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Buebos-Esteve DE, Dagamac NHA. Spatiotemporal models of dengue epidemiology in the Philippines: Integrating remote sensing and interpretable machine learning. Acta Trop 2024; 255:107225. [PMID: 38701871 DOI: 10.1016/j.actatropica.2024.107225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 04/12/2024] [Accepted: 04/19/2024] [Indexed: 05/05/2024]
Abstract
Previous dengue epidemiological analyses have been limited in spatiotemporal extent or covariate dimensions, the latter neglecting the multifactorial nature of dengue. These constraints, caused by rigid and traditional statistical tools which collapse amidst 'Big Data', prompt interpretable machine-learning (iML) approaches. Predicting dengue incidence and mortality in the Philippines, a data-limited yet high-burden country, the mlr3 universe of R packages was used to build and optimize ML models based on remotely sensed provincial and dekadal 3 NDVI and 9 rainfall features from 2016 to 2020. Between two tasks, models differ across four random forest-based learners and two clustering strategies. Among 16 candidates, rfsrc-year-case and ranger-year-death significantly perform best for predicting dengue incidence and mortality, respectively. Therefore, temporal clustering yields the best models, reflective of dengue seasonality. The two best models were subjected to tripartite global exploratory model analyses, which encompass model-agnostic post-hoc methods such as Permutation Feature Importance (PFI) and Accumulated Local Effects (ALE). PFI reveals that the models differ in their important explanatory aspect, rainfall for rfsrc-year-case and NDVI for ranger-year-death, among which long-term average (lta) features are most relevant. Trend-wise, ALE reveals that average incidence predictions are positively associated with 'Rain.lta', reflective of dengue cases peaking during the wet season. In contrast, those for mortality are negatively associated with 'NDVI.lta', reflective of urban spaces driving dengue-related deaths. By technologically addressing the challenges of the human-animal-ecosystem interface, this study adheres to the One Digital Health paradigm operationalized under Sustainable Development Goals (SDGs). Leveraging data digitization and predictive modeling for epidemiological research paves SDG 3, which prioritizes holistic health and well-being.
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Affiliation(s)
- Don Enrico Buebos-Esteve
- Initiatives for Conservation, Landscape Ecology, Bioprospecting, and Biomodeling (ICOLABB), Research Center for the Natural and Applied Sciences, University of Santo Tomas, España, Manila 1008, Philippines.
| | - Nikki Heherson A Dagamac
- Initiatives for Conservation, Landscape Ecology, Bioprospecting, and Biomodeling (ICOLABB), Research Center for the Natural and Applied Sciences, University of Santo Tomas, España, Manila 1008, Philippines; Department of Biological Sciences, College of Science, University of Santo Tomas, España, Manila 1008, Philippines; The Graduate School, University of Santo Tomas, España, Manila 1008, Philippines
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2
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Sharmin S, Roos I, Simpson-Yap S, Malpas C, Sánchez MM, Ozakbas S, Horakova D, Havrdova EK, Patti F, Alroughani R, Izquierdo G, Eichau S, Boz C, Zakaria M, Onofrj M, Lugaresi A, Weinstock-Guttman B, Prat A, Girard M, Duquette P, Terzi M, Amato MP, Karabudak R, Grand’Maison F, Khoury SJ, Grammond P, Lechner-Scott J, Buzzard K, Skibina O, van der Walt A, Butzkueven H, Turkoglu R, Altintas A, Maimone D, Kermode A, Shalaby N, Pesch VV, Butler E, Sidhom Y, Gouider R, Mrabet S, Gerlach O, Soysal A, Barnett M, Kuhle J, Hughes S, Sa MJ, Hodgkinson S, Oreja-Guevara C, Ampapa R, Petersen T, Ramo-Tello C, Spitaleri D, McCombe P, Taylor B, Prevost J, Foschi M, Slee M, McGuigan C, Laureys G, Hijfte LV, de Gans K, Solaro C, Oh J, Macdonell R, Aguera-Morales E, Singhal B, Gray O, Garber J, Wijmeersch BV, Simu M, Castillo-Triviño T, Sanchez-Menoyo JL, Khurana D, Al-Asmi A, Al-Harbi T, Deri N, Fragoso Y, Lalive PH, Sinnige LGF, Shaw C, Shuey N, Csepany T, Sempere AP, Moore F, Decoo D, Willekens B, Gobbi C, Massey J, Hardy T, Parratt J, Kalincik T. The risk of secondary progressive multiple sclerosis is geographically determined but modifiable. Brain 2023; 146:4633-4644. [PMID: 37369086 PMCID: PMC10629760 DOI: 10.1093/brain/awad218] [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: 03/01/2023] [Revised: 05/16/2023] [Accepted: 05/21/2023] [Indexed: 06/29/2023] Open
Abstract
Geographical variations in the incidence and prevalence of multiple sclerosis have been reported globally. Latitude as a surrogate for exposure to ultraviolet radiation but also other lifestyle and environmental factors are regarded as drivers of this variation. No previous studies evaluated geographical variation in the risk of secondary progressive multiple sclerosis, an advanced form of multiple sclerosis that is characterized by steady accrual of irreversible disability. We evaluated differences in the risk of secondary progressive multiple sclerosis in relation to latitude and country of residence, modified by high-to-moderate efficacy immunotherapy in a geographically diverse cohort of patients with relapsing-remitting multiple sclerosis. The study included relapsing-remitting multiple sclerosis patients from the global MSBase registry with at least one recorded assessment of disability. Secondary progressive multiple sclerosis was identified as per clinician diagnosis. Sensitivity analyses used the operationalized definition of secondary progressive multiple sclerosis and the Swedish decision tree algorithm. A proportional hazards model was used to estimate the cumulative risk of secondary progressive multiple sclerosis by country of residence (latitude), adjusted for sex, age at disease onset, time from onset to relapsing-remitting phase, disability (Multiple Sclerosis Severity Score) and relapse activity at study inclusion, national multiple sclerosis prevalence, government health expenditure, and proportion of time treated with high-to-moderate efficacy disease-modifying therapy. Geographical variation in time from relapsing-remitting phase to secondary progressive phase of multiple sclerosis was modelled through a proportional hazards model with spatially correlated frailties. We included 51 126 patients (72% female) from 27 countries. The median survival time from relapsing-remitting phase to secondary progressive multiple sclerosis among all patients was 39 (95% confidence interval: 37 to 43) years. Higher latitude [median hazard ratio = 1.21, 95% credible interval (1.16, 1.26)], higher national multiple sclerosis prevalence [1.07 (1.03, 1.11)], male sex [1.30 (1.22, 1.39)], older age at onset [1.35 (1.30, 1.39)], higher disability [2.40 (2.34, 2.47)] and frequent relapses [1.18 (1.15, 1.21)] at inclusion were associated with increased hazard of secondary progressive multiple sclerosis. Higher proportion of time on high-to-moderate efficacy therapy substantially reduced the hazard of secondary progressive multiple sclerosis [0.76 (0.73, 0.79)] and reduced the effect of latitude [interaction: 0.95 (0.92, 0.99)]. At the country-level, patients in Oman, Tunisia, Iran and Canada had higher risks of secondary progressive multiple sclerosis relative to the other studied regions. Higher latitude of residence is associated with a higher probability of developing secondary progressive multiple sclerosis. High-to-moderate efficacy immunotherapy can mitigate some of this geographically co-determined risk.
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Affiliation(s)
- Sifat Sharmin
- CORe, Department of Medicine, University of Melbourne, Melbourne 3050, Australia
- Neuroimmunology Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne 3050, Australia
| | - Izanne Roos
- CORe, Department of Medicine, University of Melbourne, Melbourne 3050, Australia
- Neuroimmunology Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne 3050, Australia
| | - Steve Simpson-Yap
- CORe, Department of Medicine, University of Melbourne, Melbourne 3050, Australia
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3050, Australia
- Menzies Institute for Medical Research, University of Tasmania, Tasmania 7000, Australia
| | - Charles Malpas
- CORe, Department of Medicine, University of Melbourne, Melbourne 3050, Australia
- Neuroimmunology Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne 3050, Australia
| | - Marina M Sánchez
- CORe, Department of Medicine, University of Melbourne, Melbourne 3050, Australia
- Neuroimmunology Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne 3050, Australia
- Department of Neurology, Hospital Germans Trias i Pujol, Badalona 08916, Spain
| | - Serkan Ozakbas
- Faculty of Medicine, Dokuz Eylul University, Konak/Izmir 35220, Turkey
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague 12808, Czech Republic
| | - Eva K Havrdova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague 12808, Czech Republic
| | - Francesco Patti
- Department of Medical and Surgical Sciences and Advanced Technologies, GF Ingrassia, Catania 95123, Italy
| | - Raed Alroughani
- Division of Neurology, Department of Medicine, Amiri Hospital, Sharq 73767, Kuwait
| | - Guillermo Izquierdo
- Multiple Sclerosis Unit, Hospital Universitario Virgen Macarena, Sevilla 41009, Spain
| | - Sara Eichau
- Multiple Sclerosis Unit, Hospital Universitario Virgen Macarena, Sevilla 41009, Spain
| | - Cavit Boz
- Faculty of Medicine, Karadeniz Technical University, Karadeniz Technical University Farabi Hospital, Trabzon 61080, Turkey
| | - Magd Zakaria
- Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt
| | - Marco Onofrj
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d’Annunzio, Chieti 66013, Italy
| | - Alessandra Lugaresi
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna 40139, Italy
| | - Bianca Weinstock-Guttman
- Department of Neurology, Jacobs Multiple Sclerosis Center for Treatment and Research, University at Buffalo, Buffalo 14202, USA
| | - Alexandre Prat
- CHUM MS Center, Faculty of Medicine, Universite de Montreal, Montreal H2L 4M1, Canada
| | - Marc Girard
- CHUM MS Center, Faculty of Medicine, Universite de Montreal, Montreal H2L 4M1, Canada
| | - Pierre Duquette
- CHUM MS Center, Faculty of Medicine, Universite de Montreal, Montreal H2L 4M1, Canada
| | - Murat Terzi
- Faculty of Medicine, 19 Mayis University, Samsun 55160, Turkey
| | - Maria Pia Amato
- Department NEUROFARBA, University of Florence, Florence 50134, Italy
| | - Rana Karabudak
- Department of Neurology, Hacettepe University, Ankara 6100, Turkey
| | | | - Samia J Khoury
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon
| | - Pierre Grammond
- Médecine spécialisée, CISSS Chaudière-Appalaches, Levis G6X 0A1, Canada
| | | | - Katherine Buzzard
- Department of Neurology, Box Hill Hospital, Melbourne 3128, Australia
| | - Olga Skibina
- Department of Neurology, Box Hill Hospital, Melbourne 3128, Australia
| | | | - Helmut Butzkueven
- Department of Neurology, The Alfred Hospital, Melbourne 3000, Australia
| | - Recai Turkoglu
- Department of Neurology, Haydarpasa Numune Training and Research Hospital, Istanbul 34668, Turkey
| | - Ayse Altintas
- Department of Neurology, School of Medicine, Koc University, Koc University Research Center for Translational Medicine (KUTTAM), Istanbul 34450, Turkey
| | - Davide Maimone
- Centro Sclerosi Multipla, UOC Neurologia, ARNAS Garibaldi, Catania 95124, Italy
| | - Allan Kermode
- Perron Institute, University of Western Australia, Nedlands 6009, Australia
| | - Nevin Shalaby
- Department of Neurology, Kasr Al Ainy MS Research Unit (KAMSU), Cairo 11562, Egypt
| | - Vincent V Pesch
- Service de Neurologie, Cliniques Universitaires Saint-Luc, Brussels 1200 BXL, Belgium
| | | | - Youssef Sidhom
- Department of Neurology, Razi Hospital, Manouba 2010, Tunisia
| | - Riadh Gouider
- Department of Neurology, Razi Hospital, Manouba 2010, Tunisia
- Clinical Investigation Center Neurosciences and Mental Health, Faculty of Medicine, University of Tunis El Manar, Tunis 1068, Tunisia
| | - Saloua Mrabet
- Department of Neurology, Razi Hospital, Manouba 2010, Tunisia
- Clinical Investigation Center Neurosciences and Mental Health, Faculty of Medicine, University of Tunis El Manar, Tunis 1068, Tunisia
| | - Oliver Gerlach
- Academic MS Center Zuyderland, Department of Neurology, Zuyderland Medical Center, Sittard-Geleen 5500, The Netherlands
- School for Mental Health and Neuroscience, Department of Neurology, Maastricht University Medical Center, Maastricht 6131 BK, The Netherlands
| | - Aysun Soysal
- Department of Neurology, Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Istanbul 34147, Turkey
| | - Michael Barnett
- Multiple Sclerosis Clinic, Brain and Mind Centre, Sydney 2050, Australia
| | - Jens Kuhle
- Neurologic Clinic and Policlinic, Departments of Medicine and Clinical Research, University Hospital and University of Basel, Basel 4000, Switzerland
| | - Stella Hughes
- Department of Neurology, Royal Victoria Hospital, Belfast BT12 6BA, UK
| | - Maria J Sa
- Department of Neurology, Centro Hospitalar Universitario de Sao Joao, Porto 4200-319, Portugal
| | - Suzanne Hodgkinson
- Immune tolerance laboratory Ingham Institute and Department of Medicine, University of New South Wales, Sydney 2170, Australia
| | | | - Radek Ampapa
- MS centrum, Nemocnice Jihlava, Jihlava 58633, Czech Republic
| | - Thor Petersen
- Department of Neurology, Aarhus University Hospital, Arhus C 8000, Denmark
| | - Cristina Ramo-Tello
- Department of Neurology, Hospital Germans Trias i Pujol, Badalona 8916, Spain
| | - Daniele Spitaleri
- Centro Sclerosi Multipla, Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati Avellino, Avellino 83100, Italy
| | - Pamela McCombe
- Royal Brisbane and Women’s Hospital, University of Queensland, Brisbane 4000, Australia
| | - Bruce Taylor
- Department of Neurology, Royal Hobart Hospital, Hobart 7000, Australia
| | - Julie Prevost
- Département de neurologie, CSSS Saint-Jérôme, Saint-Jerome J7Z 5T3, Canada
| | - Matteo Foschi
- Department of Neuroscience, Neurology Unit, S. Maria delle Croci Hospital of Ravenna, Ravenna 48121, Italy
| | - Mark Slee
- College of Medicine and Public Health, Flinders University, Adelaide 5042, Australia
| | - Chris McGuigan
- Department of Neurology, St Vincent’s University Hospital, Dublin D04 T6F4, Ireland
| | - Guy Laureys
- Department of Neurology, Universitary Hospital Ghent, Ghent 9000, Belgium
| | - Liesbeth V Hijfte
- Department of Neurology, Universitary Hospital Ghent, Ghent 9000, Belgium
| | - Koen de Gans
- Department of Neurology, Groene Hart Hospital, Gouda 2800 BB, The Netherlands
| | - Claudio Solaro
- Department of Rehabilitation, CRRF ‘Mons. Luigi Novarese’, Moncrivello (VC) 16153, Italy
| | - Jiwon Oh
- Barlo Multiple Sclerosis Centre, St. Michael’s Hospital, Toronto M5B1W8, Canada
| | | | | | - Bhim Singhal
- Department of Neurology, Bombay Hospital Institute of Medical Sciences, Mumbai 400020, India
| | - Orla Gray
- Department of Neurology, South Eastern HSC Trust, Belfast BT16, UK
| | - Justin Garber
- Department of Neurology, Westmead Hospital, Sydney 2145, Australia
| | - Bart V Wijmeersch
- Rehabilitation and MS-Centre Overpelt, Hasselt University, Hasselt 3900, Belgium
| | - Mihaela Simu
- Clinic of Neurology II, Emergency Clinical County Hospital ‘Pius Brinzeu’, Timisoara 300723, Romania
- Department of Neurology, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara 300041, Romania
| | | | | | - Dheeraj Khurana
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Abdullah Al-Asmi
- Department of Medicine, Sultan Qaboos University Hospital, Al-Khodh 123, Oman
| | - Talal Al-Harbi
- Neurology Department, King Fahad Specialist Hospital-Dammam, Khobar 31952, Saudi Arabia
| | - Norma Deri
- Hospital Fernandez, Buenos Aires 1425, Argentina
| | - Yara Fragoso
- Department of Neurology, Universidade Metropolitana de Santos, Santos 11045-002, Brazil
| | - Patrice H Lalive
- Department of Clinical Neurosciences, Division of Neurology, Faculty of Medicine, Geneva University Hospital, Geneva 1211, Switzerland
| | - L G F Sinnige
- Department of Neurology, Medical Center Leeuwarden, Leeuwarden 8934 AD, The Netherlands
| | - Cameron Shaw
- Neuroscience Department, Barwon Health, University Hospital Geelong, Geelong 3220, Australia
| | - Neil Shuey
- Department of Neurology, St Vincents Hospital, Fitzroy, Melbourne 3065, Australia
| | - Tunde Csepany
- Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen 4032, Hungary
| | - Angel P Sempere
- Department of Neurology, Hospital General Universitario de Alicante, Alicante 3010, Spain
| | - Fraser Moore
- Department of Neurology, McGill University, Montreal H3T 1E2, Canada
| | - Danny Decoo
- Department of Neurology & Neuro-Rehabilitation, AZ Alma Ziekenhuis, Sijsele-Damme 8340, Belgium
| | - Barbara Willekens
- Department of Neurology, Antwerp University Hospital, Edegem 2650, Belgium
- Translational Neurosciences Research Group, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk 2650, Belgium
| | | | | | - Todd Hardy
- Concord Repatriation General Hospital, Sydney 2139, Australia
| | - John Parratt
- Royal North Shore Hospital, Sydney 2065, Australia
| | - Tomas Kalincik
- CORe, Department of Medicine, University of Melbourne, Melbourne 3050, Australia
- Neuroimmunology Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne 3050, Australia
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Nicholas R, Rodgers J, Witts J, Lerede A, Friede T, Hillert J, Forsberg L, Glaser A, Manouchehrinia A, Ramanujam R, Spelman T, Klyve P, Drahota J, Horakova D, Joensen H, Pontieri L, Magyari M, Ellenberger D, Stahmann A, Butzkueven H, Van Der Walt A, Bezlyak V, Lines C, Middleton R. The impact of healthcare systems on the clinical diagnosis and disease-modifying treatment usage in relapse-onset multiple sclerosis: a real-world perspective in five registries across Europe. Ther Adv Neurol Disord 2023; 16:17562864231198963. [PMID: 37771841 PMCID: PMC10524069 DOI: 10.1177/17562864231198963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 08/16/2023] [Indexed: 09/30/2023] Open
Abstract
Introduction Prescribing guidance for disease-modifying treatment (DMT) in multiple sclerosis (MS) is centred on a clinical diagnosis of relapsing-remitting MS (RRMS). DMT prescription guidelines and monitoring vary across countries. Standardising the approach to diagnosis of disease course, for example, assigning RRMS or secondary progressive MS (SPMS) diagnoses, allows examination of the impact of health system characteristics on the stated clinical diagnosis and treatment access. Methods We analysed registry data from six cohorts in five countries (Czech Republic, Denmark, Germany, Sweden and United Kingdom) on patients with an initial diagnosis of RRMS. We standardised our approach utilising a pre-existing algorithm (DecisionTree, DT) to determine patient diagnoses of RRMS or secondary progressive MS (SPMS). We identified five global drivers of DMT prescribing: Provision, Availability, Funding, Monitoring and Audit, data were analysed against these concepts using meta-analysis and univariate meta-regression. Results In 64,235 patients, we found variations in DMT use between countries, with higher usage in RRMS and lower usage in SPMS, with correspondingly lower usage in the UK compared to other registers. Factors such as female gender (p = 0.041), increasing disability via Expanded Disability Status Scale (EDSS) score (p = 0.004), and the presence of monitoring (p = 0.029) in SPMS influenced the likelihood of receiving DMTs. Standardising the diagnosis revealed differences in reclassification rates from clinical RRMS to DT-SPMS, with Sweden having the lowest rate Sweden (Sweden 0.009, range: Denmark 0.103 - UK portal 0.311). Those with higher EDSS at index (p < 0.03) and female gender (p < 0.049) were more likely to be reclassified from RRMS to DT-SPMS. The study also explored the impact of diagnosis on DMT usage in clinical SPMS, finding that the prescribing environment and auditing practices affected access to treatment. Discussion This highlights the importance of a healthcare system's approach to verifying the clinical label of MS course in facilitating appropriate prescribing, with some flexibility allowed in uncertain cases to ensure continued access to treatment.
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Affiliation(s)
- Richard Nicholas
- Swansea University Medical School, Swansea, UK
- Department of Cellular and Molecular Neuroscience, Imperial College London, London, UK
- Department of Visual Neuroscience, UCL Institute of Ophthalmology, London, UK
| | - Jeff Rodgers
- Faculty of Medicine Health and Life Science, Swansea University Medical School, Swansea, UK
| | - James Witts
- Faculty of Medicine Health and Life Science, Swansea University Medical School, Swansea, UK
| | - Annalaura Lerede
- Department of Cellular and Molecular Neuroscience, Imperial College London, London, UK
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Lars Forsberg
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Anna Glaser
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Ali Manouchehrinia
- Department of Clinical Neurosciences, Centre for Molecular Medicine (CMM), Karolinska Institute, Stockholm, Sweden
| | - Ryan Ramanujam
- Department of Clinical Neurosciences, Centre for Molecular Medicine (CMM), Karolinska Institute, Stockholm, Sweden
- Department of Mathematics, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Tim Spelman
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden, MS-Register
| | - Pernilla Klyve
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Jiri Drahota
- Czech National Multiple Sclerosis Patient Registry ReMuS, IMPULS Endowment Fund, Kateřinská, CZ, Prague
- Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, First Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, First Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - Hanna Joensen
- Danish Multiple Sclerosis Registry, Department of Neurology, University Hospital Copenhagen, Rigshospitalet, Denmark
| | - Luigi Pontieri
- Danish Multiple Sclerosis Registry, Department of Neurology, University Hospital Copenhagen, Rigshospitalet, Denmark
| | - Melinda Magyari
- Danish Multiple Sclerosis Registry, Department of Neurology, University Hospital Copenhagen, Rigshospitalet, Denmark
- Department of Neurology, Danish Multiple Sclerosis Center, University Hospital Copenhagen, Rigshospitalet, Denmark
| | - David Ellenberger
- German MS Registry, MS Forschungs- und Projektentwicklungs-gGmbH, Hannover, Germany
| | - Alexander Stahmann
- German MS Registry, MS Forschungs- und Projektentwicklungs-gGmbH, Hannover, Germany
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Australia
| | - Anneke Van Der Walt
- Department of Neuroscience, Central Clinical School, Monash University, Australia
| | | | | | - Rod Middleton
- Faculty of Medicine Health and Life Science, Swansea University Medical School, Singleton Campus, Swansea SA2 8PP, UK
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Abbadessa G, Ponzano M, Bile F, Miele G, Signori A, Cepparulo S, Sparaco M, Signoriello E, Maniscalco GT, Lanzillo R, Morra VB, Lus G, Sormani MP, Lavorgna L, Bonavita S. Health related quality of life in the domain of physical activity predicts confirmed disability progression in people with relapsing remitting multiple sclerosis. Mult Scler Relat Disord 2023; 75:104731. [PMID: 37163840 DOI: 10.1016/j.msard.2023.104731] [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: 01/13/2023] [Revised: 03/18/2023] [Accepted: 04/24/2023] [Indexed: 05/12/2023]
Abstract
INTRODUCTION The diagnosis of the progression phase of Multiple Sclerosis (MS) is still retrospective and based on the objectivation of clinical disability accumulation. OBJECTIVES To assess whether the Patient Reported Outcomes Measures (PROMs) scores predict the occurrence of disease progression within three years of follow-up. METHODS Observational prospective multicenter study. Stable Relapsing-Remitting MS (RRMS) patients were enrolled. At enrollment, patients completed the following PROMs: Beck Depression Inventory- II, The Treatment Satisfaction Questionnaire for Medications, Medical Outcomes Study Short Form 36- Item (SF36), Fatigue Severity Scale. EDSS was assessed at enrollment and three years later. The outcome measure was defined as the occurrence of confirmed disability progression (CDP) within three years of follow-up. Univariable and multivariable logistic regression models were performed to study the association between the final score of each test and the outcome. RESULTS SF36-Physical Functioning (SF36-PF) was the only independent variable associated with the outcome. The ROC curve analysis determined a score of 77.5 at SF36-PF as the cut-off point identifying patients experiencing CDP within three years of follow-up [AUC: 0.66 (95% CI: 0.56-0.75)]. CONCLUSIONS RRMS patients scoring higher (>77.5) at SF36-PF subscale have a higher likelihood to experience CDP within the next three years.
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Affiliation(s)
- Gianmarco Abbadessa
- II Division of Neurology, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Marta Ponzano
- Department of Health Sciences - Section of Biostatistics University of Genoa, Italy
| | - Floriana Bile
- II Division of Neurology, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Giuseppina Miele
- II Division of Neurology, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Alessio Signori
- Department of Health Sciences - Section of Biostatistics University of Genoa, Italy
| | | | - Maddalena Sparaco
- II Division of Neurology, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Elisabetta Signoriello
- MS Centre, II Division of Neurology, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | - Roberta Lanzillo
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University of Naples, Naples, Italy
| | - Vincenzo Brescia Morra
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University of Naples, Naples, Italy
| | - Giacomo Lus
- MS Centre, II Division of Neurology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Maria Pia Sormani
- Department of Health Sciences - Section of Biostatistics University of Genoa, Italy
| | - Luigi Lavorgna
- I Division of Neurology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Simona Bonavita
- II Division of Neurology, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy.
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Forsberg L, Spelman T, Klyve P, Manouchehrinia A, Ramanujam R, Mouresan E, Drahota J, Horakova D, Joensen H, Pontieri L, Magyari M, Ellenberger D, Stahmann A, Rodgers J, Witts J, Middleton R, Nicholas R, Bezlyak V, Adlard N, Hach T, Lines C, Vukusic S, Soilu-Hänninen M, van der Walt A, Butzkueven H, Iaffaldano P, Trojano M, Glaser A, Hillert J. Proportion and characteristics of secondary progressive multiple sclerosis in five European registries using objective classifiers. Mult Scler J Exp Transl Clin 2023; 9:20552173231153557. [PMID: 36816812 PMCID: PMC9936396 DOI: 10.1177/20552173231153557] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 01/12/2023] [Indexed: 02/18/2023] Open
Abstract
Background To assign a course of secondary progressive multiple sclerosis (MS) (SPMS) may be difficult and the proportion of persons with SPMS varies between reports. An objective method for disease course classification may give a better estimation of the relative proportions of relapsing-remitting MS (RRMS) and SPMS and may identify situations where SPMS is under reported. Materials and methods Data were obtained for 61,900 MS patients from MS registries in the Czech Republic, Denmark, Germany, Sweden, and the United Kingdom (UK), including date of birth, sex, SP conversion year, visits with an Expanded Disability Status Scale (EDSS) score, MS onset and diagnosis date, relapses, and disease-modifying treatment (DMT) use. We included RRMS or SPMS patients with at least one visit between January 2017 and December 2019 if ≥ 18 years of age. We applied three objective methods: A set of SPMS clinical trial inclusion criteria ("EXPAND criteria") modified for a real-world evidence setting, a modified version of the MSBase algorithm, and a decision tree-based algorithm recently published. Results The clinically assigned proportion of SPMS varied from 8.7% (Czechia) to 34.3% (UK). Objective classifiers estimated the proportion of SPMS from 15.1% (Germany by the EXPAND criteria) to 58.0% (UK by the decision tree method). Due to different requirements of number of EDSS scores, classifiers varied in the proportion they were able to classify; from 18% (UK by the MSBase algorithm) to 100% (the decision tree algorithm for all registries). Objectively classified SPMS patients were older, converted to SPMS later, had higher EDSS at index date and higher EDSS at conversion. More objectively classified SPMS were on DMTs compared to the clinically assigned. Conclusion SPMS appears to be systematically underdiagnosed in MS registries. Reclassified patients were more commonly on DMTs.
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Affiliation(s)
- Lars Forsberg
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Tim Spelman
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Pernilla Klyve
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Ali Manouchehrinia
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ryan Ramanujam
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Mathematics, Royal Institute of Technology, Stockholm, Sweden
| | - Elena Mouresan
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jiri Drahota
- Czech National Multiple Sclerosis ReMuS, IMPULS Endowment Fund, Prague, Czech Republic
- First Faculty of Medicine and General University Hospital, Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, Prague, Czech Republic
| | - Dana Horakova
- First Faculty of Medicine and General University Hospital, Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, Prague, Czech Republic
| | - Hanna Joensen
- The Danish Multiple Sclerosis Registry, Copenhagen University Hospital, Copenhagen, Denmark
| | - Luigi Pontieri
- 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, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | | | - James Witts
- Swansea University Medical School, Swansea, UK
| | | | - Richard Nicholas
- Swansea University Medical School, Swansea, UK
- Department of Cellular and Molecular Neuroscience, Imperial College London, London, UK
| | | | | | | | | | - Sandra Vukusic
- Hôpital Neurologique, Service de Neurologie A, the European Database for Multiple Sclerosis (EDMUS), Coordinating Center and INSERM U 433, Lyon, France
| | - Merja Soilu-Hänninen
- Division of Clinical Neurosciences, University Hospital and University of Turku, Turku, Finland
| | - Anneke van der Walt
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Pietro Iaffaldano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Anna Glaser
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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6
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The uncertainty period preceding the clinical defined SPMS diagnosis and the applicability of objective classifiers - A Danish single center study. Mult Scler Relat Disord 2023; 71:104546. [PMID: 36764284 DOI: 10.1016/j.msard.2023.104546] [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: 10/11/2022] [Revised: 01/19/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND The clinical transition from relapsing-remitting multiple sclerosis (RRMS) to secondary progressive MS (SPMS) is often related to a period of diagnostic uncertainty delaying diagnosis. With emerging treatment options for SPMS how to identify RRMS patients at risk of SPMS and when to assign a SPMS diagnosis has become a matter of growing clinical concern. This study aimed to determine the period of diagnostic uncertainty among Danish MS patients. Secondly, this study examined the performance of two objective classifiers in a longitudinal setting regarding their ability to shorten the period of diagnostic uncertainty. METHODS By using the Danish Multiple Sclerosis Registry, we identified all patients linked to Rigshospitalet with clinically assigned SPMS from 2010 to 2021. We reviewed all patient records and identified the first mentioned sign of progression (FMP). The time between the dates of FMP and clinically assigned SPMS was defined as the period of diagnostic uncertainty. Secondly, we applied two objective classifiers (the Karolinska Decision tree and the MSBase criteria) to generate suggested transition dates and compared them to the ones obtain from the patient records. Detailed descriptions of the population were made at all mentioned timepoints. RESULTS In total 138 patients were included. We found a median period of diagnostic uncertainty of 2.12 years. The objective classifiers generated a median suggested transition date 3.44 and 4.48 years earlier than the date of clinically assigned SPMS, but they only provided an earlier SPMS transition date in 50.72% and 55.80% of cases. CONCLUSIONS Our findings emphasize the uncertainty related to the transition from RRMS to SPMS illustrating the need of an improved diagnostic approach. Objective classifiers might have the potential to help reduce the period of diagnostic uncertainty in the future, but in their current form they do not perform satisfactorily enough to solve all difficulties related to detecting SPMS-transition.
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Ji L, Zhang W, Huang J, Tian J, Zhong X, Luo J, Zhu S, He Z, Tong Y, Meng X, Kang Y, Bi Q. Bone metastasis risk and prognosis assessment models for kidney cancer based on machine learning. Front Public Health 2022; 10:1015952. [PMID: 36466509 PMCID: PMC9714267 DOI: 10.3389/fpubh.2022.1015952] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 11/02/2022] [Indexed: 11/19/2022] Open
Abstract
Background Bone metastasis is a common adverse event in kidney cancer, often resulting in poor survival. However, tools for predicting KCBM and assessing survival after KCBM have not performed well. Methods The study uses machine learning to build models for assessing kidney cancer bone metastasis risk, prognosis, and performance evaluation. We selected 71,414 kidney cancer patients from SEER database between 2010 and 2016. Additionally, 963 patients with kidney cancer from an independent medical center were chosen to validate the performance. In the next step, eight different machine learning methods were applied to develop KCBM diagnosis and prognosis models while the risk factors were identified from univariate and multivariate logistic regression and the prognosis factors were analyzed through Kaplan-Meier survival curve and Cox proportional hazards regression. The performance of the models was compared with current models, including the logistic regression model and the AJCC TNM staging model, applying receiver operating characteristics, decision curve analysis, and the calculation of accuracy and sensitivity in both internal and independent external cohorts. Results Our prognosis model achieved an AUC of 0.8269 (95%CI: 0.8083-0.8425) in the internal validation cohort and 0.9123 (95%CI: 0.8979-0.9261) in the external validation cohort. In addition, we tested the performance of the extreme gradient boosting model through decision curve analysis curve, Precision-Recall curve, and Brier score and two models exhibited excellent performance. Conclusion Our developed models can accurately predict the risk and prognosis of KCBM and contribute to helping improve decision-making.
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Affiliation(s)
- Lichen Ji
- Cancer Center, Department of Orthopedics, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China,Department of Laboratory Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China,Center for Rehabilitation Medicine, Osteoporosis Center, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China,Department of Orthopedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wei Zhang
- Department of Laboratory Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China,Center for Rehabilitation Medicine, Osteoporosis Center, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China,Department of Orthopedics, Zhejiang Provincial People's Hospital, Qingdao University, Qingdao, China
| | - Jiaqing Huang
- Department of Laboratory Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China,The Second Clinic Medical College, Zhejiang Chinese Medicine University, Hangzhou, China
| | - Jinlong Tian
- Cancer Center, Department of Orthopedics, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China,Department of Laboratory Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China,Center for Rehabilitation Medicine, Osteoporosis Center, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China,The First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui, China
| | - Xugang Zhong
- Department of Laboratory Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China,Center for Rehabilitation Medicine, Osteoporosis Center, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China,Department of Orthopedics, Zhejiang Provincial People's Hospital, Qingdao University, Qingdao, China
| | - Junchao Luo
- Cancer Center, Department of Orthopedics, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China,Department of Laboratory Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China,Center for Rehabilitation Medicine, Osteoporosis Center, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China,Department of Orthopedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Senbo Zhu
- Cancer Center, Department of Orthopedics, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China,Department of Laboratory Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China,Center for Rehabilitation Medicine, Osteoporosis Center, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China,Department of Orthopedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zeju He
- Cancer Center, Department of Orthopedics, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China,Department of Laboratory Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China,Center for Rehabilitation Medicine, Osteoporosis Center, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China,Department of Orthopedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yu Tong
- Cancer Center, Department of Orthopedics, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China,Department of Laboratory Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China,Center for Rehabilitation Medicine, Osteoporosis Center, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Xiang Meng
- Cancer Center, Department of Orthopedics, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China,Department of Laboratory Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China,Center for Rehabilitation Medicine, Osteoporosis Center, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China,The First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui, China
| | - Yao Kang
- Cancer Center, Department of Orthopedics, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China,Department of Laboratory Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China,Center for Rehabilitation Medicine, Osteoporosis Center, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China,Yao Kang
| | - Qing Bi
- Cancer Center, Department of Orthopedics, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China,Department of Laboratory Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China,Center for Rehabilitation Medicine, Osteoporosis Center, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China,*Correspondence: Qing Bi
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Fuh-Ngwa V, Zhou Y, Melton PE, van der Mei I, Charlesworth JC, Lin X, Zarghami A, Broadley SA, Ponsonby AL, Simpson-Yap S, Lechner-Scott J, Taylor BV. Ensemble machine learning identifies genetic loci associated with future worsening of disability in people with multiple sclerosis. Sci Rep 2022; 12:19291. [PMID: 36369345 PMCID: PMC9652373 DOI: 10.1038/s41598-022-23685-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 11/03/2022] [Indexed: 11/13/2022] Open
Abstract
Limited studies have been conducted to identify and validate multiple sclerosis (MS) genetic loci associated with disability progression. We aimed to identify MS genetic loci associated with worsening of disability over time, and to develop and validate ensemble genetic learning model(s) to identify people with MS (PwMS) at risk of future worsening. We examined associations of 208 previously established MS genetic loci with the risk of worsening of disability; we learned ensemble genetic decision rules and validated the predictions in an external dataset. We found 7 genetic loci (rs7731626: HR 0.92, P = 2.4 × 10-5; rs12211604: HR 1.16, P = 3.2 × 10-7; rs55858457: HR 0.93, P = 3.7 × 10-7; rs10271373: HR 0.90, P = 1.1 × 10-7; rs11256593: HR 1.13, P = 5.1 × 10-57; rs12588969: HR = 1.10, P = 2.1 × 10-10; rs1465697: HR 1.09, P = 1.7 × 10-128) associated with risk worsening of disability; most of which were located near or tagged to 13 genomic regions enriched in peptide hormones and steroids biosynthesis pathways by positional and eQTL mapping. The derived ensembles produced a set of genetic decision rules that can be translated to provide additional prognostic values to existing clinical predictions, with the additional benefit of incorporating relevant genetic information into clinical decision making for PwMS. The present study extends our knowledge of MS progression genetics and provides the basis of future studies regarding the functional significance of the identified loci.
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Affiliation(s)
- Valery Fuh-Ngwa
- grid.1009.80000 0004 1936 826XMenzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS 7000 Australia
| | - Yuan Zhou
- grid.1009.80000 0004 1936 826XMenzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS 7000 Australia
| | - Phillip E. Melton
- grid.1009.80000 0004 1936 826XMenzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS 7000 Australia
| | - Ingrid van der Mei
- grid.1009.80000 0004 1936 826XMenzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS 7000 Australia
| | - Jac C. Charlesworth
- grid.1009.80000 0004 1936 826XMenzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS 7000 Australia
| | - Xin Lin
- grid.1009.80000 0004 1936 826XMenzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS 7000 Australia
| | - Amin Zarghami
- grid.1009.80000 0004 1936 826XMenzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS 7000 Australia
| | - Simon A. Broadley
- grid.1022.10000 0004 0437 5432Menzies Health Institute Queensland and School of Medicine, Griffith University Gold Coast, G40 Griffith Health Centre, QLD 4222, Australia
| | - Anne-Louise Ponsonby
- grid.1058.c0000 0000 9442 535XDeveloping Brain Division, The Florey Institute for Neuroscience and Mental Health, Royal Children’s Hospital, University of Melbourne Murdoch Children’s Research Institute, Parkville, VIC 3052 Australia
| | - Steve Simpson-Yap
- grid.1008.90000 0001 2179 088XNeuroepidemiology Unit, Melbourne School of Population & Global Health, The University of Melbourne, Melbourne, VIC 3053 Australia
| | - Jeannette Lechner-Scott
- grid.266842.c0000 0000 8831 109XDepartment of Neurology, Hunter Medical Research Institute, Hunter New England Health, University of Newcastle, Callaghan, NSW 2310 Australia
| | - Bruce V. Taylor
- grid.1009.80000 0004 1936 826XMenzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS 7000 Australia
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9
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Chien C, Seiler M, Eitel F, Schmitz-Hübsch T, Paul F, Ritter K. Prediction of high and low disease activity in early MS patients using multiple kernel learning identifies importance of lateral ventricle intensity. Mult Scler J Exp Transl Clin 2022; 8:20552173221109770. [PMID: 35815061 PMCID: PMC9260586 DOI: 10.1177/20552173221109770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 06/10/2022] [Indexed: 11/15/2022] Open
Abstract
Background Lack of easy-to-interpret disease activity prediction methods in early MS can lead to worse patient prognosis. Objectives Using machine learning (multiple kernel learning – MKL) models, we assessed the prognostic value of various clinical and MRI measures for disease activity. Methods Early MS patients ( n = 148) with at least two associated clinical and MRI visits were investigated. T2-weighted MRIs were cropped to contain mainly the lateral ventricles (LV). High disease activity was defined as surpassing NEDA-3 Criteria more than once per year. Clinical demographic, MRI-extracted image-derived phenotypes (IDP), and MRI data were used as inputs for separate kernels to predict future disease activity with MKL. Model performance was compared using bootstrapped effect size analysis of mean differences. Results A total of 681 visits were included, where 81 (55%) patients had high disease activity in a combined end point measure using all follow-up visits. MKL model discrimination performance was moderate (AUC ≥ 0.62); however, modelling with combined clinical and cropped LV kernels gave the highest prediction performance (AUC = 0.70). Conclusions MRIs contain valuable information on future disease activity, especially in and around the LV. MKL techniques for combining different data types can be used for the prediction of disease activity in a relatively small MS cohort.
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Affiliation(s)
- Claudia Chien
- Claudia Chien,
Charité-Universitätsmedizin Berlin, NeuroCure Clinical Research Center,
Charitéplatz 1, 10117 Berlin, Germany.
| | | | - Fabian Eitel
- Charité – Universitätsmedizin Berlin, corporate
member of Freie Universität Berlin and Humboldt-Universität zu Berlin,
Department of Psychiatry and Neurosciences, Berlin, Germany
- Charité – Universitätsmedizin Berlin, corporate
member of Freie Universität Berlin and Humboldt-Universität zu Berlin,
Bernstein Center for Computational Neuroscience, Berlin Center for Advanced
Neuroimaging, Berlin, Germany
| | - Tanja Schmitz-Hübsch
- Charité – Universitätsmedizin Berlin, corporate
member of Freie Universität Berlin and Humboldt-Universität zu Berlin, ECRC
Experimental and Clinical Research Center, Berlin, Germany
- Charité – Universitätsmedizin Berlin, corporate
member of Freie Universität Berlin and Humboldt-Universität zu Berlin,
NeuroCure Clinical Research Center, Berlin, Germany
| | - Friedemann Paul
- Charité – Universitätsmedizin Berlin, corporate
member of Freie Universität Berlin and Humboldt-Universität zu Berlin, ECRC
Experimental and Clinical Research Center, Berlin, Germany
- Charité – Universitätsmedizin Berlin, corporate
member of Freie Universität Berlin and Humboldt-Universität zu Berlin,
NeuroCure Clinical Research Center, Berlin, Germany
- Charité – Universitätsmedizin Berlin,
corporate member of Freie Universität Berlin and Humboldt-Universität zu
Berlin, Department of Neurology, Berlin, Germany
| | - Kerstin Ritter
- Charité – Universitätsmedizin Berlin,
corporate member of Freie Universität Berlin and Humboldt-Universität zu
Berlin, Department of Psychiatry and Neurosciences, Berlin, Germany
- Charité – Universitätsmedizin Berlin,
corporate member of Freie Universität Berlin and Humboldt-Universität zu
Berlin, Bernstein Center for Computational Neuroscience, Berlin Center for
Advanced Neuroimaging, Berlin, Germany
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Interrogating large multiple sclerosis registries and databases: what information can be gained? Curr Opin Neurol 2022; 35:271-277. [PMID: 35674068 DOI: 10.1097/wco.0000000000001057] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW Although substantial progress has been made in understanding the natural history of multiple sclerosis (MS) and the development of new therapies, many questions concerning disease behavior and therapeutics remain to be answered. Data generated from real-world observational studies, based on large MS registries and databases and analyzed with advanced statistical methods, are offering the scientific community answers to some of these questions that are otherwise difficult or impossible to address. This review focuses on observational studies published in the last 2 years designed to compare the effectiveness of escalation vs. induction treatment strategies, to assess the effectiveness of treatment in pediatric-onset and late-onset MS, and to identify the clinical phenotype of secondary progressive (SP)MS. RECENT FINDINGS The main findings originating from real-world studies suggest that MS patients who will qualify for high-efficacy disease-modifying therapies (DMTs) should be offered these as early as possible to prevent irreversible accumulation of neurological disability. Especially pediatric patients derive substantial benefits from early treatment. In patients with late-onset MS, sustained exposure to DMTs may result in more favorable outcomes. Data-driven definitions are more accurate in defining transition to SPMS than diagnosis based solely on neurologists' judgment. SUMMARY Patients, physicians, industry, and policy-makers have all benefited from real-world evidence based on registry data, in answering questions of diagnostics, choice of treatment, and timing of treatment decisions.
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11
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Han J, Chitu V, Stanley ER, Wszolek ZK, Karrenbauer VD, Harris RA. Inhibition of colony stimulating factor-1 receptor (CSF-1R) as a potential therapeutic strategy for neurodegenerative diseases: opportunities and challenges. Cell Mol Life Sci 2022; 79:219. [PMID: 35366105 PMCID: PMC8976111 DOI: 10.1007/s00018-022-04225-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/06/2022] [Accepted: 02/26/2022] [Indexed: 12/12/2022]
Abstract
Microglia are specialized dynamic immune cells in the central nervous system (CNS) that plays a crucial role in brain homeostasis and in disease states. Persistent neuroinflammation is considered a hallmark of many neurodegenerative diseases, including Alzheimer’s disease (AD), Parkinson's disease (PD), Huntington’s disease (HD), amyotrophic lateral sclerosis (ALS) and primary progressive multiple sclerosis (MS). Colony stimulating factor 1-receptor (CSF-1R) is predominantly expressed on microglia and its expression is significantly increased in neurodegenerative diseases. Cumulative findings have indicated that CSF-1R inhibitors can have beneficial effects in preclinical neurodegenerative disease models. Research using CSF-1R inhibitors has now been extended into non-human primates and humans. This review article summarizes the most recent advances using CSF-1R inhibitors in different neurodegenerative conditions including AD, PD, HD, ALS and MS. Potential challenges for translating these findings into clinical practice are presented.
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Affiliation(s)
- Jinming Han
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Violeta Chitu
- Department of Developmental and Molecular Biology, Albert Einstein College of Medicine, Bronx, NY 10461 USA
| | - E. Richard Stanley
- Department of Developmental and Molecular Biology, Albert Einstein College of Medicine, Bronx, NY 10461 USA
| | | | - Virginija Danylaité Karrenbauer
- Department of Clinical Neuroscience, Center for Molecular Medicine L8:04, Karolinska Institutet, Karolinska University Hospital, 171 76 Stockholm, Sweden
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Robert A. Harris
- Applied Immunology and Immunotherapy, Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska Institutet, Karolinska University Hospital, Solna, Sweden
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Thompson AJ, Carroll W, Ciccarelli O, Comi G, Cross A, Donnelly A, Feinstein A, Fox RJ, Helme A, Hohlfeld R, Hyde R, Kanellis P, Landsman D, Lubetzki C, Marrie RA, Morahan J, Montalban X, Musch B, Rawlings S, Salvetti M, Sellebjerg F, Sincock C, Smith KE, Strum J, Zaratin P, Coetzee T. Charting a global research strategy for progressive MS-An international progressive MS Alliance proposal. Mult Scler 2021; 28:16-28. [PMID: 34850641 PMCID: PMC8688983 DOI: 10.1177/13524585211059766] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Progressive forms of multiple sclerosis (MS) affect more than 1 million individuals globally. Recent approvals of ocrelizumab for primary progressive MS and siponimod for active secondary progressive MS have opened the therapeutic door, though results from early trials of neuroprotective agents have been mixed. The recent introduction of the term 'active' secondary progressive MS into the therapeutic lexicon has introduced potential confusion to disease description and thereby clinical management. OBJECTIVE This paper reviews recent progress, highlights continued knowledge and proposes, on behalf of the International Progressive MS Alliance, a global research strategy for progressive MS. METHODS Literature searches of PubMed between 2015 and May, 2021 were conducted using the search terms "progressive multiple sclerosis", "primary progressive multiple sclerosis", "secondary progressive MS". Proposed strategies were developed through a series of in-person and virtual meetings of the International Progressive MS Alliance Scientific Steering Committee. RESULTS Sustaining and accelerating progress will require greater understanding of underlying mechanisms, identification of potential therapeutic targets, biomarker discovery and validation, and conduct of clinical trials with improved trial design. Encouraging developments in symptomatic and rehabilitative interventions are starting to address ongoing challenges experienced by people with progressive MS. CONCLUSION We need to manage these challenges and realise the opportunities in the context of a global research strategy, which will improve quality of life for people with progressive MS.
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Affiliation(s)
| | | | | | | | - Anne Cross
- Washington University in St. Louis, St. Louis, MO, USA
| | | | | | | | | | - Reinhard Hohlfeld
- Munich Cluster for Systems Neurology, Ludwig Maximilian University of Munich, Munich, Germany
| | | | | | | | | | | | | | - Xavier Montalban
- Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | - Marco Salvetti
- Department of Neurosciences, Mental Health and Sensory Organs, Centre for Experimental Neurological Therapies (CENTERS), Sapienza University of Rome, Rome, Italy/Istituto Neurologico Mediterraneo (INM) Neuromed, Pozzilli, Italy
| | - Finn Sellebjerg
- Copenhagen University Hospital-Rigshospitalet, Glostrup, Denmark
| | | | | | - Jon Strum
- International Progressive MS Alliance, Los Angeles, CA, USA
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