacomini
- Montreal Neurological Institute and Hospital, Montreal, Québec, Canada
| | - Jiwon Oh
- St. Michael's Hospital, Toronto, Ontario, Canada
| | | | | | - Fraser Clift
- Memorial University, St. John's, Newfoundland-Labrador, Canada
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Kister I, Oh C, Douglas EA, Bacon TE, O'Shea IL, Parrotta EH, Bouley A, Lathi E, Katz J. No Increase in Symptoms Toward the End of the Ocrelizumab Infusion Cycle in Patients With Multiple Sclerosis: Symptom Burden on Ocrelizumab: A Longitudinal Study (SymBOLS). Neurol Clin Pract 2023; 13:e200185. [PMID: 37674871 PMCID: PMC10479935 DOI: 10.1212/cpj.0000000000200185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/07/2023] [Indexed: 09/08/2023]
Abstract
Background and Objectives Some patients with multiple sclerosis (MS) receiving ocrelizumab (OCR) report worsening symptoms toward the end of the 6-month infusion cycle ('wearing off'). The objective of our study was to comprehensively assess changes in symptom burden across 2 consecutive OCR infusion cycles. Methods SYMptom Burden on Ocrelizumab, a Longitudinal Study (SymBOLS; NCT04855617) was an investigator-initiated, 2-center study of patients with MS starting or receiving OCR. Patients' symptoms were assessed with NeuroQoL short forms, SymptoMScreen, and Work Productivity and Activity Impairment Questionnaire at the start-cycle, mid-cycle, and end-cycle time points in each of the 2 infusion cycles. Symptom scores at the 3 time points within each cycle were compared with repeated-measures ANOVA or the Friedman rank-sum test for non-normal variables. The proportions of patients with a meaningful symptomatic change from the start to the end of each infusion cycle were calculated, and patients whose symptoms improved, worsened, and stayed the same from the start to the end of the cycle were compared with respect to demographic and clinical characteristics. Results One hundred three patients with MS provided longitudinal data for analyses (mean age [SD]: 46.7 [12.2] years, 68% female, 33% non-White, disease duration: 15.5 [5] years, 41% with the Extended Disability Status Scale score >3). On a group level, NeuroQoL and SymptoMScreen scores mostly remained stable or even improved slightly toward the end of each cycle. On an individual level, symptoms remained unchanged across either cycle for most patients, and meaningful symptom worsening from the start to the end of the cycle was no more common than improvement. Meaningful change in symptoms in both cycles was very rare and generally in the direction of improvement toward the end cycle. Despite the lack of evidence for symptom worsening with a longer time from infusion, 54% of patients endorsed feeling of "wearing off" at least sometimes, most commonly as an increase in fatigue. Discussion Our prospective study failed to uncover evidence for the worsening of symptoms with a longer time from OCR infusion. These findings cast doubt on the existence of wearing off as a physiologic phenomenon in OCR-treated patients with MS. The perception of wearing off is likely the result of natural fluctuations in MS symptoms and attribution bias.
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Affiliation(s)
- Ilya Kister
- NYU Multiple Sclerosis Comprehensive Care Center (IK, TEB), Department of Neurology; Department of Population Health (CO), NYU Grossman School of Medicine, New York; The Elliot Lewis Center for Multiple Sclerosis Care (EAD, ILOS, AB, EL, JK), Wellesley, MA; and St. Peter's MS and Headache Center (EHP), Albany, NY
| | - Cheongeun Oh
- NYU Multiple Sclerosis Comprehensive Care Center (IK, TEB), Department of Neurology; Department of Population Health (CO), NYU Grossman School of Medicine, New York; The Elliot Lewis Center for Multiple Sclerosis Care (EAD, ILOS, AB, EL, JK), Wellesley, MA; and St. Peter's MS and Headache Center (EHP), Albany, NY
| | - Elizabeth A Douglas
- NYU Multiple Sclerosis Comprehensive Care Center (IK, TEB), Department of Neurology; Department of Population Health (CO), NYU Grossman School of Medicine, New York; The Elliot Lewis Center for Multiple Sclerosis Care (EAD, ILOS, AB, EL, JK), Wellesley, MA; and St. Peter's MS and Headache Center (EHP), Albany, NY
| | - Tamar E Bacon
- NYU Multiple Sclerosis Comprehensive Care Center (IK, TEB), Department of Neurology; Department of Population Health (CO), NYU Grossman School of Medicine, New York; The Elliot Lewis Center for Multiple Sclerosis Care (EAD, ILOS, AB, EL, JK), Wellesley, MA; and St. Peter's MS and Headache Center (EHP), Albany, NY
| | - Isabella L O'Shea
- NYU Multiple Sclerosis Comprehensive Care Center (IK, TEB), Department of Neurology; Department of Population Health (CO), NYU Grossman School of Medicine, New York; The Elliot Lewis Center for Multiple Sclerosis Care (EAD, ILOS, AB, EL, JK), Wellesley, MA; and St. Peter's MS and Headache Center (EHP), Albany, NY
| | - Erica H Parrotta
- NYU Multiple Sclerosis Comprehensive Care Center (IK, TEB), Department of Neurology; Department of Population Health (CO), NYU Grossman School of Medicine, New York; The Elliot Lewis Center for Multiple Sclerosis Care (EAD, ILOS, AB, EL, JK), Wellesley, MA; and St. Peter's MS and Headache Center (EHP), Albany, NY
| | - Andrew Bouley
- NYU Multiple Sclerosis Comprehensive Care Center (IK, TEB), Department of Neurology; Department of Population Health (CO), NYU Grossman School of Medicine, New York; The Elliot Lewis Center for Multiple Sclerosis Care (EAD, ILOS, AB, EL, JK), Wellesley, MA; and St. Peter's MS and Headache Center (EHP), Albany, NY
| | - Ellen Lathi
- NYU Multiple Sclerosis Comprehensive Care Center (IK, TEB), Department of Neurology; Department of Population Health (CO), NYU Grossman School of Medicine, New York; The Elliot Lewis Center for Multiple Sclerosis Care (EAD, ILOS, AB, EL, JK), Wellesley, MA; and St. Peter's MS and Headache Center (EHP), Albany, NY
| | - Joshua Katz
- NYU Multiple Sclerosis Comprehensive Care Center (IK, TEB), Department of Neurology; Department of Population Health (CO), NYU Grossman School of Medicine, New York; The Elliot Lewis Center for Multiple Sclerosis Care (EAD, ILOS, AB, EL, JK), Wellesley, MA; and St. Peter's MS and Headache Center (EHP), Albany, NY
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Garjani A, Liu BJY, Allen CM, Gunzler DD, Gerry SW, Planchon SM, das Nair R, Chataway J, Tallantyre EC, Ontaneda D, Evangelou N. Decentralised clinical trials in multiple sclerosis research. Mult Scler 2023; 29:317-325. [PMID: 35735014 PMCID: PMC9972228 DOI: 10.1177/13524585221100401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Randomised controlled trials (RCTs) play an important role in multiple sclerosis (MS) research, ensuring that new interventions are safe and efficacious before their introduction into clinical practice. Trials have been evolving to improve the robustness of their designs and the efficiency of their conduct. Advances in digital and mobile technologies in recent years have facilitated this process and the first RCTs with decentralised elements became possible. Decentralised clinical trials (DCTs) are conducted remotely, enabling participation of a more heterogeneous population who can participate in research activities from different locations and at their convenience. DCTs also rely on digital and mobile technologies which allows for more flexible and frequent assessments. While hospitals quickly adapted to e-health and telehealth assessments during the COVID-19 pandemic, the conduct of conventional RCTs was profoundly disrupted. In this paper, we review the existing evidence and gaps in knowledge in the design and conduct of DCTs in MS.
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Affiliation(s)
- Afagh Garjani
- Mental Health and Clinical Neurosciences
Academic Unit, School of Medicine, University of Nottingham, Nottingham,
UK/Academic Neurology, Nottingham University Hospitals NHS Trust,
Nottingham, UK
| | | | - Christopher Martin Allen
- Mental Health and Clinical Neurosciences
Academic Unit, School of Medicine, University of Nottingham, Nottingham,
UK/Academic Neurology, Nottingham University Hospitals NHS Trust,
Nottingham, UK
| | | | - Stephen William Gerry
- Centre for Statistics in Medicine, Nuffield
Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences,
University of Oxford, Oxford, UK
| | | | - Roshan das Nair
- Mental Health and Clinical Neurosciences
Academic Unit, School of Medicine, University of Nottingham, Nottingham,
UK/Institute of Mental Health, Nottinghamshire Healthcare NHS Foundation
Trust, Nottingham, UK
| | - Jeremy Chataway
- Queen Square Multiple Sclerosis Centre,
Department of Neuroinflammation, UCL Queen Square Institute of Neurology,
Faculty of Brain Sciences, University College London, London, UK/National
Institute for Health Research, University College London Hospitals
Biomedical Research Centre, London, UK/MRC CTU at UCL, Institute of Clinical
Trials and Methodology, University College London, London, UK
| | - Emma C Tallantyre
- Helen Durham Neuro-Inflammatory Unit,
University Hospital of Wales, Cardiff, UK/Division of Psychological Medicine
and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Daniel Ontaneda
- Mellen Center for Multiple Sclerosis,
Cleveland Clinic, Cleveland, OH, USA
| | - Nikos Evangelou
- N Evangelou Academic Neurology, Nottingham
University Hospitals NHS Trust, C Floor, South Block, Queen’s Medical Centre,
Nottingham NG7 2UH, UK. ;
@nikosevangelou3
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Lane J, Ng HS, Poyser C, Lucas RM, Tremlett H. Multiple sclerosis incidence: A systematic review of change over time by geographical region. Mult Scler Relat Disord 2022; 63:103932. [DOI: 10.1016/j.msard.2022.103932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/25/2022] [Accepted: 05/28/2022] [Indexed: 11/28/2022]
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8
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Teljas C, Boström I, Marrie RA, Landtblom A, Manouchehrinia A, Hillert J, McKay KA. Validating the diagnosis of multiple sclerosis using Swedish administrative data in Värmland County. Acta Neurol Scand 2021; 144:680-686. [PMID: 34357597 DOI: 10.1111/ane.13514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/09/2021] [Accepted: 07/25/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Multiple sclerosis (MS) is a chronic neurodegenerative disease of the central nervous system. Identifying MS at the population level is important for disease surveillance and allocation of resources. The Swedish National Patient Registry (NPR) has been used to study the epidemiology of MS, but the accuracy of this resource is not known. We aimed to validate a definition of MS using the Swedish NPR in Värmland County using a longitudinal cohort design. MATERIALS AND METHODS Data were extracted from the NPR, the Total Population Register, the Swedish MS Register, and medical records for the years 2001-2013. Fifteen algorithms of hospitalizations and clinic visits for MS were developed and compared with findings in medical records, which acted as the "gold standard" definition. Sensitivity, specificity, and positive and negative predictive values (PPV, NPV) were estimated. RESULTS Of 805 eligible persons identified in the NPR, 763 had MS (94.8%) according to medical records. Of these, 544 (71.3%) were also registered in the SMSreg. The case definition that had a well-balanced sensitivity and specificity required three or more clinic or hospital visits for MS (sensitivity of 85.3% (95% CI: 82.6-87.8) and specificity of 81.0% (95%CI: 65.9-91.4). CONCLUSIONS Multiple case definitions with high sensitivity and moderate specificity were found, suggesting that the NPR can be used to accurately identify persons with MS.
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Affiliation(s)
- Cecilia Teljas
- Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden
| | - Inger Boström
- Department of Biomedical and Clinical Sciences Faculty of Medicine and Health Sciences Linköping University Sweden
| | - Ruth Ann Marrie
- Rady Faculty of Health Sciences Max Rady College of MedicineUniversity of Manitoba Winnipeg MB Canada
| | - Anne‐Marie Landtblom
- Department of Biomedical and Clinical Sciences Faculty of Medicine and Health Sciences Linköping University Sweden
- Department of Neuroscience Uppsala University Uppsala Sweden
| | - Ali Manouchehrinia
- Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden
- Center for Molecular Medicine Karolinska University Hospital Stockholm Sweden
| | - Jan Hillert
- Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden
| | - Kyla A. McKay
- Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden
- Center for Molecular Medicine Karolinska University Hospital Stockholm Sweden
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Marrie RA, Tan Q, Ekuma O, Marriott JJ. Development and Internal Validation of a Disability Algorithm for Multiple Sclerosis in Administrative Data. Front Neurol 2021; 12:754144. [PMID: 34795632 PMCID: PMC8592934 DOI: 10.3389/fneur.2021.754144] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/11/2021] [Indexed: 12/04/2022] Open
Abstract
Objective: We developed and internally validated an algorithm for disability status in multiple sclerosis (MS) using administrative data. Methods: We linked administrative data from Manitoba, Canada to a clinical dataset with Expanded Disability Status Scale (EDSS) scores for people with MS. Clinical EDSS scores constituted the reference standard. We created candidate indicators using the administrative data. These included indicators based on use of particular health care services (home care, long-term care, rehabilitation admission), use of specific diagnostic codes (such as spasticity, quadriplegia), and codes based on use of Employment and Income Insurance. We developed algorithms to predict severe disability (EDSS ≥6.0), and to predict disability as a continuous measure. We manually developed algorithms, and also employed regression approaches. After we selected our preferred algorithms for disability, we tested their association with health care use due to any cause and infection after potential confounders. Results: We linked clinical and administrative data for 1,767 persons with MS, most of whom were women living in urban areas. All individual indicators tested had specificities >90% for severe disability, and all but a diagnosis of visual disturbance had positive predictive values (PPV) >70%. The combination of home care or long-term care use or rehabilitation admission had a sensitivity of 61.9%, specificity of 90.76%, PPV of 70.06% and negative predictive of 87.21%. Based on regression modeling, the best-performing algorithm for predicting the EDSS as a continuous variable included age, home care use, long-term care admission, admission for rehabilitation, visual disturbance, other paralytic syndromes and spasticity. The mean difference between observed and predicted values of the EDSS was −0.0644 (95%CI −0.1632, 0.0304). Greater disability, whether measured using the clinical EDSS or either of the administrative data algorithms was similarly associated with increased hospitalization rates due to any cause and infection. Conclusion: We developed and internally validated an algorithm for disability in MS using administrative data that may support population-based studies that wish to account for disability status but do not have access to clinical data sources with this information. We also found that more severe disability is associated with increased health care use, including due to infection.
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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
| | - Qier Tan
- Manitoba Centre for Health Policy, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Okechukwu Ekuma
- Manitoba Centre for Health Policy, 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
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10
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Koch-Henriksen N, Magyari M. Apparent changes in the epidemiology and severity of multiple sclerosis. Nat Rev Neurol 2021; 17:676-688. [PMID: 34584250 DOI: 10.1038/s41582-021-00556-y] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2021] [Indexed: 02/08/2023]
Abstract
Multiple sclerosis (MS) is an immunological disease that causes acute inflammatory lesions and chronic inflammation in the CNS, leading to tissue damage and disability. As awareness of MS has increased and options for therapy have come into use, a large amount of epidemiological data have been collected, enabling studies of changes in incidence and disease course over time. Overall, these data seem to indicate that the incidence of MS has increased, but the course of the disease has become milder, particularly in the 25 years since the first disease-modifying therapies (DMTs) became available. A clear understanding of these trends and the reasons for them is important for understanding the factors that influence the development and progression of MS, and for clinical management with respect to prevention and treatment decisions. In this Review, we consider the evidence for changes in the epidemiology of MS, focusing on trends in the incidence of the disease over time and trends in the disease severity. In addition, we discuss the factors influencing these trends, including refinement of diagnostic criteria and improvements in health-care systems that have increased diagnosis in people with mild disease, and the introduction and improvement of DMT.
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Affiliation(s)
- Nils Koch-Henriksen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. .,The Danish Multiple Sclerosis Registry, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Melinda Magyari
- The Danish Multiple Sclerosis Registry, Copenhagen University Hospital, Copenhagen, Denmark.,Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital, Copenhagen, Denmark
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Pétrin J, McColl MA, Donnelly C, French S, Finlayson M. Prioritizing the healthcare access concerns of Canadians with MS. Mult Scler J Exp Transl Clin 2021; 7:20552173211029672. [PMID: 34290879 PMCID: PMC8276490 DOI: 10.1177/20552173211029672] [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: 03/16/2021] [Accepted: 06/10/2021] [Indexed: 11/16/2022] Open
Abstract
Background Canadians with MS are high users of healthcare services, yet they report multiple unmet needs, high disease burden, and low satisfaction with care. Engaging patients in healthcare planning can lead to improvements in access and care. There is currently limited evidence that has harnessed the perspectives of Canadians with MS. Objective To identify and prioritize the healthcare access concerns of Canadians with MS. Methods A cross-sectional online survey informed by the Concerns Report Methodology was used to address the objective. Participants were recruited through multiple methods. Descriptive statistics were used to identify the main barriers to healthcare providers, and concerns report methods were used to calculate needs indexes to prioritize concerns of participants. Results 324 Canadians with MS participated in the study between November 18, 2019 and March 27, 2020. The most pressing healthcare access concerns of Canadians with MS were related to availability of healthcare providers with MS knowledge and affordability of services that aim to improve wellness. Conclusion These findings provide healthcare planners with prioritized access concerns of Canadians with MS, which can be used to guide strategic planning to improve the quality of life of these individuals.
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Affiliation(s)
- Julie Pétrin
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Mary Ann McColl
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Catherine Donnelly
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Simon French
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Marcia Finlayson
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
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12
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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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13
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Rollot F, Fauvernier M, Uhry Z, Vukusic S, Bossard N, Remontet L, Leray E. Effects of Age and Disease Duration on Excess Mortality in Patients With Multiple Sclerosis From a French Nationwide Cohort. Neurology 2021; 97:e403-e413. [PMID: 34011577 DOI: 10.1212/wnl.0000000000012224] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 04/20/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To determine the effects of current age and disease duration on excess mortality in multiple sclerosis (MS), we describe the dynamics of excess death rates over these 2 time scales and study the effect of age at MS clinical onset on these dynamics, separately in each initial phenotype. METHODS We used data from 18 French MS expert centers participating in the Observatoire Français de la Sclérose en Plaques. Patients with MS living in metropolitan France and having a clinical onset between 1960 and 2014 were included. Vital status was updated on January 1, 2016. For each MS phenotype separately (relapsing onset [RMS] or primary progressive [PPMS]), we used an innovative statistical method to model the logarithm of excess death rates by a multidimensional penalized spline of age and disease duration. RESULTS Among 37,524 patients (71% women, mean age at MS onset ± SD 33.0 ± 10.6 years), 2,883 (7.7%) deaths were observed and 7.8% of patients were lost to follow-up. For patients with RMS, there was no excess mortality during the first 10 years after disease onset; afterwards, whatever the age at onset, excess death rates increased with current age. From current age 70, the excess death rate values converged and became identical whatever the age at disease onset, which means that disease duration had no more effect. Excess death rates were higher in men, with an excess hazard ratio of 1.46 (95% confidence interval 1.25-1.70). In contrast, in patients with PPMS, excess death rates rapidly increased from disease onset, and were associated with age at onset, but not with sex. CONCLUSIONS In RMS, current age has a stronger effect on MS mortality than disease duration, while their respective effects are not clear in PPMS.
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Affiliation(s)
- Fabien Rollot
- From the Université de Lyon (F.R., S.V.), Université Claude Bernard Lyon 1; Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation (F.R., S.V.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; Observatoire Français de la Sclérose en Plaques (F.R., S.V.), Centre de Recherche en Neurosciences de Lyon, INSERM 1028 and CNRS UMR 5292, Lyon; Eugene Devic EDMUS Foundation Against Multiple Sclerosis (F.R., S.V.), Bron; Service de Biostatistique-Bioinformatique (M.F., Z.U., N.B., L.R.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Evolutive UMR 5558 (M.F., N.B., L.R.), Université Lyon 1 and CNRS, Villeurbanne; Direction des Maladies Nontransmissibles et des Traumatismes (Z.U.), Santé Publique France, Saint-Maurice; REPERES-EA 7449 (E.L.), Univ Rennes/EHESP; and CIC-P 1414 (E.L.), CHU Rennes, France.
| | - Mathieu Fauvernier
- From the Université de Lyon (F.R., S.V.), Université Claude Bernard Lyon 1; Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation (F.R., S.V.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; Observatoire Français de la Sclérose en Plaques (F.R., S.V.), Centre de Recherche en Neurosciences de Lyon, INSERM 1028 and CNRS UMR 5292, Lyon; Eugene Devic EDMUS Foundation Against Multiple Sclerosis (F.R., S.V.), Bron; Service de Biostatistique-Bioinformatique (M.F., Z.U., N.B., L.R.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Evolutive UMR 5558 (M.F., N.B., L.R.), Université Lyon 1 and CNRS, Villeurbanne; Direction des Maladies Nontransmissibles et des Traumatismes (Z.U.), Santé Publique France, Saint-Maurice; REPERES-EA 7449 (E.L.), Univ Rennes/EHESP; and CIC-P 1414 (E.L.), CHU Rennes, France
| | - Zoe Uhry
- From the Université de Lyon (F.R., S.V.), Université Claude Bernard Lyon 1; Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation (F.R., S.V.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; Observatoire Français de la Sclérose en Plaques (F.R., S.V.), Centre de Recherche en Neurosciences de Lyon, INSERM 1028 and CNRS UMR 5292, Lyon; Eugene Devic EDMUS Foundation Against Multiple Sclerosis (F.R., S.V.), Bron; Service de Biostatistique-Bioinformatique (M.F., Z.U., N.B., L.R.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Evolutive UMR 5558 (M.F., N.B., L.R.), Université Lyon 1 and CNRS, Villeurbanne; Direction des Maladies Nontransmissibles et des Traumatismes (Z.U.), Santé Publique France, Saint-Maurice; REPERES-EA 7449 (E.L.), Univ Rennes/EHESP; and CIC-P 1414 (E.L.), CHU Rennes, France
| | - Sandra Vukusic
- From the Université de Lyon (F.R., S.V.), Université Claude Bernard Lyon 1; Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation (F.R., S.V.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; Observatoire Français de la Sclérose en Plaques (F.R., S.V.), Centre de Recherche en Neurosciences de Lyon, INSERM 1028 and CNRS UMR 5292, Lyon; Eugene Devic EDMUS Foundation Against Multiple Sclerosis (F.R., S.V.), Bron; Service de Biostatistique-Bioinformatique (M.F., Z.U., N.B., L.R.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Evolutive UMR 5558 (M.F., N.B., L.R.), Université Lyon 1 and CNRS, Villeurbanne; Direction des Maladies Nontransmissibles et des Traumatismes (Z.U.), Santé Publique France, Saint-Maurice; REPERES-EA 7449 (E.L.), Univ Rennes/EHESP; and CIC-P 1414 (E.L.), CHU Rennes, France
| | - Nadine Bossard
- From the Université de Lyon (F.R., S.V.), Université Claude Bernard Lyon 1; Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation (F.R., S.V.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; Observatoire Français de la Sclérose en Plaques (F.R., S.V.), Centre de Recherche en Neurosciences de Lyon, INSERM 1028 and CNRS UMR 5292, Lyon; Eugene Devic EDMUS Foundation Against Multiple Sclerosis (F.R., S.V.), Bron; Service de Biostatistique-Bioinformatique (M.F., Z.U., N.B., L.R.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Evolutive UMR 5558 (M.F., N.B., L.R.), Université Lyon 1 and CNRS, Villeurbanne; Direction des Maladies Nontransmissibles et des Traumatismes (Z.U.), Santé Publique France, Saint-Maurice; REPERES-EA 7449 (E.L.), Univ Rennes/EHESP; and CIC-P 1414 (E.L.), CHU Rennes, France
| | - Laurent Remontet
- From the Université de Lyon (F.R., S.V.), Université Claude Bernard Lyon 1; Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation (F.R., S.V.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; Observatoire Français de la Sclérose en Plaques (F.R., S.V.), Centre de Recherche en Neurosciences de Lyon, INSERM 1028 and CNRS UMR 5292, Lyon; Eugene Devic EDMUS Foundation Against Multiple Sclerosis (F.R., S.V.), Bron; Service de Biostatistique-Bioinformatique (M.F., Z.U., N.B., L.R.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Evolutive UMR 5558 (M.F., N.B., L.R.), Université Lyon 1 and CNRS, Villeurbanne; Direction des Maladies Nontransmissibles et des Traumatismes (Z.U.), Santé Publique France, Saint-Maurice; REPERES-EA 7449 (E.L.), Univ Rennes/EHESP; and CIC-P 1414 (E.L.), CHU Rennes, France
| | - Emmanuelle Leray
- From the Université de Lyon (F.R., S.V.), Université Claude Bernard Lyon 1; Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation (F.R., S.V.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; Observatoire Français de la Sclérose en Plaques (F.R., S.V.), Centre de Recherche en Neurosciences de Lyon, INSERM 1028 and CNRS UMR 5292, Lyon; Eugene Devic EDMUS Foundation Against Multiple Sclerosis (F.R., S.V.), Bron; Service de Biostatistique-Bioinformatique (M.F., Z.U., N.B., L.R.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Evolutive UMR 5558 (M.F., N.B., L.R.), Université Lyon 1 and CNRS, Villeurbanne; Direction des Maladies Nontransmissibles et des Traumatismes (Z.U.), Santé Publique France, Saint-Maurice; REPERES-EA 7449 (E.L.), Univ Rennes/EHESP; and CIC-P 1414 (E.L.), CHU Rennes, France
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14
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Lefort M, Foucher Y, Lenain R, Vukusic S, Edan G, Leray E. Long-term effect of first-line injectable multiple sclerosis treatments: Input of a time-dependent propensity score. Pharmacoepidemiol Drug Saf 2020; 29:1680-1688. [PMID: 33078476 DOI: 10.1002/pds.5154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 09/04/2020] [Accepted: 10/14/2020] [Indexed: 11/11/2022]
Abstract
PURPOSE The long-term effect of beta-interferon and glatiramer acetate on multiple sclerosis (MS) disability progression has resulted in controversial results, probably due to a lack of appropriate control of biases as raised in observational studies. In particular, the time of the therapeutic decision is difficult to define when the controls are not treated. METHODS This retrospective observational study was based on a series of patients from the MS expert center in Rennes, France. We used a time-dependent propensity score defined as the linear predictor of a Cox model estimating the hazard of being treated at each time from MS onset. The matching procedure resulted in two groups: patients matched as treated and as not yet treated. The restricted mean times (RMST) to reach a moderate level of disability or worsening of the disability were compared between the two groups in an intention-to-treat analysis. RESULTS Of the 2383 patients included in the study, 556 were matched as treated. The matching procedure provided a good balance of both the time-fixed and the time-dependent covariates. A slight difference was observed for the time to reach a moderate level of disability, in favor of the "not yet treated" group (difference in the RMST: -0.62 [-0.91; -0.33]) while no difference was found in terms of worsening of the disability (-0.03 [-0.24; 0.33]). CONCLUSION This unexpected result is probably due to unmeasured confounders. However, this time-dependent PS warrants consideration in long-term effectiveness studies.
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Affiliation(s)
- Mathilde Lefort
- Pharmaco-epidemiology and health Services Research Department, Rennes University, EHESP, REPERES - EA 7449, Rennes, France.,Neurology Department, Univ Rennes, CHU Rennes, Inserm, CIC 1414 [(Centre d'Investigation Clinique de Rennes)], Rennes, France
| | - Yohann Foucher
- Biostatistic Department, INSERM UMR 1246 - SPHERE, Nantes University, Tours University, Nantes, France.,Nephrology Department, Nantes University Hospital, Nantes, France
| | - Remi Lenain
- Biostatistic Department, INSERM UMR 1246 - SPHERE, Nantes University, Tours University, Nantes, France.,Nephrology Department, Lille University Hospital, Lille, France
| | - Sandra Vukusic
- Neurology Department, Hospices Civils de Lyon, Service de Neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Bron, France.,Neurology Department, Observatoire Français de la Sclérose en Plaques, Centre de Recherche en Neurosciences de Lyon, INSERM 1028 et CNRS UMR 5292, Lyon, France.,Neurology Department, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France.,Neurology Department, Eugène Devic EDMUS Foundation against Multiple Sclerosis, State-Approved Foundation, Bron, France
| | - Gilles Edan
- Neurology Department, Univ Rennes, CHU Rennes, Inserm, CIC 1414 [(Centre d'Investigation Clinique de Rennes)], Rennes, France.,Neurology Department, CHU Pontchaillou, Rennes, France
| | - Emmanuelle Leray
- Pharmaco-epidemiology and health Services Research Department, Rennes University, EHESP, REPERES - EA 7449, Rennes, France.,Neurology Department, Univ Rennes, CHU Rennes, Inserm, CIC 1414 [(Centre d'Investigation Clinique de Rennes)], Rennes, France.,METIS Department, EHESP French School of Public Health, Rennes, France
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15
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Mirmosayyeb O, Brand S, Barzegar M, Afshari-Safavi A, Nehzat N, Shaygannejad V, Sadeghi Bahmani D. Clinical Characteristics and Disability Progression of Early- and Late-Onset Multiple Sclerosis Compared to Adult-Onset Multiple Sclerosis. J Clin Med 2020; 9:jcm9051326. [PMID: 32370288 PMCID: PMC7290335 DOI: 10.3390/jcm9051326] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 04/26/2020] [Accepted: 04/27/2020] [Indexed: 12/25/2022] Open
Abstract
Background: Compared to the adult onset of multiple sclerosis (AOMS), both early-onset (EOMS) and late-onset (LOMS) are much less frequent, but are often under- or misdiagnosed. The aims of the present study were: 1. To compare demographic and clinical features of individuals with EOMS, AOMS and LOMS, and 2. To identify predictors for disability progression from relapsing remitting MS (RRMS) to secondary progressive MS (SPMS). Method: Data were taken from the Isfahan Hakim MS database. Cases were classified as EOMS (MS onset ≤18 years), LOMS (MS onset >50 years) and AOMS (MS >18 and ≤50 years). Patients’ demographic and clinical (initial symptoms; course of disease; disease patterns from MRI; disease progress) information were gathered and assessed. Kaplan–Meier and Cox proportional hazard regressions were conducted to determine differences between the three groups in the time lapse in conversion from relapsing remitting MS to secondary progressive MS. Results: A total of 2627 MS cases were assessed; of these 127 were EOMS, 84 LOMS and 2416 AOMS. The mean age of those with EOMS was 14.5 years; key symptoms were visual impairments, brain stem dysfunction, sensory disturbances and motor dysfunctions. On average, 24.6 years after disease onset, 14.2% with relapsing remitting MS (RRMS) were diagnosed with secondary progressive MS (SPMS). The key predictor variable was a higher Expanded Disability Status Scale (EDSS) score at disease onset. Compared to individuals with AOMS and LOMS, those with EOMS more often had one or two relapses in the first two years, and more often gadolinium-enhancing brain lesions. For individuals with AOMS, mean age was 29.4 years; key symptoms were sensory disturbances, motor dysfunctions and visual impairments. On average, 20.5 years after disease onset, 15.6% with RRMS progressed to SPMS. The key predictors at disease onset were: a higher EDSS score, younger age, a shorter inter-attack interval and spinal lesions. Compared to individuals with EOMS and LOMS, individuals with AOMS more often had either no or three and more relapses in the first two years. For individuals with LOMS, mean age was 53.8 years; key symptoms were motor dysfunctions, sensory disturbances and visual impairments. On average, 14 years after disease onset, 25.3% with RRMS switched to an SPMS. The key predictors at disease onset were: occurrence of spinal lesions and spinal gadolinium-enhancement. Compared to individuals with EOMS and AOMS, individuals with LOMS more often had no relapses in the first two years, and higher EDSS scores at disease onset and at follow-up. Conclusion: Among a large sample of MS sufferers, cases with early onset and late onset are observable. Individuals with early, adult and late onset MS each display distinct features which should be taken in consideration in their treatment.
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Affiliation(s)
- Omid Mirmosayyeb
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran; (O.M.); (M.B.); (N.N.)
- Universal Council of Epidemiology (UCE), Universal Scientific Education and Research Network (USERN), Tehran University of Medical Sciences, Tehran 14197-33151, Iran
- Department of Neurology, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
| | - Serge Brand
- Center of Depression, Stress and Sleep Disorders, Psychiatric Clinics (UPK), University of Basel, 4002 Basel, Switzerland; (S.B.); (D.S.B.)
- Division of Sport Science and Psychosocial Health, Department of Sport, Exercise, and Health, University of Basel, 4032 Basel, Switzerland
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences (KUMS), Kermanshah 6719851351, Iran
- Sleep Disorders Research Center, Health Institute, Kermanshah University of Medical Sciences (KUMS), Kermanshah 6719851351, Iran
- School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran 1416753955, Iran
| | - Mahdi Barzegar
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran; (O.M.); (M.B.); (N.N.)
- Department of Neurology, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
| | - Alireza Afshari-Safavi
- Department of Biostatistics and Epidemiology, Faculty of Health, North Khorasan University of Medical Sciences, Bojnurd 74877-94149, Iran;
| | - Nasim Nehzat
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran; (O.M.); (M.B.); (N.N.)
- Universal Council of Epidemiology (UCE), Universal Scientific Education and Research Network (USERN), Tehran University of Medical Sciences, Tehran 14197-33151, Iran
- Faculty of Pharmacy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz 6135715794, Iran
| | - Vahid Shaygannejad
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran; (O.M.); (M.B.); (N.N.)
- Department of Neurology, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
- Correspondence:
| | - Dena Sadeghi Bahmani
- Center of Depression, Stress and Sleep Disorders, Psychiatric Clinics (UPK), University of Basel, 4002 Basel, Switzerland; (S.B.); (D.S.B.)
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences (KUMS), Kermanshah 6719851351, Iran
- Departments of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL 35209, USA
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16
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Marangi A, Farina G, Vicenzi V, Forlivesi S, Calabria F, Marchioretto F, Forgione A, Rossi F, Stenta G, Vianello M, Gajofatto A, Benedetti MD. Changing therapeutic strategies and persistence to disease-modifying treatments in a population of multiple sclerosis patients from Veneto region, Italy. Mult Scler Relat Disord 2020; 41:102004. [PMID: 32078935 DOI: 10.1016/j.msard.2020.102004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 01/18/2020] [Accepted: 02/07/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND The availability of new disease-modifying treatments (DMTs) in the last years has changed the therapeutic strategies used in Multiple Sclerosis (MS). We aimed to describe trend in DMTs utilization and persistence to treatment in a large sample of patients attending 10 MS centres from four provinces of Veneto, Italy. METHODS Demographic, clinical and DMTs information of patients regularly followed from January 2011 to August 2018 were recorded and analysed. Persistence at 12, 24 months and at last follow-up was assessed by Kaplan Meier survival analysis. Multivariable Cox- proportional hazard model was used to identify predictors of persistence. RESULTS Of 3025 MS patients 65.7% were in treatment al last follow-up. Dimethylfumarate (DMF) was the most prescribed single drug among first-line and fingolimod among second-line DMTs. In the cohort of 1391 cases starting any DMT since 2011 12.9% stopped within 6 months, 24% within 12 and 40.3% within 24 months. Disease duration > 5 years at therapy start was predictive of greater risk of discontinuation, while age and sex were not. DMF use was predictive of higher persistence at 12 and 24 months, but not at last follow-up when azathioprine and glatiramer acetate showed the highest persistence compared to other DMTs. Side effects represented the main reason of discontinuation. CONCLUSION The use of the new oral DMTs greatly increased since their approval but persistence in the long-term is not better than with old drugs. The treatment choice is still a challenge both for patients and their doctors.
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Affiliation(s)
- Antonio Marangi
- Neurology Unit, St Bortolo Hospital, Vicenza, Italy; Department of Neurosciences, Biomedicine and Movement Sciences, Section of Neurology B, University of Verona, Verona, Italy.
| | - Gabriele Farina
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Neurology B, University of Verona, Verona, Italy; Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Virginia Vicenzi
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Stefano Forlivesi
- Section of Neurology A, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Francesca Calabria
- Section of Neurology A, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Antonio Forgione
- Neurology Unit, Pederzoli Hospital, Peschiera del Garda, Verona, Italy
| | - Francesca Rossi
- Neurology Unit, Mater Salutis Hospital (AULSS9), Legnago, Verona, Italy
| | | | | | - Alberto Gajofatto
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Neurology B, University of Verona, Verona, Italy
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17
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Cohen JA, Trojano M, Mowry EM, Uitdehaag BMJ, Reingold SC, Marrie RA. Leveraging real-world data to investigate multiple sclerosis disease behavior, prognosis, and treatment. Mult Scler 2020; 26:23-37. [PMID: 31778094 PMCID: PMC6950891 DOI: 10.1177/1352458519892555] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 11/10/2019] [Indexed: 12/21/2022]
Abstract
Randomized controlled clinical trials and real-world observational studies provide complementary information but with different validity. Some clinical questions (disease behavior, prognosis, validation of outcome measures, comparative effectiveness, and long-term safety of therapies) are often better addressed using real-world data reflecting larger, more representative populations. Integration of disease history, clinician-reported outcomes, performance tests, and patient-reported outcome measures during patient encounters; imaging and biospecimen analyses; and data from wearable devices increase dataset utility. However, observational studies utilizing these data are susceptible to many potential sources of bias, creating barriers to acceptance by regulatory agencies and the medical community. Therefore, data standardization and validation within datasets, harmonization across datasets, and application of appropriate analysis methods are important considerations. We review approaches to improve the scope, quality, and analyses of real-world data to advance understanding of multiple sclerosis and its treatment, as an example of opportunities to better support patient care and research.
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Affiliation(s)
- Jeffrey A Cohen
- Department of Neurology, Mellen Center for
Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland
Clinic, Cleveland, OH, USA
| | - Maria Trojano
- Department of Basic Medical Sciences,
Neurosciences and Sense Organs, University of Bari “Aldo Moro,” Bari,
Italy
| | - Ellen M Mowry
- Department of Neurology, School of Medicine, The
Johns Hopkins University, Baltimore, MD, USA
| | - Bernard MJ Uitdehaag
- Department of Neurology, Amsterdam University
Medical Center, Amsterdam, The Netherlands
| | | | - Ruth Ann Marrie
- Departments of Internal Medicine (Neurology) and
Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College
of Medicine, University of Manitoba, Winnipeg, MB, Canada
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18
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Roux J, Guilleux A, Lefort M, Leray E. Use of healthcare services by patients with multiple sclerosis in France over 2010-2015: a nationwide population-based study using health administrative data. Mult Scler J Exp Transl Clin 2019; 5:2055217319896090. [PMID: 31903222 PMCID: PMC6923529 DOI: 10.1177/2055217319896090] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/31/2019] [Accepted: 11/21/2019] [Indexed: 12/21/2022] Open
Abstract
Background Most of the knowledge about people with multiple sclerosis (PwMS) in France
comes from cohorts, which may suffer from recruitment bias or from the
unique registry located in Lorraine, East France. Objective To describe use of care in the French population of PwMS, over 2010–2015. Methods All PwMS in the French national health data system (97% of the general
population covered) were included. Demographics, and use of care were
described (visits with general practitioners (GPs), neurologists, nurses,
physiotherapists and hospitalisations). A focus on the neurological
follow-up was also conducted. Results A total of 112,415 PwMS were identified (sex ratio F:M = 2.4, median age 46),
of whom 5005 died during follow-up. The median numbers of visits with GPs
and neurologists were 6.6 and 1.3 respectively per patient-year. Moreover,
53,457 (47.6%) received multiple sclerosis (MS) treatments; about 13% of
patients had no neurological follow-up, and 81.8% had at least one
hospitalisation. Conclusions For the first time in France, this exhaustive dataset offered the opportunity
to provide objective figures regarding care practices for MS at the national
level, without any selection bias. It also allowed description of patients
with MS according to their neurological follow-up, especially those who were
absent from cohorts led by neurologists.
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Affiliation(s)
- J Roux
- Univ Rennes, EHESP, REPERES (Pharmacoepidemiology and health services research-EA 7449), Rennes, France
| | - A Guilleux
- Univ Rennes, EHESP, REPERES (Pharmacoepidemiology and health services research-EA 7449), Rennes, France
| | - M Lefort
- Univ Rennes, EHESP, REPERES (Pharmacoepidemiology and health services research-EA 7449), Rennes, France
| | - E Leray
- Univ Rennes, EHESP, REPERES (Pharmacoepidemiology and health services research-EA 7449), Rennes, France
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McKay KA, Ernstsson O, Manouchehrinia A, Olsson T, Hillert J. Determinants of quality of life in pediatric- and adult-onset multiple sclerosis. Neurology 2019; 94:e932-e941. [PMID: 31732567 PMCID: PMC7238943 DOI: 10.1212/wnl.0000000000008667] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/29/2019] [Indexed: 11/15/2022] Open
Abstract
Objective To evaluate quality of life (QoL), measured by the EQ-5D, in adults with pediatric-onset multiple sclerosis (POMS) or adult-onset multiple sclerosis (AOMS) and explore determinants of QoL in both groups. Methods Data were collected from the nationwide Swedish multiple sclerosis (MS) registry. Demographic characteristics, EQ-5D-3 level, Multiple Sclerosis Impact Scale (MSIS-29) score, Expanded Disability Status Scale (EDSS) score, Symbol Digit Modalities Test score, relapses, and disease-modifying therapy (DMT) exposure were collected on an approximately annual basis (2011–2019). Patients with definite MS with ≥2 EQ-5D measurements collected between ages 18 and 50 were included. The principal outcome was the EQ-5D visual analogue scale (EQ-VAS) score. Linear mixed models compared all available EQ-VAS scores between patients with POMS and patients with AOMS and determinants of EQ-VAS among patients with POMS and patients with AOMS (assessed separately). Results A total of 5,094 persons met inclusion criteria: 354 (6.9%) had POMS. A total of 21,357 unique EQ-5D scores were recorded. Most participants were female (70.0%) with a relapsing-onset disease course (98.1%). There was no difference in EQ-VAS scores between patients with POMS and patients with AOMS following adjustment for confounders (β-coefficient for patients with POMS vs patients with AOMS [reference]: 0.99; 95% confidence interval −0.89 to 2.87). Experiencing a relapse, severe neurologic disability (EDSS ≥6.0 vs <3.0), and higher MSIS-29 psychological score were consistently associated with lower QoL, while higher information processing efficiency and exposure to first-line DMTs were associated with higher QoL scores in both groups. Conclusions There were no differences in QoL between patients with POMS and patients with AOMS in adulthood. Findings provide support for a focus on reducing neurologic disability and improving psychological status as approaches to potentially improve the QoL of persons with MS.
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Affiliation(s)
- Kyla A McKay
- From the Departments of Clinical Neuroscience (K.A.M., A.M., T.O., J.H.) and Learning, Informatics, Management and Ethics (O.E.), Karolinska Institutet; and Centre for Molecular Medicine (K.A.M., A.M., T.O.), Karolinska University Hospital, Stockholm, Sweden.
| | - Olivia Ernstsson
- From the Departments of Clinical Neuroscience (K.A.M., A.M., T.O., J.H.) and Learning, Informatics, Management and Ethics (O.E.), Karolinska Institutet; and Centre for Molecular Medicine (K.A.M., A.M., T.O.), Karolinska University Hospital, Stockholm, Sweden
| | - Ali Manouchehrinia
- From the Departments of Clinical Neuroscience (K.A.M., A.M., T.O., J.H.) and Learning, Informatics, Management and Ethics (O.E.), Karolinska Institutet; and Centre for Molecular Medicine (K.A.M., A.M., T.O.), Karolinska University Hospital, Stockholm, Sweden
| | - Tomas Olsson
- From the Departments of Clinical Neuroscience (K.A.M., A.M., T.O., J.H.) and Learning, Informatics, Management and Ethics (O.E.), Karolinska Institutet; and Centre for Molecular Medicine (K.A.M., A.M., T.O.), Karolinska University Hospital, Stockholm, Sweden
| | - Jan Hillert
- From the Departments of Clinical Neuroscience (K.A.M., A.M., T.O., J.H.) and Learning, Informatics, Management and Ethics (O.E.), Karolinska Institutet; and Centre for Molecular Medicine (K.A.M., A.M., T.O.), Karolinska University Hospital, Stockholm, Sweden
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20
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Mahamud Z, Burman J, Zelano J. Prognostic impact of epilepsy in multiple sclerosis. Mult Scler Relat Disord 2019; 38:101497. [PMID: 31726355 DOI: 10.1016/j.msard.2019.101497] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 10/25/2019] [Accepted: 11/01/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The incidence of epilepsy, a disease generally associated with increased morbidity and mortality, is increased in multiple sclerosis (MS) but its impact on MS prognosis is largely unknown. OBJECTIVES To investigate the association between acquired epilepsy and mortality in MS and to examine the occurrence of epilepsy as a stated cause of death in MS. To examine the association between acquired epilepsy and subsequent conversion to secondary progressive MS (SPMS). METHODS Using the Swedish MS register, we conducted a nationwide register-based cohort study including 10,383 patients with MS onset between 31/12/1991 and 31/12/2014, and with no history of epilepsy before MS onset. Data on epilepsy diagnosis and cause of death (COD) were extracted from comprehensive national registers. Cox regression was used to estimate hazard ratios (HR) of death stratified by MS course, and SPMS conversion after epilepsy diagnosis. The HRs were adjusted for age at MS onset and sex. RESULTS The adjusted HR of death after epilepsy diagnosis for unselected MS patients was 3.85 (95% CI: 2.53-5.85). Stratifying by disease course, the adjusted HR of death after epilepsy diagnosis in primary progressive MS was 2.28 (95% CI: 0.99-5.26) and in relapsing-onset MS (ROMS), 5.48 (95% CI: 3.33-9.04). Further subdivision of ROMS revealed the adjusted risk of death after epilepsy diagnosis in relapsing remitting MS to be 3.84 (95% CI: 1.57-9.42) and 6.66 (95% CI: 3.18-13.92) in SPMS. Epilepsy was the underlying COD in 4.55% of MS patients with epilepsy. The majority (50%) of MS patients with epilepsy had MS as their stated underlying COD. Adjusted HR of conversion to SPMS after epilepsy diagnosis was 0.83 (95% CI: 0.45-1.56). CONCLUSION Epilepsy in MS is associated with increased mortality although death from epilepsy is rare. Most MS patients with epilepsy died of MS, and epilepsy was most lethal when developed in SPMS. We thus suggest that development of epilepsy is a marker of severe MS. Despite this, we found no association between epilepsy and conversion to SPMS.
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Affiliation(s)
- Zamzam Mahamud
- Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Joachim Burman
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Johan Zelano
- Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.
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Harding KE, Wardle M, Carruthers R, Robertson N, Zhu F, Kingwell E, Tremlett H. Socioeconomic status and disability progression in multiple sclerosis: A multinational study. Neurology 2019; 92:e1497-e1506. [PMID: 30796140 DOI: 10.1212/wnl.0000000000007190] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 11/16/2018] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To examine the association between socioeconomic status (SES) and disability outcomes and progression in multiple sclerosis (MS). METHODS Health administrative and MS clinical data were linked for 2 cohorts of patients with MS in British Columbia (Canada) and South East Wales (UK). SES was measured at MS symptom onset (±3 years) based on neighborhood-level average income. The association between SES at MS onset and sustained and confirmed Expanded Disability Status Scale (EDSS) 6.0 and 4.0 and onset of secondary progression of MS (SPMS) were assessed using Cox proportional hazards models. EDSS scores were also examined via linear regression, using generalized estimating equations (GEE) with an exchangeable working correlation. Models were adjusted for onset age, sex, initial disease course, and disease-modifying drug exposure. Random effect models (meta-analysis) were used to combine results from the 2 cohorts. RESULTS A total of 3,113 patients with MS were included (2,069 from Canada; 1,044 from Wales). A higher SES was associated with a lower hazard of reaching EDSS 6.0 (adjusted hazard ratio [aHR] 0.90, 95% confidence interval [CI] 0.89-0.91), EDSS 4.0 (aHR 0.93, 0.88-0.98), and SPMS (aHR 0.94, 0.88-0.99). The direction of findings was similar when all EDSS scores were included (GEE: β = -0.13, -0.18 to -0.08). CONCLUSIONS Lower neighborhood-level SES was associated with a higher risk of disability progression. Reasons for this association are likely to be complex but could include factors amenable to modification, such as lifestyle or comorbidity. Our findings are relevant for planning and development of MS services.
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Affiliation(s)
- Katharine E Harding
- From the Faculty of Medicine (Neurology) and Djavad Mowafaghian Centre for Brain Health (K.E.H., R.C., F.Z., E.K., H.T.), University of British Columbia, Vancouver, Canada; Institute of Psychological Medicine and Clinical Neuroscience (K.E.H., N.R.), Cardiff University, University Hospital of Cardiff; and Helen Durham Centre for Neuroinflammatory Disease, Department of Neurology (M.W., N.R.), University Hospital of Wales, Heath Park, Cardiff, UK.
| | - Mark Wardle
- From the Faculty of Medicine (Neurology) and Djavad Mowafaghian Centre for Brain Health (K.E.H., R.C., F.Z., E.K., H.T.), University of British Columbia, Vancouver, Canada; Institute of Psychological Medicine and Clinical Neuroscience (K.E.H., N.R.), Cardiff University, University Hospital of Cardiff; and Helen Durham Centre for Neuroinflammatory Disease, Department of Neurology (M.W., N.R.), University Hospital of Wales, Heath Park, Cardiff, UK
| | - Robert Carruthers
- From the Faculty of Medicine (Neurology) and Djavad Mowafaghian Centre for Brain Health (K.E.H., R.C., F.Z., E.K., H.T.), University of British Columbia, Vancouver, Canada; Institute of Psychological Medicine and Clinical Neuroscience (K.E.H., N.R.), Cardiff University, University Hospital of Cardiff; and Helen Durham Centre for Neuroinflammatory Disease, Department of Neurology (M.W., N.R.), University Hospital of Wales, Heath Park, Cardiff, UK
| | - Neil Robertson
- From the Faculty of Medicine (Neurology) and Djavad Mowafaghian Centre for Brain Health (K.E.H., R.C., F.Z., E.K., H.T.), University of British Columbia, Vancouver, Canada; Institute of Psychological Medicine and Clinical Neuroscience (K.E.H., N.R.), Cardiff University, University Hospital of Cardiff; and Helen Durham Centre for Neuroinflammatory Disease, Department of Neurology (M.W., N.R.), University Hospital of Wales, Heath Park, Cardiff, UK
| | - Feng Zhu
- From the Faculty of Medicine (Neurology) and Djavad Mowafaghian Centre for Brain Health (K.E.H., R.C., F.Z., E.K., H.T.), University of British Columbia, Vancouver, Canada; Institute of Psychological Medicine and Clinical Neuroscience (K.E.H., N.R.), Cardiff University, University Hospital of Cardiff; and Helen Durham Centre for Neuroinflammatory Disease, Department of Neurology (M.W., N.R.), University Hospital of Wales, Heath Park, Cardiff, UK
| | - Elaine Kingwell
- From the Faculty of Medicine (Neurology) and Djavad Mowafaghian Centre for Brain Health (K.E.H., R.C., F.Z., E.K., H.T.), University of British Columbia, Vancouver, Canada; Institute of Psychological Medicine and Clinical Neuroscience (K.E.H., N.R.), Cardiff University, University Hospital of Cardiff; and Helen Durham Centre for Neuroinflammatory Disease, Department of Neurology (M.W., N.R.), University Hospital of Wales, Heath Park, Cardiff, UK
| | - Helen Tremlett
- From the Faculty of Medicine (Neurology) and Djavad Mowafaghian Centre for Brain Health (K.E.H., R.C., F.Z., E.K., H.T.), University of British Columbia, Vancouver, Canada; Institute of Psychological Medicine and Clinical Neuroscience (K.E.H., N.R.), Cardiff University, University Hospital of Cardiff; and Helen Durham Centre for Neuroinflammatory Disease, Department of Neurology (M.W., N.R.), University Hospital of Wales, Heath Park, Cardiff, UK
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Roddam H, Rog D, Janssen J, Wilson N, Cross L, Olajide O, Dey P. Inequalities in access to health and social care among adults with multiple sclerosis: A scoping review of the literature. Mult Scler Relat Disord 2019; 28:290-304. [DOI: 10.1016/j.msard.2018.12.043] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 12/11/2018] [Accepted: 12/31/2018] [Indexed: 11/30/2022]
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23
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Derakhshani N, Azami-Aghdash S, Ghojazadeh M, Naghavi-Behzad M, Asl V, Samei B. A pilot study of fear of disease consequences and its relationship with quality of life, depression and anxiety in patients with multiple sclerosis. INTERNATIONAL ARCHIVES OF HEALTH SCIENCES 2019. [DOI: 10.4103/iahs.iahs_9_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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24
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Setayeshgar S, Kingwell E, Zhu F, Zhang X, Zhang T, Marrie RA, Carruthers R, Tremlett H. Use of the new oral disease-modifying therapies for multiple sclerosis in British Columbia, Canada: the first five-years. Mult Scler Relat Disord 2018; 25:57-60. [DOI: 10.1016/j.msard.2018.07.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 07/03/2018] [Accepted: 07/06/2018] [Indexed: 01/09/2023]
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Wijnands JM, Zhu F, Kingwell E, Zhao Y, Ekuma O, Lu X, Evans C, Fisk JD, Marrie RA, Tremlett H. Five years before multiple sclerosis onset: Phenotyping the prodrome. Mult Scler 2018; 25:1092-1101. [PMID: 29979093 DOI: 10.1177/1352458518783662] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The multiple sclerosis (MS) prodrome is poorly characterized. OBJECTIVE To phenotype the MS prodrome via health care encounters. METHODS Using data from a population-based cohort study linking administrative and clinical data in four Canadian provinces, we compared physician and hospital encounters and prescriptions filled (via International Classification of Diseases chapters, physician specialty or drug classes) for MS subjects in the 5 years before the first demyelinating claim in an administrative cohort or the clinical symptom onset in an MS clinic-derived cohort, to age-, sex- and geographically matched controls. Rate ratios (RRs), 95% confidence intervals (95% CIs) and proportions were estimated. RESULTS The administrative and clinical cohorts included 13,951/66,940 and 3202/16,006 people with and without MS (cases/controls). Compared to controls, in the 5 years before the first demyelinating claim or symptom onset, cases had more physician and hospital encounters for the nervous (RR (range) = 2.31; 95% CI: 1.05-5.10 to 4.75; 95% CI: 3.11-7.25), sensory (RR (range) = 1.40; 95% CI: 1.34-1.46 to 2.28; 95% CI: 1.72-3.02), musculoskeletal (RR (range) = 1.19; 95% CI: 1.07-1.33 to 1.70; 95% CI: 1.57-1.85) and genito-urinary systems (RR (range) = 1.17; 95% CI: 1.05-1.30 to 1.59; 95% CI: 1.48-1.70). Cases had more psychiatrist and urologist encounters (RR (range) = 1.48; 95% CI: 1.36-1.62 to 1.80; 95% CI: 1.61-2.01), and higher proportions of musculoskeletal, genito-urinary or hormonal-related prescriptions (1.1-1.5 times higher, all p < 0.02). However, cases had fewer pregnancy-related encounters than controls (RR = 0.78; 95% CI: 0.71-0.86 to 0.88; 95% CI: 0.84-0.92). CONCLUSION Phenotyping the prodrome 5 years before clinical recognition of MS is feasible.
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Affiliation(s)
- José Ma Wijnands
- Division of Neurology, Faculty of Medicine, The University of British Columbia and Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, Canada
| | - Feng Zhu
- Division of Neurology, Faculty of Medicine, The University of British Columbia and Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, Canada
| | - Elaine Kingwell
- Division of Neurology, Faculty of Medicine, The University of British Columbia and Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, Canada
| | - Yinshan Zhao
- Division of Neurology, Faculty of Medicine, The University of British Columbia and Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, Canada
| | - Okechukwu Ekuma
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
| | - Xinya Lu
- Saskatchewan Health Quality Council, Saskatoon, SK, Canada
| | - Charity Evans
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
| | - John D Fisk
- Departments of Psychiatry, Psychology and Neuroscience, and Medicine, Dalhousie University, Halifax, NS, Canada
| | - Ruth Ann Marrie
- Departments of Internal Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences and Health Sciences Centre, University of Manitoba, Winnipeg, MB, Canada
| | - Helen Tremlett
- Division of Neurology, Faculty of Medicine, The University of British Columbia and Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, Canada
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Marrie RA, Patten SB, Berrigan LI, Tremlett H, Wolfson C, Warren S, Leung S, Fiest KM, McKay KA, Fisk JD. Diagnoses of Depression and Anxiety Versus Current Symptoms and Quality of Life in Multiple Sclerosis. Int J MS Care 2018; 20:76-84. [PMID: 29670493 PMCID: PMC5898919 DOI: 10.7224/1537-2073.2016-110] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Studies assessing the prevalence of depression and anxiety in multiple sclerosis (MS) have used various ascertainment methods that capture different constructs. The relationships between these methods are incompletely understood. Psychiatric comorbidity is associated with lower health-related quality of life (HRQOL) in MS, but the effects of past diagnoses of depression and anxiety on HRQOL are largely unknown. We compared the prevalence of depression and anxiety in persons with MS using administrative data, self-reported physician diagnoses, and symptom-based measures and compared characteristics of persons classified as depressed or anxious by each method. We evaluated whether HRQOL was most affected by previous diagnoses of depression or anxiety or by current symptoms. METHODS We linked clinical and administrative data for 859 participants with MS. HRQOL was measured by the Health Utilities Index Mark 3. We classified participants as depressed or anxious using administrative data, self-reported physician diagnoses, and the Hospital Anxiety and Depression Scale. Multivariable linear regression examined whether diagnosed depression or anxiety affected HRQOL after accounting for current symptoms. RESULTS Lifetime prevalence estimates for depression were approximately 30% regardless of methods used, but 35.8% with current depressive symptoms were not captured by either administrative data or self-reported diagnoses. Prevalence estimates of anxiety ranged from 11% to 19%, but 65.6% with current anxiety were not captured by either administrative data or self-reported diagnoses. Previous diagnoses did not decrease HRQOL after accounting for current symptoms. CONCLUSIONS Depression and, to a greater extent, anxiety remain underdiagnosed and undertreated in MS; both substantially contribute to reduced HRQOL in MS.
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Schapira AHV. Advances and insights into neurological practice 2016−17. Eur J Neurol 2017; 24:1425-1434. [DOI: 10.1111/ene.13480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Kowalec K, McKay KA, Patten SB, Fisk JD, Evans C, Tremlett H, Marrie RA. Comorbidity increases the risk of relapse in multiple sclerosis: A prospective study. Neurology 2017; 89:2455-2461. [PMID: 29117961 DOI: 10.1212/wnl.0000000000004716] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 09/20/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the association between comorbidity and relapse rate in individuals with multiple sclerosis (MS). METHODS We recruited individuals with prevalent relapsing-onset MS from 4 Canadian MS Clinics to participate in a 2-year prospective multicenter cohort study involving cross-sectional assessment of comorbidities and relapses. Comorbidities were recorded using questionnaires, and relapses were captured from medical records at each visit. The association between comorbidities at baseline and relapse rate over the subsequent 2-year follow-up period was examined using Poisson regression, adjusting for age, sex, disability, disease duration, and treatment status. RESULTS Of 885 participants, 678 (76.6%) were women, averaging age 48.2 years at baseline. Anxiety (40.2%), depression (21.1%), hypertension (17.7%), migraine (18.1%), and hyperlipidemia (11.9%) were the most prevalent comorbidities. The frequency of participants experiencing relapses remained constant at 14.9% and 13.2% in years 1 and 2 post-baseline. After adjustment, participants reporting ≥3 baseline comorbidities (relative to none) had a higher relapse rate over the subsequent 2 years (adjusted rate ratio 1.45, 95% confidence interval [CI] 1.00-2.08). Migraine and hyperlipidemia were associated with increased relapse rate (adjusted rate ratio 1.38; 95% CI 1.01-1.89 and 1.67; 95% CI 1.07-2.61, respectively). CONCLUSIONS Individuals with migraine, hyperlipidemia, or a high comorbidity burden (3 or more conditions) had an increased relapse rate over 2 years. These findings have potential implications for understanding the pathophysiology of MS relapses, and suggest that closer monitoring of individuals with specific or multiple comorbidities may be needed. Future research is needed to understand if the presence of comorbidity warrants a tailored approach to MS management.
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Affiliation(s)
- Kaarina Kowalec
- From the Faculty of Medicine (K.K., K.A.M., H.T.), Division of Neurology and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver; Cumming School of Medicine (S.B.P.), Departments of Community Health Sciences and Psychiatry, University of Calgary; Department of Psychiatry, Psychology & Neuroscience and Medicine (J.D.F.), Dalhousie University, Nova Scotia Health Authority; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Kyla A McKay
- From the Faculty of Medicine (K.K., K.A.M., H.T.), Division of Neurology and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver; Cumming School of Medicine (S.B.P.), Departments of Community Health Sciences and Psychiatry, University of Calgary; Department of Psychiatry, Psychology & Neuroscience and Medicine (J.D.F.), Dalhousie University, Nova Scotia Health Authority; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Scott B Patten
- From the Faculty of Medicine (K.K., K.A.M., H.T.), Division of Neurology and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver; Cumming School of Medicine (S.B.P.), Departments of Community Health Sciences and Psychiatry, University of Calgary; Department of Psychiatry, Psychology & Neuroscience and Medicine (J.D.F.), Dalhousie University, Nova Scotia Health Authority; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - John D Fisk
- From the Faculty of Medicine (K.K., K.A.M., H.T.), Division of Neurology and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver; Cumming School of Medicine (S.B.P.), Departments of Community Health Sciences and Psychiatry, University of Calgary; Department of Psychiatry, Psychology & Neuroscience and Medicine (J.D.F.), Dalhousie University, Nova Scotia Health Authority; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Charity Evans
- From the Faculty of Medicine (K.K., K.A.M., H.T.), Division of Neurology and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver; Cumming School of Medicine (S.B.P.), Departments of Community Health Sciences and Psychiatry, University of Calgary; Department of Psychiatry, Psychology & Neuroscience and Medicine (J.D.F.), Dalhousie University, Nova Scotia Health Authority; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Helen Tremlett
- From the Faculty of Medicine (K.K., K.A.M., H.T.), Division of Neurology and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver; Cumming School of Medicine (S.B.P.), Departments of Community Health Sciences and Psychiatry, University of Calgary; Department of Psychiatry, Psychology & Neuroscience and Medicine (J.D.F.), Dalhousie University, Nova Scotia Health Authority; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Ruth Ann Marrie
- From the Faculty of Medicine (K.K., K.A.M., H.T.), Division of Neurology and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver; Cumming School of Medicine (S.B.P.), Departments of Community Health Sciences and Psychiatry, University of Calgary; Department of Psychiatry, Psychology & Neuroscience and Medicine (J.D.F.), Dalhousie University, Nova Scotia Health Authority; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
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de Jong HJI, Kingwell E, Shirani A, Cohen Tervaert JW, Hupperts R, Zhao Y, Zhu F, Evans C, van der Kop ML, Traboulsee A, Gustafson P, Petkau J, Marrie RA, Tremlett H. Evaluating the safety of β-interferons in MS: A series of nested case-control studies. Neurology 2017; 88:2310-2320. [PMID: 28500224 PMCID: PMC5567323 DOI: 10.1212/wnl.0000000000004037] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 03/21/2017] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To examine the association between interferon-β (IFN-β) and potential adverse events using population-based health administrative data in British Columbia, Canada. METHODS Patients with relapsing-remitting multiple sclerosis (RRMS) who were registered at a British Columbia Multiple Sclerosis Clinic (1995-2004) were eligible for inclusion and were followed up until death, absence from British Columbia, exposure to a non-IFN-β disease-modifying drug, or December 31, 2008. Incidence rates were estimated for each potential adverse event (selected a priori and defined with ICD-9/10 diagnosis codes from physician and hospital claims). A nested case-control study was conducted to assess the odds of previous IFN-β exposure for each potential adverse event with at least 30 cases. Cases were matched by age (±5 years), sex, and year of cohort entry, with up to 20 randomly selected (by incidence density sampling) controls. Odds ratios (ORs) with 95% confidence intervals (95% CIs) were estimated with conditional logistic regression adjusted for age at cohort entry. RESULTS Of the 2,485 eligible patients, 77.9% were women, and 1,031 were treated with IFN-β during follow-up. From the incidence analyses, 27 of the 47 potential adverse events had at least 30 cases. Patients with incident stroke (ORadj 1.83, 95% CI 1.16-2.89), migraine (ORadj 1.55, 95% CI 1.18-2.04), depression (ORadj 1.33, 95% CI 1.13-1.56), and hematologic abnormalities (ORadj 1.32, 95% CI 1.01-1.72) were more likely to have previous exposure to IFN-β than controls. CONCLUSIONS Among patients with RRMS, IFN-β was associated with a 1.8- and 1.6-fold increase in the risk of stroke and migraine and 1.3-fold increases in depression and hematologic abnormalities.
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Affiliation(s)
- Hilda J I de Jong
- From the Division of Neurology and Centre for Brain Health (H.J.I.d.J., E.K., A.S., Y.Z., F.Z., M.L.v.d.K., A.T., H.T.), Department of Medicine, and Vancouver Coastal Health Research Institute, University of British Columbia, Canada; School for Mental Health and Neuroscience (H.J.I.d.J., J.W.C.T., R.H.), Maastricht University Medical Center, the Netherlands; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon, Canada; Department Public Health Sciences (M.L.v.d.K.), Karolinska Institutet, Stockholm, Sweden; Department of Statistics (P.G., J.P.), University of British Columbia, Vancouver, Canada; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Elaine Kingwell
- From the Division of Neurology and Centre for Brain Health (H.J.I.d.J., E.K., A.S., Y.Z., F.Z., M.L.v.d.K., A.T., H.T.), Department of Medicine, and Vancouver Coastal Health Research Institute, University of British Columbia, Canada; School for Mental Health and Neuroscience (H.J.I.d.J., J.W.C.T., R.H.), Maastricht University Medical Center, the Netherlands; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon, Canada; Department Public Health Sciences (M.L.v.d.K.), Karolinska Institutet, Stockholm, Sweden; Department of Statistics (P.G., J.P.), University of British Columbia, Vancouver, Canada; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Afsaneh Shirani
- From the Division of Neurology and Centre for Brain Health (H.J.I.d.J., E.K., A.S., Y.Z., F.Z., M.L.v.d.K., A.T., H.T.), Department of Medicine, and Vancouver Coastal Health Research Institute, University of British Columbia, Canada; School for Mental Health and Neuroscience (H.J.I.d.J., J.W.C.T., R.H.), Maastricht University Medical Center, the Netherlands; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon, Canada; Department Public Health Sciences (M.L.v.d.K.), Karolinska Institutet, Stockholm, Sweden; Department of Statistics (P.G., J.P.), University of British Columbia, Vancouver, Canada; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Jan Willem Cohen Tervaert
- From the Division of Neurology and Centre for Brain Health (H.J.I.d.J., E.K., A.S., Y.Z., F.Z., M.L.v.d.K., A.T., H.T.), Department of Medicine, and Vancouver Coastal Health Research Institute, University of British Columbia, Canada; School for Mental Health and Neuroscience (H.J.I.d.J., J.W.C.T., R.H.), Maastricht University Medical Center, the Netherlands; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon, Canada; Department Public Health Sciences (M.L.v.d.K.), Karolinska Institutet, Stockholm, Sweden; Department of Statistics (P.G., J.P.), University of British Columbia, Vancouver, Canada; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Raymond Hupperts
- From the Division of Neurology and Centre for Brain Health (H.J.I.d.J., E.K., A.S., Y.Z., F.Z., M.L.v.d.K., A.T., H.T.), Department of Medicine, and Vancouver Coastal Health Research Institute, University of British Columbia, Canada; School for Mental Health and Neuroscience (H.J.I.d.J., J.W.C.T., R.H.), Maastricht University Medical Center, the Netherlands; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon, Canada; Department Public Health Sciences (M.L.v.d.K.), Karolinska Institutet, Stockholm, Sweden; Department of Statistics (P.G., J.P.), University of British Columbia, Vancouver, Canada; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Yinshan Zhao
- From the Division of Neurology and Centre for Brain Health (H.J.I.d.J., E.K., A.S., Y.Z., F.Z., M.L.v.d.K., A.T., H.T.), Department of Medicine, and Vancouver Coastal Health Research Institute, University of British Columbia, Canada; School for Mental Health and Neuroscience (H.J.I.d.J., J.W.C.T., R.H.), Maastricht University Medical Center, the Netherlands; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon, Canada; Department Public Health Sciences (M.L.v.d.K.), Karolinska Institutet, Stockholm, Sweden; Department of Statistics (P.G., J.P.), University of British Columbia, Vancouver, Canada; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Feng Zhu
- From the Division of Neurology and Centre for Brain Health (H.J.I.d.J., E.K., A.S., Y.Z., F.Z., M.L.v.d.K., A.T., H.T.), Department of Medicine, and Vancouver Coastal Health Research Institute, University of British Columbia, Canada; School for Mental Health and Neuroscience (H.J.I.d.J., J.W.C.T., R.H.), Maastricht University Medical Center, the Netherlands; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon, Canada; Department Public Health Sciences (M.L.v.d.K.), Karolinska Institutet, Stockholm, Sweden; Department of Statistics (P.G., J.P.), University of British Columbia, Vancouver, Canada; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Charity Evans
- From the Division of Neurology and Centre for Brain Health (H.J.I.d.J., E.K., A.S., Y.Z., F.Z., M.L.v.d.K., A.T., H.T.), Department of Medicine, and Vancouver Coastal Health Research Institute, University of British Columbia, Canada; School for Mental Health and Neuroscience (H.J.I.d.J., J.W.C.T., R.H.), Maastricht University Medical Center, the Netherlands; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon, Canada; Department Public Health Sciences (M.L.v.d.K.), Karolinska Institutet, Stockholm, Sweden; Department of Statistics (P.G., J.P.), University of British Columbia, Vancouver, Canada; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Mia L van der Kop
- From the Division of Neurology and Centre for Brain Health (H.J.I.d.J., E.K., A.S., Y.Z., F.Z., M.L.v.d.K., A.T., H.T.), Department of Medicine, and Vancouver Coastal Health Research Institute, University of British Columbia, Canada; School for Mental Health and Neuroscience (H.J.I.d.J., J.W.C.T., R.H.), Maastricht University Medical Center, the Netherlands; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon, Canada; Department Public Health Sciences (M.L.v.d.K.), Karolinska Institutet, Stockholm, Sweden; Department of Statistics (P.G., J.P.), University of British Columbia, Vancouver, Canada; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Anthony Traboulsee
- From the Division of Neurology and Centre for Brain Health (H.J.I.d.J., E.K., A.S., Y.Z., F.Z., M.L.v.d.K., A.T., H.T.), Department of Medicine, and Vancouver Coastal Health Research Institute, University of British Columbia, Canada; School for Mental Health and Neuroscience (H.J.I.d.J., J.W.C.T., R.H.), Maastricht University Medical Center, the Netherlands; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon, Canada; Department Public Health Sciences (M.L.v.d.K.), Karolinska Institutet, Stockholm, Sweden; Department of Statistics (P.G., J.P.), University of British Columbia, Vancouver, Canada; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Paul Gustafson
- From the Division of Neurology and Centre for Brain Health (H.J.I.d.J., E.K., A.S., Y.Z., F.Z., M.L.v.d.K., A.T., H.T.), Department of Medicine, and Vancouver Coastal Health Research Institute, University of British Columbia, Canada; School for Mental Health and Neuroscience (H.J.I.d.J., J.W.C.T., R.H.), Maastricht University Medical Center, the Netherlands; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon, Canada; Department Public Health Sciences (M.L.v.d.K.), Karolinska Institutet, Stockholm, Sweden; Department of Statistics (P.G., J.P.), University of British Columbia, Vancouver, Canada; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - John Petkau
- From the Division of Neurology and Centre for Brain Health (H.J.I.d.J., E.K., A.S., Y.Z., F.Z., M.L.v.d.K., A.T., H.T.), Department of Medicine, and Vancouver Coastal Health Research Institute, University of British Columbia, Canada; School for Mental Health and Neuroscience (H.J.I.d.J., J.W.C.T., R.H.), Maastricht University Medical Center, the Netherlands; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon, Canada; Department Public Health Sciences (M.L.v.d.K.), Karolinska Institutet, Stockholm, Sweden; Department of Statistics (P.G., J.P.), University of British Columbia, Vancouver, Canada; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Ruth Ann Marrie
- From the Division of Neurology and Centre for Brain Health (H.J.I.d.J., E.K., A.S., Y.Z., F.Z., M.L.v.d.K., A.T., H.T.), Department of Medicine, and Vancouver Coastal Health Research Institute, University of British Columbia, Canada; School for Mental Health and Neuroscience (H.J.I.d.J., J.W.C.T., R.H.), Maastricht University Medical Center, the Netherlands; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon, Canada; Department Public Health Sciences (M.L.v.d.K.), Karolinska Institutet, Stockholm, Sweden; Department of Statistics (P.G., J.P.), University of British Columbia, Vancouver, Canada; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Helen Tremlett
- From the Division of Neurology and Centre for Brain Health (H.J.I.d.J., E.K., A.S., Y.Z., F.Z., M.L.v.d.K., A.T., H.T.), Department of Medicine, and Vancouver Coastal Health Research Institute, University of British Columbia, Canada; School for Mental Health and Neuroscience (H.J.I.d.J., J.W.C.T., R.H.), Maastricht University Medical Center, the Netherlands; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon, Canada; Department Public Health Sciences (M.L.v.d.K.), Karolinska Institutet, Stockholm, Sweden; Department of Statistics (P.G., J.P.), University of British Columbia, Vancouver, Canada; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
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30
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Wijnands JMA, Kingwell E, Zhu F, Zhao Y, Högg T, Stadnyk K, Ekuma O, Lu X, Evans C, Fisk JD, Marrie RA, Tremlett H. Health-care use before a first demyelinating event suggestive of a multiple sclerosis prodrome: a matched cohort study. Lancet Neurol 2017; 16:445-451. [PMID: 28434855 DOI: 10.1016/s1474-4422(17)30076-5] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 02/27/2017] [Accepted: 03/02/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Degenerative processes in neurodegenerative diseases can start years before clinical manifestation. We aimed to establish whether a multiple sclerosis prodromal period exists by examining patterns of health-care use before a first demyelinating event. METHODS In this matched cohort study, we used data from linked health administrative and clinical databases from four Canadian provinces (British Columbia, Saskatchewan, Manitoba, and Nova Scotia) to compare hospital, physician, and prescription use data from people with multiple sclerosis and matched general population controls in the 5 years before the first demyelinating disease claim (health administrative index date) or clinically reported symptom onset (clinical index date). Rate ratios (RRs) were estimated using negative binomial regression and combined across provinces using random effect models. The primary outcome was all-cause use of health care during each of the 5 years before the health administrative or clinical index date. FINDINGS The health administrative cohort included 14 428 multiple sclerosis cases and 72 059 matched controls for whom data were available between April, 1984, and April, 2014. Annual health-care use increased steadily between 5 years and 1 year before the first demyelinating disease claim in people with multiple sclerosis compared with controls (from RR 1·26 [95% CI 1·16-1·36] to 1·78 [1·50-2·10] for hospital admissions; from 1·24 [1·16-1·32] to 1·88 [1·72-2·07] for physician claims; and from 1·23 [1·06-1·41] to 1·49 [1·41-1·59] for prescriptions, assessed as drug classes). Similar patterns for physician claims and prescriptions were observed in the cohort with available clinical symptom onset (3202 individuals with multiple sclerosis and 16 006 controls), although the differences in use in each of the 5 years mostly did not reach statistical significance. INTERPRETATION More frequent use of health care in patients with multiple sclerosis than in controls in the 5 years before a first demyelinating event, according to health administrative data, suggests the existence of a measurable multiple sclerosis prodrome. These findings have clinical and research implications, including the establishment of an earlier window of opportunity to identify and potentially treat multiple sclerosis. FUNDING National Multiple Sclerosis Society.
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Affiliation(s)
- José M A Wijnands
- Medicine (Neurology), University of British Columbia, Vancouver, BC, Canada; Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, Canada
| | - Elaine Kingwell
- Medicine (Neurology), University of British Columbia, Vancouver, BC, Canada; Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, Canada
| | - Feng Zhu
- Medicine (Neurology), University of British Columbia, Vancouver, BC, Canada; Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, Canada
| | - Yinshan Zhao
- Medicine (Neurology), University of British Columbia, Vancouver, BC, Canada; Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, Canada
| | - Tanja Högg
- Department of Statistics, University of British Columbia, Vancouver, BC, Canada
| | | | - Okechukwu Ekuma
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
| | - Xinya Lu
- Health Quality Council, Saskatoon, SK, Canada
| | - Charity Evans
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
| | - John D Fisk
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada; Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada; Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Ruth Ann Marrie
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Helen Tremlett
- Medicine (Neurology), University of British Columbia, Vancouver, BC, Canada; Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, Canada.
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