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Fernández Ó, Sörensen PS, Comi G, Vermersch P, Hartung HP, Leocani L, Berger T, Van Wijmeersch B, Oreja-Guevara C. Managing multiple sclerosis in individuals aged 55 and above: a comprehensive review. Front Immunol 2024; 15:1379538. [PMID: 38646534 PMCID: PMC11032020 DOI: 10.3389/fimmu.2024.1379538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/21/2024] [Indexed: 04/23/2024] Open
Abstract
Multiple Sclerosis (MS) management in individuals aged 55 and above presents unique challenges due to the complex interaction between aging, comorbidities, immunosenescence, and MS pathophysiology. This comprehensive review explores the evolving landscape of MS in older adults, including the increased incidence and prevalence of MS in this age group, the shift in disease phenotypes from relapsing-remitting to progressive forms, and the presence of multimorbidity and polypharmacy. We aim to provide an updated review of the available evidence of disease-modifying treatments (DMTs) in older patients, including the efficacy and safety of existing therapies, emerging treatments such as Bruton tyrosine kinase (BTKs) inhibitors and those targeting remyelination and neuroprotection, and the critical decisions surrounding the initiation, de-escalation, and discontinuation of DMTs. Non-pharmacologic approaches, including physical therapy, neuromodulation therapies, cognitive rehabilitation, and psychotherapy, are also examined for their role in holistic care. The importance of MS Care Units and advance care planning are explored as a cornerstone in providing patient-centric care, ensuring alignment with patient preferences in the disease trajectory. Finally, the review emphasizes the need for personalized management and continuous monitoring of MS patients, alongside advocating for inclusive study designs in clinical research to improve the management of this growing patient demographic.
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Affiliation(s)
- Óscar Fernández
- Departament of Pharmacology, Faculty of Medicine; Institute of Biomedical Research of Malaga (IBIMA), Regional University Hospital of Malaga, Malaga, Spain
- Department of Pharmacology and Pediatry, Faculty of Medicine, University of Malaga, Malaga, Spain
| | - Per Soelberg Sörensen
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Copenhagen and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Giancarlo Comi
- Department of Neurorehabilitation Sciences, Multiple Sclerosis Centre Casa di Cura Igea, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Patrick Vermersch
- Univ. Lille, Inserm U1172 LilNCog, CHU Lille, FHU Precise, Lille, France
| | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
- Brain and Mind Center, University of Sydney, Sydney, NSW, Australia
- Department of Neurology, Palacky University Olomouc, Olomouc, Czechia
| | - Letizia Leocani
- Department of Neurorehabilitation Sciences, Multiple Sclerosis Centre Casa di Cura Igea, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, Vienna, Austria
| | - Bart Van Wijmeersch
- University MS Centre, Hasselt-Pelt, Belgium
- Rehabilitation and Multiple Sclerosis (MS), Noorderhart Hospitals, Pelt, Belgium
| | - Celia Oreja-Guevara
- Department of Neurology, Hospital Clínico Universitario San Carlos, IdISSC, Madrid, Spain
- Department of Medicine, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
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Habbestad A, Willumsen JS, Aarseth JH, Grytten N, Midgard R, Wergeland S, Myhr KM, Torkildsen Ø. Increasing age of multiple sclerosis onset from 1920 to 2022: a population-based study. J Neurol 2024; 271:1610-1617. [PMID: 38097800 PMCID: PMC10973050 DOI: 10.1007/s00415-023-12047-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/04/2023] [Accepted: 10/06/2023] [Indexed: 03/28/2024]
Abstract
OBJECTIVE To study the age at onset of relapsing-remitting multiple sclerosis (RRMS) during the past century. METHODS This is a population-based cohort study of persons diagnosed with RRMS in Hordaland, Møre, and Romsdal counties, Western Norway, from 1920 to 2022. Individual patient data were available and assessed from previously conducted prevalence and incidence studies in addition to hospital records up until October 31, 2022. Participants were categorized according to onset period and analyzed for temporal trends in age at onset, time from onset to diagnosis, and distribution of onset over time. RESULTS We identified 3364 persons with confirmed RRMS. The mean age at onset significantly increased (p < 0.001) throughout the study period, despite a decrease in time from symptom onset to diagnosis (p < 0.001). The proportion of persons with MS onset after 50 years of age increased from 2.6% before 1970 to 11.9% after 2010. We also found a trend toward a bimodal distribution of age at onset that peaked at around 30 years and 40-45 years of age in the latest period. CONCLUSION Age at onset of MS significantly increased throughout the study period. This was mainly due to an increasing number of persons with MS, predominantly female, experiencing onset after 40-45 years of age. This bimodal distribution could indicate different susceptibility periods of MS or changes in exposure to risk factors during the observation period.
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Affiliation(s)
- A Habbestad
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, 5021, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - J S Willumsen
- Department of Neurology, Molde Hospital, Molde, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - J H Aarseth
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, 5021, Bergen, Norway
- Norwegian Multiple Sclerosis Registry and Biobank, Haukeland University Hospital, Bergen, Norway
| | - N Grytten
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, 5021, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - R Midgard
- Department of Neurology, Molde Hospital, Molde, Norway
| | - S Wergeland
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, 5021, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Norwegian Multiple Sclerosis Registry and Biobank, Haukeland University Hospital, Bergen, Norway
| | - K M Myhr
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, 5021, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ø Torkildsen
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, 5021, Bergen, Norway.
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.
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Freeman L, Lucas A, Zhou J, Hayward B, Gough M, Livingston T. Outcomes and Health Care Service Use in Adults 50 Years or Older With and Without Multiple Sclerosis: A 6-Year Observational Analysis. Int J MS Care 2023; 25:56-62. [PMID: 36923575 PMCID: PMC10010108 DOI: 10.7224/1537-2073.2021-124] [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: 11/18/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) typically presents in young adulthood. Recent data show the highest prevalence of MS in people aged 55 to 64 years; however, there are limited studies of this population. METHODS Administrative US claims data from IBM-Truven MarketScan commercial and Medicare databases (2011-2017) were analyzed. People with MS 50 years or older were assigned to the aging MS cohort (n = 10,746). The matched controls were people 50 years or older without MS (n = 10,746). Multivariable models compared outcomes between groups. RESULTS Infections were more frequent in the aging MS cohort vs matched controls (61% vs 45%; P < .0001); urinary tract, acute upper respiratory tract, and herpes zoster were the most frequent infection types. Malignancy rates were 20% for both groups (P = .8167); skin, breast, and prostate malignancies were the most frequent types. Skilled nursing facilities (aging MS cohort, 12%; matched controls, 3%; P < .0001) and MRI (aging MS cohort, 87%; matched controls, 37%; P < .0001) were used more frequently in the aging MS cohort; brain and spine were the most frequent types of MRI in the aging MS cohort. Time to first cane/walker or wheelchair use was shorter in the aging MS cohort (cane/walker use: HR, 2.1; 95% CI, 1.9-2.3; P < .0001; wheelchair use: HR, 6.9; 95% CI, 6.0-8.1; P < .0001). CONCLUSIONS In people 50 years or older, measures typically associated with worse health primarily resulted from having MS rather than being a consequence of aging alone.
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Affiliation(s)
- Leorah Freeman
- From the Department of Neurology, Dell Medical School, The University of Texas at Austin, Austin, TX, USA (LF, AL)
| | - Ashlea Lucas
- From the Department of Neurology, Dell Medical School, The University of Texas at Austin, Austin, TX, USA (LF, AL)
| | - Jia Zhou
- EMD Serono, Rockland, MA, USA (JZ, BH, TL)
| | | | - Mallory Gough
- Ashfield MedComms, an Ashfield Health company, Macclesfield, United Kingdom (MG)
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Sipilä JOT. Regarding: High Correlations Among Worldwide Prevalences of Dementias, Parkinson's Disease, Multiple Sclerosis and Motor Neuron Diseases Indicate Common Causative Factors. Neurosci Insights 2022; 17:26331055221129634. [PMID: 36329908 PMCID: PMC9623354 DOI: 10.1177/26331055221129634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Jussi OT Sipilä
- Jussi OT Sipilä, Department of Neurology,
North Karelia Central Hospital, Tikkamäentie 16, FI-80521 Joensuu, Finland.
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Willumsen JS, Grytten N, Aarseth J, Myklebust TÅ, Myhr KM, Midgard R. Mortality and cause of death in multiple sclerosis in western Norway 1950-2021: a registry-based linkage study. J Neurol Neurosurg Psychiatry 2022; 93:jnnp-2022-329169. [PMID: 36096665 PMCID: PMC9606487 DOI: 10.1136/jnnp-2022-329169] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 08/08/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Persons with multiple sclerosis (pwMS) have higher risk of mortality compared with the general population. Longitudinal studies are important for understanding the evolution of survival in pwMS. OBJECTIVE Examine changes in mortality among pwMS during the past seven decades. METHODS We followed pwMS from Hordaland and Møre and Romsdal in Western Norway, with disease onset from before 1950, identified from population-based epidemiological surveys and the Norwegian MS Registry and Biobank, until 1 January 2021. Data were linked to the Norwegian Cause of Death Registry to obtain underlying cause of death. We examined all-cause, and cause-specific mortality using standardised mortality ratios (SMR) and excess death rates (EDR). We calculated life expectancies and assessed survival stratified by sex, age and disease phenotype at onset. We compared hazard ratios (HRs) for mortality, in pwMS diagnosed before and after the era of disease-modifying treatment (DMT). RESULTS Of 3624 pwMS, 964 (55.5% women) had died, predominantly of multiple sclerosis (49.0%). Median life expectancy for pwMS was 74.3 years (95% CI 73.3 to 75.3), compared with 83.1 years for the general population (p<0.001). From disease onset, pwMS survived 14.6 years shorter than the general population (p<0.001). Overall, SMR was 2.3 (95% CI 2.13 to 2.42) and EDR was 6.8 (95% CI 6.42 to 7.09) for pwMS. Treatment-eligible pwMS diagnosed in the DMT era had the lowest risk of mortality, HR 0.49 (95% CI 0.34 to 0.70,p<0.001). CONCLUSION Excess mortality among pwMS declined during the past seven decades, possibly due to improved diagnostics, better symptomatic treatment and access to DMTs.
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Affiliation(s)
- Johannes Sverre Willumsen
- Department of Neurology, Møre og Romsdal Hospital Trust, Molde, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Nina Grytten
- Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland Universitetssjukehus, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Neuro-SysMed, Department of Neurology, Haukeland Universitetssjukehus, Bergen, Norway
| | - Jan Aarseth
- Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland Universitetssjukehus, Bergen, Norway
- Neuro-SysMed, Department of Neurology, Haukeland Universitetssjukehus, Bergen, Norway
- Norwegian MS Registry and Biobank, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Tor Åge Myklebust
- Department of Research and Innovation, Møre og Romsdal Hospital Trust, Ålesund, Norway
| | - Kjell-Morten Myhr
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Neuro-SysMed, Department of Neurology, Haukeland Universitetssjukehus, Bergen, Norway
| | - Rune Midgard
- Department of Neurology, Møre og Romsdal Hospital Trust, Molde, Norway
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Razi O, Tartibian B, Laher I, Govindasamy K, Zamani N, Rocha-Rodrigues S, Suzuki K, Zouhal H. Multimodal Benefits of Exercise in Patients With Multiple Sclerosis and COVID-19. Front Physiol 2022; 13:783251. [PMID: 35492581 PMCID: PMC9048028 DOI: 10.3389/fphys.2022.783251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 03/31/2022] [Indexed: 11/24/2022] Open
Abstract
Multiple sclerosis (MS) is a demyelinating disease characterized by plaque formation and neuroinflammation. The plaques can present in various locations, causing a variety of clinical symptoms in patients with MS. Coronavirus disease-2019 (COVID-19) is also associated with systemic inflammation and a cytokine storm which can cause plaque formation in several areas of the brain. These concurring events could exacerbate the disease burden of MS. We review the neuro-invasive properties of SARS-CoV-2 and the possible pathways for the entry of the virus into the central nervous system (CNS). Complications due to this viral infection are similar to those occurring in patients with MS. Conditions related to MS which make patients more susceptible to viral infection include inflammatory status, blood-brain barrier (BBB) permeability, function of CNS cells, and plaque formation. There are also psychoneurological and mood disorders associated with both MS and COVID-19 infections. Finally, we discuss the effects of exercise on peripheral and central inflammation, BBB integrity, glia and neural cells, and remyelination. We conclude that moderate exercise training prior or after infection with SARS-CoV-2 can produce health benefits in patients with MS patients, including reduced mortality and improved physical and mental health of patients with MS.
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Affiliation(s)
- Omid Razi
- Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, Razi University, Kermanshah, Iran
| | - Bakhtyar Tartibian
- Department of Sports Injuries, Faculty of Physical Education and Sports Sciences, Allameh Tabataba’i University, Tehran, Iran
| | - Ismail Laher
- Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Karuppasamy Govindasamy
- Department of Physical Education & Sports Science, SRM Institute of Science and Technology, Kattankulathur, India
| | - Nastaran Zamani
- Department of Biology, Faculty of Science, Payame-Noor University, Tehran, Iran
| | - Silvia Rocha-Rodrigues
- Escola Superior de Desporto e Lazer, Instituto Politécnico de Viana do Castelo, Viana do Castelo, Portugal
- Research Centre in Sports Sciences, Health Sciences and Human Development (CIDESD), Quinta de Prados, Edifício Ciências de Desporto, Vila Real, Portugal
- Tumor & Microenvironment Interactions Group, i3S, Porto, Portugal
| | - Katsuhiko Suzuki
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
- *Correspondence: Katsuhiko Suzuki, ; Hassane Zouhal,
| | - Hassane Zouhal
- Laboratoire Mouvement, Sport, Santé, University of Rennes, Rennes, France
- Institut International des Sciences du Sport (2I2S), Irodouer, France
- *Correspondence: Katsuhiko Suzuki, ; Hassane Zouhal,
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Gbaguidi B, Guillemin F, Soudant M, Debouverie M, Mathey G, Epstein J. Age-period-cohort analysis of the incidence of multiple sclerosis over twenty years in Lorraine, France. Sci Rep 2022; 12:1001. [PMID: 35046460 PMCID: PMC8770673 DOI: 10.1038/s41598-022-04836-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 12/31/2021] [Indexed: 01/21/2023] Open
Abstract
Multiple sclerosis (MS) is a neurodegenerative disease of the central nervous system. An increase in MS incidence over time is reported in several regions of the world. We aimed to describe the evolution of the annual MS incidence in the Lorraine region, France, from 1996 to 2015 and to analyze potential components of a possible change by a temporal effect of age at MS onset, MS onset period, and birth cohort, overall and for each sex. Cases were identified from ReLSEP, a population-based registry of MS cases living in Lorraine, northeastern France, with MS onset between 1996 and 2015. Age-period-cohort modeling was used to describe trends in MS incidence. Annual age- and sex-standardized incidences were relatively stable: 6.76/100 000 population (95%CI [5.76-7.91]) in 1996 and 6.78/100 000 (95%CI [5.72-7.97]) in 2015. The incidence ratio between women and men was 2.4. For all time periods, the peak incidence occurred between ages 25 and 35 years. Age-period-adjusted cohort and age-cohort-adjusted period analyses did not reveal a period or cohort effect. The incidence of MS remained stable over the study period in Lorraine, and we could not identify any particular effect of disease onset period or birth period on this evolution.
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Affiliation(s)
- Brigitte Gbaguidi
- Inserm, CIC-1433 Clinical Epidemiology, CHRU de Nancy, University of Lorraine, 9 Allée du Morvan, 54505, Vandoeuvre-les-Nancy, France
| | - Francis Guillemin
- Inserm, CIC-1433 Clinical Epidemiology, CHRU de Nancy, University of Lorraine, 9 Allée du Morvan, 54505, Vandoeuvre-les-Nancy, France
| | - Marc Soudant
- Inserm, CIC-1433 Clinical Epidemiology, CHRU de Nancy, University of Lorraine, 9 Allée du Morvan, 54505, Vandoeuvre-les-Nancy, France
| | - Marc Debouverie
- Département of Neurology, CHRU de Nancy, 29 Avenue du Maréchal de Lattre de Tassigny, 54000, Nancy, France
| | - Guillaume Mathey
- Département of Neurology, CHRU de Nancy, 29 Avenue du Maréchal de Lattre de Tassigny, 54000, Nancy, France
| | - Jonathan Epstein
- Inserm, CIC-1433 Clinical Epidemiology, CHRU de Nancy, University of Lorraine, 9 Allée du Morvan, 54505, Vandoeuvre-les-Nancy, France.
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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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Epidemiology, treatment patterns and healthcare utilizations in multiple sclerosis in Taiwan. Sci Rep 2021; 11:7727. [PMID: 33833257 PMCID: PMC8032718 DOI: 10.1038/s41598-021-86347-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/26/2021] [Indexed: 11/29/2022] Open
Abstract
“Real-world” data on the nationwide epidemiology and treatment patterns of multiple sclerosis (MS) is very scarce in Asia. This study is aim to evaluate the 10-years trends in epidemiology and treatment patterns of MS with Taiwan’s National Health Insurance Database (NHIRD). Patients aged 20 years or older and were newly diagnosed with MS between 2007 and 2016 were identified. The crude incidences of MS were presented annually and stratified by sex and age. Baseline characteristics and treatment patterns, particularly disease-modifying drugs (DMDs), were also analyzed. This study included 555 MS patients (mean age was 36.9 and 74.4% were female). The crude incidence rate of MS decreased slightly from 0.43 per 100,000 persons in 2007 to 0.24 per 100,000 persons in 2015. The female to male ratios remained mainly between 2 to 3. Approximately 80% of MS patients received initial DMDs, with interferon β-1a as the dominant one. Furthermore, 37.5% of MS patients received subsequent DMDs, with fingolimod being the most frequently used. The median times from diagnosis to initial and to subsequent DMDs were 77 and 1239 days, respectively. This nationwide study provides up-to-date and sophisticated estimates of MS epidemiology and treatment pattern in “real-world” setting in Taiwan.
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Kouchaki E, Namdari M, Khajeali N, Etesam F, Asgarian FS. Prevalence of Suicidal Ideation in Multiple Sclerosis Patients: Meta-Analysis of International Studies. SOCIAL WORK IN PUBLIC HEALTH 2020; 35:655-663. [PMID: 32865151 DOI: 10.1080/19371918.2020.1810839] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The aim of this study is to estimate the worldwide prevalence of suicidal ideation in multiple sclerosis patients. Two researchers selected words such as "epidemiology" or "prevalence" or "incidence" and "suicidal ideation in multiple sclerosis" and searched them as relevant keywords in international databases such as PubMed, Web of Science CINAHL, Embase, Psyc INFO, and Scopus. A point prevalence with 95% confidence interval was estimated. The variances of each study were calculated using the binomial distribution formula. Heterogeneity among the studies was tested by a Q-Cochran test with a significance level less than 0.1. Index of changes attributed to heterogeneity (I2) was assessed. From among the 170 total articles found from 2011 to February 2019, we pooled and analyzed the data of eight final eligible studies, based on the inclusion criteria. The prevalence of suicidal ideation in multiple sclerosis patients was estimated as 13% (CI 95% = 0.09-0.17). A subgroup analysis was conducted based on the type of countries; it revealed that prevalence is higher in developed countries (15%; CI 95% = 0.1-0.2). Pooled worldwide prevalence of suicidal ideation in the MS population was calculated at 13% by random effect. It is recommended that training, counseling, and psychological support be used to help these patients.
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Affiliation(s)
- Ebrahim Kouchaki
- Physiology Research Center, Kashan University of Medical Sciences , Kashan, Iran
| | - Mahshid Namdari
- Department of Community Oral Health, Dental School, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Nasrin Khajeali
- Education and Research Education Development Center, North Khorasan University of Medical Science , Bojnurd, Iran
| | - Farnaz Etesam
- Baharloo Hospital, Tehran University of Medical Sciences , Tehran, Iran
| | - Fatemeh Sadat Asgarian
- Social Determinants of Health (SDH) Research Center, Kashan University of Medical Sciences , Kashan, Iran
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Willumsen JS, Aarseth JH, Myhr KM, Midgard R. High incidence and prevalence of MS in Møre and Romsdal County, Norway, 1950-2018. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2020; 7:7/3/e713. [PMID: 32217642 PMCID: PMC7136041 DOI: 10.1212/nxi.0000000000000713] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 02/17/2020] [Indexed: 12/24/2022]
Abstract
Objective To determine prevalence and longitudinal trends in incidence of MS in Møre and Romsdal County, Western Norway, from 1950 to 2018. Methods Retrospective longitudinal population-based observational study. All patients diagnosed, or living, with MS in Møre and Romsdal were identified as incident or prevalent cases from local, regional, and national sources. We compiled the data in the Norwegian Multiple Sclerosis Registry and Biobank and used the aggregated data set to calculate incidence and prevalence rates using population measures obtained from Statistics Norway. Results On January 1, 2018, the estimated prevalence was 335.8 (95% CI, 314.1–358.5) per 100,000 inhabitants, with a female:male ratio of 2.3. From 1950 through 2017, we observed a considerable (p < 0.001) increase in average annual incidence rates from 2.1 (95% CI, 1.3–3.3) to 14.4 (95% CI, 11.9–17.3) per 100,000. From 2005 through 2017, the incidence among women increased from 17.1 (95% CI, 14.0–20.7) to 23.2 (95% CI, 18.7–28.5) per 100,000, whereas the incidence among men declined from 10.3 (95% CI, 7.9–13.2) to 5.9 (95% CI, 3.4–8.8) per 100,000. Conclusion Møre and Romsdal County in Western Norway has the highest prevalence of MS reported in Norway. The incidence has steadily increased since 1950, and during the latest 15 years, we observed opposing trends in sex-specific incidence rates.
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Affiliation(s)
- Johannes Sverre Willumsen
- From the Department of Neurology (J.S.W., R.M.), Møre og Romsdal Hospital Trust, Molde; Department of Neuromedicine and Movement Science (J.S.W.), Norwegian University of Science and Technology, Trondheim; Department of Neurology (J.H.A.), Haukeland University Hospital, The Norwegian Multiple Sclerosis Registry and Biobank, Bergen; Department of Neurology (K.-M.M.), Haukeland University Hospital, Neuro-SysMed; Department of Clinical Medicine (K.-M.M.), University of Bergen; and St. Olavs University Hospital and Norwegian University of Science and Technology (R.M.), Clinical Trial Unit Central Norway, Trondheim.
| | - Jan Harald Aarseth
- From the Department of Neurology (J.S.W., R.M.), Møre og Romsdal Hospital Trust, Molde; Department of Neuromedicine and Movement Science (J.S.W.), Norwegian University of Science and Technology, Trondheim; Department of Neurology (J.H.A.), Haukeland University Hospital, The Norwegian Multiple Sclerosis Registry and Biobank, Bergen; Department of Neurology (K.-M.M.), Haukeland University Hospital, Neuro-SysMed; Department of Clinical Medicine (K.-M.M.), University of Bergen; and St. Olavs University Hospital and Norwegian University of Science and Technology (R.M.), Clinical Trial Unit Central Norway, Trondheim
| | - Kjell-Morten Myhr
- From the Department of Neurology (J.S.W., R.M.), Møre og Romsdal Hospital Trust, Molde; Department of Neuromedicine and Movement Science (J.S.W.), Norwegian University of Science and Technology, Trondheim; Department of Neurology (J.H.A.), Haukeland University Hospital, The Norwegian Multiple Sclerosis Registry and Biobank, Bergen; Department of Neurology (K.-M.M.), Haukeland University Hospital, Neuro-SysMed; Department of Clinical Medicine (K.-M.M.), University of Bergen; and St. Olavs University Hospital and Norwegian University of Science and Technology (R.M.), Clinical Trial Unit Central Norway, Trondheim
| | - Rune Midgard
- From the Department of Neurology (J.S.W., R.M.), Møre og Romsdal Hospital Trust, Molde; Department of Neuromedicine and Movement Science (J.S.W.), Norwegian University of Science and Technology, Trondheim; Department of Neurology (J.H.A.), Haukeland University Hospital, The Norwegian Multiple Sclerosis Registry and Biobank, Bergen; Department of Neurology (K.-M.M.), Haukeland University Hospital, Neuro-SysMed; Department of Clinical Medicine (K.-M.M.), University of Bergen; and St. Olavs University Hospital and Norwegian University of Science and Technology (R.M.), Clinical Trial Unit Central Norway, Trondheim
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12
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Jakimovski D, Bergsland N, Dwyer MG, Hagemeier J, Ramasamy DP, Szigeti K, Guttuso T, Lichter D, Hojnacki D, Weinstock-Guttman B, Benedict RHB, Zivadinov R. Long-standing multiple sclerosis neurodegeneration: volumetric magnetic resonance imaging comparison to Parkinson's disease, mild cognitive impairment, Alzheimer's disease, and elderly healthy controls. Neurobiol Aging 2020; 90:84-92. [PMID: 32147244 DOI: 10.1016/j.neurobiolaging.2020.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/30/2020] [Accepted: 02/03/2020] [Indexed: 12/16/2022]
Abstract
Multiple sclerosis (MS) exhibits neurodegeneration driven disability progression. We compared the extent of neurodegeneration among 112 long-standing MS patients, 37 Parkinson's disease (PD) patients, 34 amnestic mild cognitive impairment (aMCI) patients, 37 Alzheimer's disease (AD) patients, and 184 healthy controls. 3T MRI volumes of whole brain (WBV), white matter (WMV), gray matter (GMV), cortical (CV), deep gray matter (DGM), and nuclei-specific volumes of thalamus, caudate, putamen, globus pallidus, and hippocampus were derived with SIENAX and FIRST software. Аge and sex-adjusted analysis of covariance was used. WBV was not significantly different between diseases. MS had significantly lower WMV compared to other disease groups (p < 0.021). Only AD had smaller GMV and CV when compared to MS (both p < 0.001). MS had smaller DGM volume than PD and aMCI (p < 0.001 and p = 0.026, respectively) and lower thalamic volume when compared to all other neurodegenerative diseases (p < 0.008). Long-standing MS exhibits comparable global atrophy with lower WMV and thalamic volume when compared to other classical neurodegenerative diseases.
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Affiliation(s)
- Dejan Jakimovski
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Niels Bergsland
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA; IRCCS, Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Michael G Dwyer
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Jesper Hagemeier
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Deepa P Ramasamy
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Kinga Szigeti
- Jacobs Multiple Sclerosis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Thomas Guttuso
- Jacobs Multiple Sclerosis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - David Lichter
- Jacobs Multiple Sclerosis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - David Hojnacki
- Jacobs Multiple Sclerosis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA; Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Bianca Weinstock-Guttman
- Jacobs Multiple Sclerosis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA; Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Ralph H B Benedict
- Jacobs Multiple Sclerosis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA; Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA; Jacobs Multiple Sclerosis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA; Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA; Center for Biomedical Imaging at Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY, USA.
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13
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Koch-Henriksen N, Thygesen LC, Stenager E, Laursen B, Magyari M. Incidence of MS has increased markedly over six decades in Denmark particularly with late onset and in women. Neurology 2018; 90:e1954-e1963. [PMID: 29720546 DOI: 10.1212/wnl.0000000000005612] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 02/28/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe the pattern of development of incidence of multiple sclerosis (MS) over 60 years in Denmark with age-period-cohort analyses and seasonality of birth. METHODS Data on virtually all patients with onset of MS have since 1950 been prospectively recorded and kept in the Danish Multiple Sclerosis Registry with multiple sources of notification. Annualized incidence rates per 100,000 were directly standardized to the European Standard Population. RESULTS We have registered 19,536 cases with clinical onset of confirmed MS in Denmark from 1950 to 2009. From the 1950-1959 to the 2000-2009 onset period, incidence more than doubled in women, with an increase from 5.91 (95% confidence interval [CI]: 5.60-6.24) to 12.33 (95% CI: 11.91-12.75) per 100,000 per year compared with a modest 24% increase in men from 4.52 (95% CI: 4.24-4.81) to 6.08 (95% CI: 5.79-6.38). With age at onset of 50 years and older, incidence increased with a factor 4.30 in women and 2.72 in men. The female/male sex ratio increased over time and with year of birth. Age-period-cohort analysis revealed a significant birth cohort effect in addition to the age and period effect. We found no statistically significant seasonality of births. CONCLUSION The incidence of MS has doubled in women, most pronounced with late onset, and has only modestly increased in men. Lifestyle changes in the female population that could include fewer childbirths, increased occurrence of obesity, and increased cigarette consumption may have a role.
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Affiliation(s)
- Nils Koch-Henriksen
- From the Clinical Institute (N.K.-H.), Department of Clinical Epidemiology, University of Aarhus; Danish Multiple Sclerosis Registry (N.K.-H., E.S., M.M.) and Department of Neurology (M.M.), Rigshospitalet, University of Copenhagen; National Institute of Public Health (L.C.T., B.L.), University of Southern Denmark in Copenhagen; Institute of Regional Health Research (E.S.), University of Southern Denmark, Odense.
| | - Lau Caspar Thygesen
- From the Clinical Institute (N.K.-H.), Department of Clinical Epidemiology, University of Aarhus; Danish Multiple Sclerosis Registry (N.K.-H., E.S., M.M.) and Department of Neurology (M.M.), Rigshospitalet, University of Copenhagen; National Institute of Public Health (L.C.T., B.L.), University of Southern Denmark in Copenhagen; Institute of Regional Health Research (E.S.), University of Southern Denmark, Odense
| | - Egon Stenager
- From the Clinical Institute (N.K.-H.), Department of Clinical Epidemiology, University of Aarhus; Danish Multiple Sclerosis Registry (N.K.-H., E.S., M.M.) and Department of Neurology (M.M.), Rigshospitalet, University of Copenhagen; National Institute of Public Health (L.C.T., B.L.), University of Southern Denmark in Copenhagen; Institute of Regional Health Research (E.S.), University of Southern Denmark, Odense
| | - Bjarne Laursen
- From the Clinical Institute (N.K.-H.), Department of Clinical Epidemiology, University of Aarhus; Danish Multiple Sclerosis Registry (N.K.-H., E.S., M.M.) and Department of Neurology (M.M.), Rigshospitalet, University of Copenhagen; National Institute of Public Health (L.C.T., B.L.), University of Southern Denmark in Copenhagen; Institute of Regional Health Research (E.S.), University of Southern Denmark, Odense
| | - Melinda Magyari
- From the Clinical Institute (N.K.-H.), Department of Clinical Epidemiology, University of Aarhus; Danish Multiple Sclerosis Registry (N.K.-H., E.S., M.M.) and Department of Neurology (M.M.), Rigshospitalet, University of Copenhagen; National Institute of Public Health (L.C.T., B.L.), University of Southern Denmark in Copenhagen; Institute of Regional Health Research (E.S.), University of Southern Denmark, Odense
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14
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Hamidi V, Couto E, Ringerike T, Klemp M. A Multiple Treatment Comparison of Eleven Disease-Modifying Drugs Used for Multiple Sclerosis. J Clin Med Res 2018; 10:88-105. [PMID: 29317954 PMCID: PMC5755648 DOI: 10.14740/jocmr3168w] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 09/05/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Several disease-modifying drug therapies are available for the treatment of multiple sclerosis (MS). To ensure the most appropriate MS management, we assessed the effectiveness and cost-effectiveness of the disease-modifying medicines used for MS. METHODS We conducted a systematic review including 11 disease-modifying drugs used for treatment of adult patients diagnosed with relapsing-remitting MS. We performed a network meta-analysis using both direct and indirect evidence. We examined the endpoints, annual relapse, disability progression, mortality, serious adverse events and withdrawal from the study due to adverse events. Cost-effectiveness was assessed by developing a decision model. The model calculated costs and quality-adjusted life years (QALYs) with different treatment strategies. Uncertainties in the parameter values were explored with a probabilistic sensitivity analysis and several scenario analyses. RESULTS Alemtuzumab 12 mg was the most effective against annual relapse (high quality evidence). For disability progression, dimethyl fumarate 240 mg and fingolimod 0.5 mg and 1.25 mg were more effective treatment alternatives (high quality evidence). For withdrawal due to adverse events, the conclusion is unclear due to the low quality of the available evidence. Peg-interferon beta-1a was associated with more adverse events (than the other treatments). None of the examined treatments had an effect on overall mortality compared to placebo. The economic analysis indicated that alemtuzumab was more effective in terms of QALYs and less costly than the other treatment alternatives. Discarding alemtuzumab, three treatment alternatives (interferon beta-1b (Extavia), peg-interferon beta-1a and natalizumab) could be considered cost-effective depending on the willingness-to-pay (WTP) threshold. Assuming a WTP below EUR 111,690 per QALY, interferon beta-1b (Extavia) was approximately 36% likely to be the most cost-effective treatment, followed by peg-interferon beta-1a (approximately 34% likely). CONCLUSIONS Our results showed that alemtuzumab can be considered as more effective and less costly than the other treatment alternatives. There is a substantial potential cost saving if more patients start on the more effective and less costly treatment alternatives.
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Affiliation(s)
- Vida Hamidi
- Norwegian Institute of Public Health, Norway
| | | | | | - Marianne Klemp
- Norwegian Institute of Public Health, Norway
- Department of Pharmacology, University of Oslo, Norway
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15
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Schmedt N, Khil L, Berger K, Riedel O. Incidence of Multiple Sclerosis in Germany: A Cohort Study Applying Different Case Definitions Based on Claims Data. Neuroepidemiology 2017; 49:91-98. [DOI: 10.1159/000481990] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 10/04/2017] [Indexed: 11/19/2022] Open
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16
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Blozik E, Rapold R, Eichler K, Reich O. Epidemiology and costs of multiple sclerosis in Switzerland: an analysis of health-care claims data, 2011-2015. Neuropsychiatr Dis Treat 2017; 13:2737-2745. [PMID: 29138568 PMCID: PMC5677381 DOI: 10.2147/ndt.s143180] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Medical therapy for multiple sclerosis (MS) is expensive. Quantifying the burden of MS is fundamental for health-care planning and the allocation of resources for the management of MS. This study provides current national estimates of prevalence, incidence, mortality, and costs of MS in Switzerland using claims data between 2011 and 2015. METHODS We analyzed health insurance claims of adult persons enrolled with a large health insurance group covering about 13% of the Swiss population between 2011 and 2015. The identification of patients with MS was based on prescription data of MS-specific medication using the Anatomical Therapeutic Chemical Classification system as proxy for clinical diagnosis. We estimated prevalence, mortality, and costs of basic health insurance between 2011 and 2015. Furthermore, incidence of MS was calculated for 2015. All results were weighted with census data to achieve an extrapolation to the Swiss general population level. Cost of illness was estimated as direct medical cost from the perspective of a Swiss health insurance using multivariate linear regression analysis. RESULTS Of the 943,639 subjects in the year 2015, 1,606 were identified as MS patients resulting in a prevalence of 190 per 100,000 (95% CI: 180-190 per 100,000). Incidence was 16 per 100,000 (95% CI: 13-19 per 100,000). According to regression analysis, the total cost of illness for basic mandatory health insurance was 26,710 Swiss Francs (CHF) (95% CI: 26,100-27,300) per person per year with the cost of medication being almost identical 26,960 CHF (95% CI: 26,170-27,800). CONCLUSIONS MS affects 10,000-15,000 persons in Switzerland, and the prevalence has increased over the last 22 years. These persons have high need and demand for health care. High costs are primarily due to expenses for medication. Given the imbalance of MS medication therapy from the perspective of basic health insurance on the disposable resources, it is crucial to increase transparency related to the volume, type, and allocation of expenses.
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Affiliation(s)
- Eva Blozik
- Department of Health Sciences, Helsana Group, Zürich, Switzerland
- Institute of General Practice, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Division of General Practice, University Medical Center Freiburg, Freiburg, Germany
| | - Roland Rapold
- Department of Health Sciences, Helsana Group, Zürich, Switzerland
| | - Klaus Eichler
- Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Oliver Reich
- Department of Health Sciences, Helsana Group, Zürich, Switzerland
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17
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Bjørnevik K, Riise T, Benjaminsen E, Celius EG, Dahl OP, Kampman MT, Løken-Amsrud KI, Midgard R, Myhr KM, Torkildsen Ø, Vatne A, Grytten N. Level of education and multiple sclerosis risk over a 50-year period: Registry-based sibling study. Mult Scler 2017; 23:213-219. [PMID: 27207453 PMCID: PMC5302076 DOI: 10.1177/1352458516646863] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 03/17/2016] [Accepted: 04/05/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND The conflicting results from studies on socioeconomic status (SES) and multiple sclerosis (MS) risk might be due to a change in the distribution of environmental exposures over time or to methodological limitations in previous research. OBJECTIVE To examine the association between SES and MS risk during 50 years. METHODS We included patients registered in Norwegian MS registries and prevalence studies born between 1930 and 1979, and identified their siblings and parents using the Norwegian Population Registry. Information on education was retrieved from the National Education Registry, categorized into four levels (primary, secondary, undergraduate and graduate) and compared in patients and siblings using conditional logistic regression. RESULTS A total of 4494 MS patients and 9193 of their siblings were included in the analyses. Level of education was inversely associated with MS risk ( p trend < 0.001) with an odds ratio (OR) of 0.73 (95% confidence interval (CI): 0.59-0.90) when comparing the highest and lowest levels. The effect estimates did not vary markedly between participants born before or after the median year of birth (1958), but we observed a significant effect modification by parental education ( p = 0.047). CONCLUSION Level of education was inversely associated with MS risk, and the estimates were similar in the earliest and latest birth cohorts.
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Affiliation(s)
- Kjetil Bjørnevik
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway/The Norwegian Multiple Sclerosis Competence Center, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Trond Riise
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway/The Norwegian Multiple Sclerosis Competence Center, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | | | - Elisabeth G Celius
- Department of Neurology, Oslo University Hospital, Ullevål, Oslo, Norway/Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ole P Dahl
- Department of Neurology, Namsos Hospital, Namsos, Norway
| | - Margitta T Kampman
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway
| | | | - Rune Midgard
- Molde Hospital, Molde, Norway/Unit for Applied Clinical Research, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kjell-Morten Myhr
- The Kristian Gerhard Jebsen Centre for MS Research, Department of Clinical Medicine, University of Bergen, Bergen, Norway/The Norwegian Multiple Sclerosis Registry and Biobank, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Øivind Torkildsen
- The Norwegian Multiple Sclerosis Competence Center, Department of Neurology, Haukeland University Hospital, Bergen, Norway/The Kristian Gerhard Jebsen Centre for MS Research, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Anita Vatne
- Department of Neurology, Sørlandet Hospital Kristiansand, Kristiansand, Norway
| | - Nina Grytten
- The Norwegian Multiple Sclerosis Competence Center, Department of Neurology, Haukeland University Hospital, Bergen, Norway/The Kristian Gerhard Jebsen Centre for MS Research, Department of Clinical Medicine, University of Bergen, Bergen, Norway
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18
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Berg‐Hansen P, Moen SM, Harbo HF, Celius EG. Comments on the review article 'Time trends in the incidence and prevalence of multiple sclerosis in Norway during eight decades'. Acta Neurol Scand 2015; 132:364-7. [PMID: 26423981 PMCID: PMC5054854 DOI: 10.1111/ane.12489] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This article is a commentary to the Review article by Grytten et al, published in Supplement 132:29–36 (DOI: 10.1111/ane.12428).
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Affiliation(s)
- P. Berg‐Hansen
- Department of Neurology Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine University of Oslo Norway
| | - S. M. Moen
- Department of Neurology Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine University of Oslo Norway
| | - H. F. Harbo
- Department of Neurology Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine University of Oslo Norway
| | - E. G. Celius
- Department of Neurology Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine University of Oslo Norway
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Steelman AJ. Infection as an Environmental Trigger of Multiple Sclerosis Disease Exacerbation. Front Immunol 2015; 6:520. [PMID: 26539193 PMCID: PMC4609887 DOI: 10.3389/fimmu.2015.00520] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 09/24/2015] [Indexed: 01/19/2023] Open
Abstract
Over the past several decades, significant advances have been made in identifying factors that contribute to the pathogenesis of multiple sclerosis (MS) and have culminated in the approval of some effective therapeutic strategies for disease intervention. However, the mechanisms by which environmental factors, such as infection, contribute to the pathogenesis and/or symptom exacerbation remain to be fully elucidated. Relapse frequency in MS patients contributes to neurological impairment and, in the initial phases of disease, serves as a predictor of poor disease prognosis. The purpose of this review is to examine the evidence that supports a role for peripheral infection in modulating the natural history of this disease. Evidence supporting a role for infection in promoting exacerbation in animal models of MS is also reviewed. Finally, a few mechanisms by which infection may exacerbate symptoms of MS and other neurological diseases are discussed. Those who comprise the majority of MS patients acquire approximately two upper-respiratory infections per year; furthermore, this type of infection doubles the risk for MS relapse, underscoring the contribution of this relationship as being potentially important and particularly detrimental.
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Affiliation(s)
- Andrew J Steelman
- Department of Animal Sciences, College of Agricultural, Consumer and Environmental Sciences, University of Illinois Urbana-Champaign , Urbana, IL , USA ; Neuroscience Program, University of Illinois Urbana-Champaign , Urbana, IL , USA ; Division of Nutritional Sciences, University of Illinois Urbana-Champaign , Urbana, IL , USA
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