Big Multiple Sclerosis Data network: an international registry research network

BACKGROUND

The Big Multiple Sclerosis Data (BMSD) network ( https://bigmsdata.org ) was initiated in 2014 and includes the national multiple sclerosis (MS) registries of the Czech Republic, Denmark, France, Italy, and Sweden as well as the international MSBase registry. BMSD has addressed the ethical, legal, technical, and governance-related challenges for data sharing and so far, published three scientific papers on pooled datasets as proof of concept for its collaborative design.

DATA COLLECTION

Although BMSD registries operate independently on different platforms, similarities in variables, definitions and data structure allow joint analysis of data. Certain coordinated modifications in how the registries collect adverse event data have been implemented after BMSD consensus decisions, showing the ability to develop together.

DATA MANAGEMENT

Scientific projects can be proposed by external sponsors via the coordinating centre and each registry decides independently on participation, respecting its governance structure. Research datasets are established in a project-to-project fashion and a project-specific data model is developed, based on a unifying core data model. To overcome challenges in data sharing, BMSD has developed procedures for federated data analysis.

FUTURE PERSPECTIVES

Presently, BMSD is seeking a qualification opinion from the European Medicines Agency (EMA) to conduct post-authorization safety studies (PASS) and aims to pursue a qualification opinion also for post-authorization effectiveness studies (PAES). BMSD aspires to promote the advancement of real-world evidence research in the MS field.

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

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.

Proportion and characteristics of secondary progressive multiple sclerosis in five European registries using objective classifiers

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.

Isolation and in vitro propagation of human choroidal fibroblasts. Morphology and characterization of the cultures

Subretinal ingrowth of choroidal fibroblasts is of importance in several clinical settings such as age-related macular degeneration or after traumas such as laser treatment and infection. In the present investigation we describe a method for isolation and propagation of human choroidal fibroblasts in vitro. Outgrowth from the outseeded choroid was studied by means of phase contrast microscopy, scanning electron microscopy and by immunohistochemical methods. The secondary cultures were found to contain almost only fibroblasts (more than 95% of the cells), some contaminating retinal pigment cells were also found. Choroidal fibroblasts contribute to the fibrovascular subretinal scarring process, and our cell culturing system seems to be a suitable tool for studying factors regulating the behavior of these cells in vitro.

[Contusion of the eyeball. Changes in trauma types and their treatment]

All journals of patients admitted to the Eye Department, Ullevål hospital with the diagnosis ocular contusion were examined during three periods in the course of the 24 years from 1968 to 1991. The distribution of age, sex and number of patients in the different periods remained almost unchanged. The hospitalization period decreased from six days in the first period to two days in the last period, but this did not increase the incidence of complications. The number of working traumas was reduced, and traumas by violence remained unchanged. There was a large percentage increase in sport traumas, caused mainly by a ball, and these now account for more than 1/3 of all contusions. The prognosis was good in most patients.

Topical anesthesia and adjustable sutures in strabismus surgery

Our experience with the use of topical anesthesia and adjustable sutures in a one-stage operation for treatment of strabismus is discussed, and selected cases are presented. In addition to using the method in recession, we have also developed a method for using adjustable sutures in resection of muscles. We have also found the method useful in reoperations and in operations on paretic muscles.

[Surgery of strabismus performed during topical anesthesia using adjustable sutures]

Retrobulbar, peribulbar and general anaesthesia for strabismus operations all share the disadvantage that they do not permit preoperative evaluation of the effect of the operation. To overcome this problem, we now operate selected cases in topical anaesthesia, using adjustable sutures. In addition to using adjustable sutures in recession, we have developed a method of adjustable resection. During a six month period, 70% of our grown-up patients were operated by this method. We find it a useful supplement to traditional strabismus surgery, also in reoperations and in operations on paretic muscles.

[Tear gas and eye injuries]

In the course of the last year, the Eye Clinic, Ullevål hospital has treated six cases of corneal injury caused by violent use of tear gas spray cannisters. In some cases there was total abrasion of the corneal epithelium, which could take several weeks to heal. We want to draw attention to this "weapon", the use of which seems to be spreading among young people.