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Stenson K, O'Callaghan L, Mellor J, Wright J, Gibson G, Earl L, Barlow S, Fournier CN. Healthcare resource utilization at different stages of amyotrophic lateral sclerosis: Results from a real-world survey. J Neurol Sci 2023; 452:120764. [PMID: 37639764 DOI: 10.1016/j.jns.2023.120764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 07/17/2023] [Accepted: 08/08/2023] [Indexed: 08/31/2023]
Abstract
People with amyotrophic lateral sclerosis (pALS) require complex, multi-disciplinary care, resulting in extensive healthcare resource utilization (HCRU). To investigate the relationship between HCRU and ALS progression, the study objectives were (i) to characterize HCRU in pALS and (ii) to establish whether this varied according to disease stage, as defined using three different methodologies: neurologist-defined early/mid/late stage, the King's clinical staging system for ALS, and the Milan Torino Staging system for ALS (MiToS). Real-world data were drawn from the Adelphi ALS Disease-Specific Programme™, a point-in-time survey of neurologists in France, Germany, Italy, Spain, the UK, and the USA conducted July 2020-March 2021. The analysis included survey responses from 142 physicians with respect to 880 pALS. With advancing ALS stage, significant differences were observed in the number of healthcare professional consultations and X-rays per person (both p < 0.05 for all staging systems), and the proportion of pALS with emergency room admissions, intensive care unit admissions, and assisted ventilation (all p < 0.05 for all staging systems). Across stages, >55% of pALS received care from a general neurologist and a general/primary care practitioner. With increasing stage, there was a significant difference in the proportion receiving care from a physical therapist, pulmonologist/respiratory care practitioner, respiratory therapist, speech/language therapist, and palliative care team, and in the proportion receiving care only from professional caregivers (all p < 0.05 for all staging systems). This study confirmed the substantial HCRU required to support pALS through all stages of ALS and highlighted an increasing need for healthcare resources as the disease progresses.
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Luna J, Couratier P, Lahmadi S, Lautrette G, Fontana A, Tortelli R, Logroscino G, Preux PM, Copetti M, Benoit M. Comparison of the ability of the King's and MiToS staging systems to predict disease progression and survival in amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2021; 22:478-485. [PMID: 33829938 DOI: 10.1080/21678421.2021.1903506] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Assessing clinical progression in amyotrophic lateral sclerosis (ALS) remains a challenge. We evaluated the validity and predictive capabilities of the King's and Milano-Torino Staging (MiToS) systems in a cohort of patients with ALS to demonstrate their benefit in clinical practice.Methodology: A cohort study was performed by including ALS incident cases in a referral center from 2007 to 2016. The staging systems were determined at time of diagnosis and follow-up. The standardized median times to reach each stage were computed. A multi-state model in the framework of the Cox model evaluated the predictive value of measurements. The survival C-statistic was reported as a measure of prediction ability.Results: Overall, 298 incident cases were included. The King's and MiToS systems described a progressive increase in the risk of dying with each elapsed stage. However, a lower resolution for late disease description for the King's system was observed, and late stages overlapped for the MiToS system. Slight variations in the staging systems appeared to improve performance based on validity and prediction abilities: (i) in the King's (C-statistic = 0.783), by adding a new stage involving the need for both gastrostomy and NIV: (ii) in the MiToS (C-statistic = 0.792), by merging stage 3 and stage 4 into a single stage 3.Conclusion: Both King's and MiToS are valid systems but have certain limitations. Variations in the staging systems may provide a more suitable framework for describing progression and survival. Further research is needed to evaluate the variations in the staging systems.
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Affiliation(s)
- Jaime Luna
- INSERM, University of Limoges, CHU Limoges, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST,Limoges, France.,Department of Neurology, ALS expert centre, CHU Limoges,Limoges, France
| | - Philippe Couratier
- INSERM, University of Limoges, CHU Limoges, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST,Limoges, France.,Department of Neurology, ALS expert centre, CHU Limoges,Limoges, France
| | - Sanae Lahmadi
- Department of Neurology, ALS expert centre, CHU Limoges,Limoges, France
| | | | - Andrea Fontana
- Unit of Biostatistics, IRCCS ''Casa Sollievo della Sofferenza'', San Giovanni Rotondo, Italy
| | - Rosanna Tortelli
- Unit of Neurodegenerative Diseases, Department of Clinical Research in Neurology, University of Bari ''Aldo Moro'', at ''Pia Fondazione Cardinale G. Panico'', Lecce, Italy.,Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Giancarlo Logroscino
- Unit of Neurodegenerative Diseases, Department of Clinical Research in Neurology, University of Bari ''Aldo Moro'', at ''Pia Fondazione Cardinale G. Panico'', Lecce, Italy.,Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari ''Aldo Moro'', Bari, Italy
| | - Pierre-Marie Preux
- INSERM, University of Limoges, CHU Limoges, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST,Limoges, France.,Centre d'Epidémiologie, de Biostatistique et de Méthodologie de la Recherche, CHU Limoges, Limoges, France
| | - Massimilano Copetti
- Unit of Biostatistics, IRCCS ''Casa Sollievo della Sofferenza'', San Giovanni Rotondo, Italy
| | - Marin Benoit
- INSERM, University of Limoges, CHU Limoges, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST,Limoges, France
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Corcia P, Beltran S, Lautrette G, Bakkouche S, Couratier P. Staging amyotrophic lateral sclerosis: A new focus on progression. Rev Neurol (Paris) 2018; 175:277-282. [PMID: 30606512 DOI: 10.1016/j.neurol.2018.09.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 09/04/2018] [Accepted: 09/07/2018] [Indexed: 12/11/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is a heterogenous motoneuronal neurodegenerative condition with a panel of phenotypes exhibiting different clinical patterns. Two compounds are currently available for the treatment of ALS but the majority of trials have failed to show a positive effect on prognosis. One of the explanations which could be put forward involves the way efficacy is evaluated: clinicians agree that the ALSFRS-revised scale used in all trials does not fit with highlighting a positive effect. So, the development and validation of new tools allowing a reliable assessment of ALS has become a key issue in clinical research. Over the last three years, two functional scales (the King's College and MiToS staging systems) have been proposed. These scales rely on two different approaches to ALS: an anatomical and prognostic concept, and loss of autonomy. Both scales propose five stages. We will discuss below the contribution of these two scales to clinical evaluation and the questions which remain to be resolved in the future.
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Affiliation(s)
- P Corcia
- Centre Constitutif SLA, CHU Tours, 2, boulevard Tonnellé, 37044 Tours cedex 1, France; Fédération des centres SLA de Tours et Limoges, Litorals, France.
| | - S Beltran
- Centre Constitutif SLA, CHU Tours, 2, boulevard Tonnellé, 37044 Tours cedex 1, France; Fédération des centres SLA de Tours et Limoges, Litorals, France
| | - G Lautrette
- Centre Constitutif SLA, CHU Tours, 2, boulevard Tonnellé, 37044 Tours cedex 1, France; Centre de coordination de la filière FILSLAN, CHU Limoges, France
| | - S Bakkouche
- Centre Constitutif SLA, CHU Tours, 2, boulevard Tonnellé, 37044 Tours cedex 1, France
| | - P Couratier
- Fédération des centres SLA de Tours et Limoges, Litorals, France; Centre de coordination de la filière FILSLAN, CHU Limoges, France
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