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Lis M, Niedziela N, Adamczyk-Zostawa J, Zalejska-Fiolka J, Błachut M, Szczygieł J, Świętek A, Adamczyk-Sowa M. Can Vitamin D Reduce Inflammation? The Influence of Supplementation on Selected Immunological Markers. Int J Mol Sci 2024; 25:7592. [PMID: 39062835 PMCID: PMC11277077 DOI: 10.3390/ijms25147592] [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: 05/20/2024] [Revised: 06/19/2024] [Accepted: 06/24/2024] [Indexed: 07/28/2024] Open
Abstract
There is increasing evidence that vitamin D (VitD) supplementation may reduce inflammation in individuals with multiple sclerosis (MS). The aim of this study was to evaluate the effect of different doses of VitD on selected markers of inflammation in patients with relapsing-remitting MS (RRMS). Participants were divided depending on the supplemented dose of VitD into a high-dose (2000 IU/d; HD) group and a low-dose (15,960 IU/month; LD) group (n = 23 and n = 29, respectively). The concentration of 25(OH)D and the levels of CXCL16, PTX3, ALCAM, IL-1RA, and OPG were measured initially and after six months of VitD supplementation in blood serum. A significant increase in the concentrations of CXCL16, PTX3, and OPG was observed during the study (p = 0.02, p = 0.01, and p < 0.01, respectively). Furthermore, a higher increase in PTX3 and OPG in the LD group was observed (p = 0.04 and p = 0.03, respectively). A significant positive correlation was observed between the 25(OH)D serum concentration and PTX3 (R = 0.28, p < 0.05) and OPG (R = 0.28, p < 0.05) only at the beginning of the study. In patients with RRMS, such doses of VitD might be too low to induce obvious beneficial effects on the pro-inflammatory and inflammatory balance.
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Affiliation(s)
- Martyna Lis
- Department of Neurology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland; (M.L.); (M.A.-S.)
| | - Natalia Niedziela
- Department of Neurology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland; (M.L.); (M.A.-S.)
| | - Jowita Adamczyk-Zostawa
- Department of Ophthalmology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland
| | - Jolanta Zalejska-Fiolka
- Department of Biochemistry, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland
| | - Michał Błachut
- Department of Psychiatry, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland
| | - Jarosław Szczygieł
- Department of Neurology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland; (M.L.); (M.A.-S.)
| | - Agata Świętek
- Silesia LabMed Research and Implementation Center, Medical University of Silesia in Katowice, 19 Jordana St., 41-808 Zabrze, Poland;
| | - Monika Adamczyk-Sowa
- Department of Neurology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland; (M.L.); (M.A.-S.)
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Elkama A, Orhan G, Karahalil B. Association of vitamin D receptor polymorphisms with vitamin D and calcium levels in Turkish multiple sclerosis patients. Neurodegener Dis Manag 2022; 12:323-331. [PMID: 35848285 DOI: 10.2217/nmt-2022-0005] [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: 11/21/2022] Open
Abstract
Aim: The present study was conducted to assess the impact of gene (vitamin D receptor [VDR] polymorphisms) - environment (serum vitamin D and calcium levels) interaction on multiple sclerosis (MS) risk. Materials & methods: FokI, BsmI, TaqI and ApaI genotyping were performed in 149 MS patients and 127 controls. We measured serum vitamin D and calcium levels. Results: No significant difference between VDR polymorphisms and MS risk was detected. In patients with FokI ff, BsmI Bb, TaqI Tt and ApaI AA genotypes, vitamin D levels were statistically higher. Serum calcium levels were significantly lower in patients with FokI FF, Ff, all BsmI and TaqI genotypes and ApaI AA and Aa genotypes. Conclusion: No significant association was found between VDR polymorphisms with MS risk.
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Affiliation(s)
- Aylin Elkama
- Department of Toxicology, Faculty of Pharmacy, Gazi University, Ankara, 06330, Turkey
| | - Gürdal Orhan
- Clinic of Neurology, Ankara Bilkent City Hospitals, Bilkent, Ankara, 06800, Turkey
| | - Bensu Karahalil
- Department of Toxicology, Faculty of Pharmacy, Gazi University, Ankara, 06330, Turkey
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Azadvari M, Mirmosayyeb O, Hosseini M, Vaheb S, Razavi SZE. The prevalence of osteoporosis/osteopenia in patients with multiple sclerosis (MS): a systematic review and meta-analysis. Neurol Sci 2022; 43:3879-3892. [PMID: 35038045 DOI: 10.1007/s10072-022-05871-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 01/06/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The prevalence of osteoporosis is reported differently. We designed this systematic review and meta-analysis to estimate pooled prevalence of osteoporosis and osteopenia in patients with MS. METHODS Independently, two researchers searched PubMed, Scopus, EMBASE, Web of Science, and google scholar along with gray literature (conference abstracts and references of the references) up to March 2021. We collected data regarding first author, country of origin, number of enrolled patients, number cases with osteoporosis/ osteopenia, mean age, F/M ratio, mean EDSS, and mean duration of the disease. RESULTS Literature search revealed 847 articles and 658 remained after deleting duplicates. Finally, 29 original articles and 6 conference papers remained for meta-analysis. A total of 13,906 patients were evaluated. The pooled prevalence of osteoporosis was 17% (95% CI: 14-20%) (I2 = 90.4%, p < 0.001). The pooled prevalence of osteopenia was 43% (95% CI: 35-51%) (I2 = 97.9%, p < 0.001). CONCLUSION Osteoporosis/osteopenia should be considered in patients with MS.
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Affiliation(s)
- Mohaddeseh Azadvari
- Department of Physical Medicine and Rehabilitation, Sina & Imam Khomeini Hospital, Tehran Medical University, Tehran, Iran
| | - Omid Mirmosayyeb
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Universal Council of Epidemiology (UCE), Universal Scientific Education and Research Network (USERN), Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Hosseini
- Department of Physical Medicine and Rehabilitation, Imam Khomeini Hospital, Tehran Medical University, Tehran, Iran
| | - Saeed Vaheb
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Seyede Zahra Emami Razavi
- Department of Physical Medicine and Rehabilitation, Imam Khomeini Hospital, Tehran Medical University, Tehran, Iran.
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POPA FL, ILIESCU MG, STANCIU M, GEORGEANU V. Rehabilitation in a case of severe osteoporosis with prevalent fractures in a patient known with multiple sclerosis and prolonged glucocorticoid therapy. BALNEO AND PRM RESEARCH JOURNAL 2021. [DOI: 10.12680/balneo.2021.451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction. Osteoporosis has a major influence on the quality of life because of its impact on bone strength. Osteoporosis and fractures are frequent in patients with multiple sclerosis, decreased mobility being an important risk factor in these patients.
Objectives. This paper presents a case of severe osteoporosis in a patient with multiple sclerosis, to emphasize a correlation between this two pathologies.
Material and Methods. We present the case of a female Caucasian patient, aged 65 years, known with progressive multiple sclerosis, on long-term use of glucocorticoids, and severe osteoporosis, who is investigated for mechanical pain and functional deficiency in the lumbar spine and the right hip, motor deficit, predominantly on right limbs and walking disorders. The patient was diagnosed with severe osteoporosis treated with raloxifene and bisphosphonates, with multiple vertebral fractures and vitamin D deficiency. During hospitalization the patient followed myorelaxant therapy and an individualized rehabilitation program.
Results and discussion. During follow-up, there was a significant increase followed by a recent decrease in bone mass density in the lumbar spine and hip. The patient was recommended a loading dose of cholecalciferol for three months and initiation of teriparatide therapy after restoring 25-hydroxy vitamin D levels.
Conclusion. In patients with multiple sclerosis,screening and early management of osteoporosis and osteopenia are essential.
Keywords: multiple sclerosis, glucocorticoid therapy, osteoporosis,
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Affiliation(s)
- Florina-Ligia POPA
- 1. “Emergency Clinical County Hospital of Sibiu, Department of Medical Reabilitation”, Sibiu,Romania 2. “Lucian Blaga“ University of Sibiu, Romania
| | - Madalina Gabriela ILIESCU
- “Ovidius” University of Constanta, Romania 4. Balneal and Rehabilitation Sanatorium of Techirghiol, Constanta, Romania
| | - Mihaela STANCIU
- 1. “Emergency Clinical County Hospital of Sibiu, Department of Medical Reabilitation”, Sibiu,Romania 2. “Lucian Blaga“ University of Sibiu, Romania
| | - Vlad GEORGEANU
- 5. „Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
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Eating Pattern and Nutritional Risks among People with Multiple Sclerosis Following a Modified Paleolithic Diet. Nutrients 2020; 12:nu12061844. [PMID: 32575774 PMCID: PMC7353368 DOI: 10.3390/nu12061844] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/05/2020] [Accepted: 06/15/2020] [Indexed: 02/06/2023] Open
Abstract
Preliminary studies suggest that a modified Paleolithic diet may benefit symptoms of fatigue in progressive multiple sclerosis (MS). However, this diet restricts the consumption of eggs, dairy, and gluten-containing grains, which may increase the risk of micronutrient deficiencies. Therefore, we evaluated the nutritional safety of this diet among people with progressive MS. Three nonconsecutive 24-h dietary recalls were collected from (n = 19) progressive MS participants in the final months of a diet intervention study and analyzed using Nutrition Data System for Research (NDSR) software. Food group intake was calculated, and intake of micronutrients was evaluated and compared to individual recommendations using Nutrient Adequacy Ratios (NARs). Blood was drawn at baseline and the end of the study to evaluate biomarker changes. Mean intake of fruits and vegetables exceeded nine servings/day and most participants excluded food groups. The intake of all micronutrients from food were above 100% NAR except for vitamin D (29.6 ± 34.6%), choline (73.2 ± 27.2%), and calcium (60.3 ± 22.8%), and one participant (1/19) exceeded the Tolerable Upper Limit (UL) for zinc, one (1/19) for vitamin A, and 37% (7/19) exceeded the chronic disease risk reduction (CDRR) for sodium. When intake from supplements was included in the analysis, several individuals exceeded ULs for magnesium (5/19), zinc (2/19), sodium (7/19), and vitamins A (2/19), D (9/19), C (1/19), B6 (3/19), and niacin (10/19). Serum values of vitamins D, B12, K1, K2, and folate significantly increased compared to respective baseline values, while homocysteine and magnesium values were significantly lower at 12 months. Calcium and vitamin A serum levels did not change. This modified Paleolithic diet is associated with minimal nutritional risks. However, excessive intake from supplements may be of concern.
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Bone metabolism and vitamin D status in patients with multiple sclerosis. Neurol Neurochir Pol 2016; 50:251-7. [PMID: 27375138 DOI: 10.1016/j.pjnns.2016.04.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 04/09/2016] [Accepted: 04/18/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Vitamin D (VD), an important factor for bone health immobilization and immune regulation, has been shown to have low serum concentration in multiple sclerosis (MS) patients. Those patients have also multiple fracture risk factors, including progressive immobilization and long-term glucocorticoids treatment. The aim of the study was to analyze bone health (osteopenia or osteoporosis prevalence) and VD serum concentration in MS patients as well as the influence of disease activity and treatment on bone health. MATERIALS AND METHODS The study involved 72 MS patients: 52 women and 20 men. Mean age was 40.3±10.5 yrs, mean EDSS (Expanded Disability Status Scale) 3.3±1.9. Bone health was analyzed using standard densitometry in the lumbar spine and femoral neck. Serum levels of VD, calcium, phosphate and parathormone were assessed. We compared two groups of patients with multiple sclerosis: relapsing - remitting MS (RRMS) and progressive relapsing MS (PRMS). RESULTS Densitometry revealed osteopenia in twenty-six (36.1%) patients and osteoporosis in eleven (15.3%), no bone fractures were presented. Sixty-eight MS patients (94.4%) had lower VD serum level if compared to population referential values. Thirteen patients (18.1%) had severe VD deficiency. Densitometry parameter (T-score of the lumbar spine) worsened with EDSS increase (r=-0.43, P=0.001). There was a statistically significant negative correlation between VD concentration and EDSS score (r=-0.31; P=0.009). CONCLUSIONS Our study indicates that patients with MS have high incidence of osteopenia and osteoporosis and vitamin D deficiency. Bone health disturbances studied by densitometry are related to the disability caused by MS.
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Pidgeon TS, Borenstein T, Daniels AH, Murali J, Hayda RA. Understanding Multiple Sclerosis. JBJS Rev 2014; 2:01874474-201407000-00003. [DOI: 10.2106/jbjs.rvw.m.00120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Tyblova M, Kalincik T, Zikan V, Havrdova E. Impaired ambulation and steroid therapy impact negatively on bone health in multiple sclerosis. Eur J Neurol 2014; 22:624-32. [PMID: 24931814 DOI: 10.1111/ene.12479] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 03/25/2014] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND PURPOSE The prevalence of osteopenia and osteoporosis is higher amongst patients with multiple sclerosis in comparison with the general population. In addition to the general determinants of bone health, two factors may contribute to reduced bone mineral density in multiple sclerosis: physical disability and corticosteroid therapy. The aim of this study was to examine the effect of physical disability and steroid exposure on bone health in weight-bearing bones and spine and on the incidence of low-trauma fractures in multiple sclerosis. METHODS In this retrospective analysis of prospectively collected data, associations between bone mineral density (at the femoral neck, total femur and the lumbar spine) and its change with disability or cumulative steroid dose were evaluated with random-effect models adjusted for demographic and clinical determinants of bone health. The incidence of low-trauma fractures during the study follow-up was evaluated with Andersen-Gill models. RESULTS Overall, 474 and 438 patients were included in cross-sectional and longitudinal analyses (follow-up 2347 patient-years), respectively. The effect of severely impaired gait was more apparent in weight-bearing bones (P ≤ 10(-15) ) than in spine (P = 0.007). The effect of cumulative steroid dose was relatively less pronounced but diffuse (P ≤ 10(-4) ). Risk of low-trauma fractures was associated with disability (P = 0.02) but not with cumulative steroid exposure and was greater amongst patients with severely impaired gait (annual risk 3.5% vs. 3.0%). Synergistic effects were found only between cumulative steroid dose in patients ambulatory without support (P = 0.02). CONCLUSIONS Bone health and the incidence of low-trauma fractures in multiple sclerosis are more related to impaired gait than to extended corticosteroid therapy.
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Affiliation(s)
- M Tyblova
- Department of Neurology, Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Prague, Czech Republic
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Lambrinoudaki I, Patikas E, Kaparos G, Armeni E, Rizos D, Thoda P, Alexandrou A, Antoniou A, Tsivgoulis G, Gatzonis S, Panoulis C, Triantafyllou N. Vitamin D receptor Bsm1 polymorphism, calcium metabolism and bone mineral density in patients with multiple sclerosis: a pilot study. Neurol Sci 2012; 34:1433-9. [DOI: 10.1007/s10072-012-1259-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 11/22/2012] [Indexed: 01/23/2023]
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Moen SM, Celius EG, Sandvik L, Brustad M, Nordsletten L, Eriksen EF, Holmøy T. Bone turnover and metabolism in patients with early multiple sclerosis and prevalent bone mass deficit: a population-based case-control study. PLoS One 2012; 7:e45703. [PMID: 23029191 PMCID: PMC3446908 DOI: 10.1371/journal.pone.0045703] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 08/22/2012] [Indexed: 01/21/2023] Open
Abstract
Background Low bone mass is prevalent in ambulatory multiple sclerosis (MS) patients even shortly after clinical onset. The mechanism is not known, but could involve shared etiological risk factors between MS and low bone mass such as hypovitaminosis D operating before disease onset, or increased bone loss after disease onset. The aim of this study was to explore the mechanism of the low bone mass in early-stage MS patients. Methodology/Principal Findings We performed a population-based case-control study comparing bone turnover (cross-linked N-terminal telopeptide of type 1 collagen; NTX, bone alkaline phosphatase; bALP), metabolism (25-hydroxy- and 1, 25-dihydroxyvitamin D, calcium, phosphate, and parathyroid hormone), and relevant lifestyle factors in 99 patients newly diagnosed with clinically isolated syndrome (CIS) or MS, and in 159 age, sex, and ethnicity matched controls. After adjustment for possible confounders, there were no significant differences in NTX (mean 3.3; 95% CI −6.9, 13.5; p = 0.519), bALP (mean 1.6; 95% CI −0.2, 3.5; p = 0.081), or in any of the parameters related to bone metabolism in patients compared to controls. The markers of bone turnover and metabolism were not significantly correlated with bone mass density, or associated with the presence of osteoporosis or osteopenia within or between the patient and control groups. Intake of vitamin D and calcium, reported UV exposure, and physical activity did not differ significantly. Conclusions/Significance Bone turnover and metabolism did not differ significantly in CIS and MS patients with prevalent low bone mass compared to controls. These findings indicate that the bone deficit in patients newly diagnosed with MS and CIS is not caused by recent acceleration of bone loss, and are compatible with shared etiological factors between MS and low bone mass.
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Affiliation(s)
- Stine Marit Moen
- Department of Neurology, Oslo University Hospital Ullevål, Oslo, Norway.
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Bazelier MT, Bentzen J, Vestergaard P, Stenager E, Leufkens HGM, van Staa TP, de Vries F. The risk of fracture in incident multiple sclerosis patients: The Danish National Health Registers. Mult Scler 2012; 18:1609-16. [DOI: 10.1177/1352458512442755] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Patients with multiple sclerosis (MS) may be at increased risk of fractures owing to osteoporosis and falling. Objective: To evaluate the risk of fracture in incident MS patients drawn from a dedicated MS registry compared with population-based controls. Methods: We conducted a population-based cohort study (1996–2007) utilising the Danish National Health Registers that were linked to the Danish MS Registry and the Danish MS Treatment Registry. Incident MS patients (2963 cases) were 1:6 matched by year of birth, gender, calendar time and region to persons without MS (controls). Cox proportional hazards models and logistic regression were used to estimate the risk of fracture in MS. Time-dependent adjustments were made for age, history of diseases and drug use. Results: Compared with controls, patients with MS had no overall increased risk of fracture (adjusted hazard ratio (adj. HR): 1.0, 95% CI: 0.9–1.2). However, the risk of femur/hip fracture (adj. HR: 1.9, 95% CI: 1.1–3.4) was significantly increased compared to controls. As compared with unexposed patients, MS patients who had been exposed to a short course of methylprednisolone in the prior year had no significantly increased risk of osteoporotic fracture (adj. HR: 1.2, 95% CI: 0.5–2.9). Disabled MS patients with Expanded Disability Status Scale [EDSS] scores between 6 and 10, had a 2.6-fold increased risk of osteoporotic fracture (adjusted odds ratio (adj. OR): 2.6, 95% CI: 1.0–6.6) compared to patients with an EDSS score between 0 and 3. Conclusion: Patients with MS had a higher risk of femur/hip fracture than controls. Disability status is probably more important than glucocorticoid use in the aetiology of MS and osteoporotic fracture.
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Affiliation(s)
- Marloes T Bazelier
- Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Netherlands
| | - Joan Bentzen
- National Institute of Public Health, University of Southern Denmark, Denmark
| | | | - Egon Stenager
- The Danish Multiple Sclerosis Registry, Rigshospitalet, Denmark
- MS Clinic of Southern Jutland, Denmark
- Institute of Regional Health Service Research, University of Southern Denmark, Denmark
| | - Hubert GM Leufkens
- Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Netherlands
| | - Tjeerd-Pieter van Staa
- Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Netherlands
- MRC Lifecourse Epidemiology Unit, University of Southampton, UK
- General Practice Research Database, Medicines and Healthcare products Regulatory Agency, UK
| | - Frank de Vries
- Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Netherlands
- MRC Lifecourse Epidemiology Unit, University of Southampton, UK
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre, Netherlands
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