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Lotan I, Romanow G, Salky R, Molazadeh N, Vishnevetsky A, Anderson M, Bilodeau PA, Cutter G, Levy M. Low mortality rate in a large cohort of myelin oligodendrocyte glycoprotein antibody disease (MOGAD). Ann Clin Transl Neurol 2023; 10:664-667. [PMID: 36852731 PMCID: PMC10109314 DOI: 10.1002/acn3.51750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/26/2023] [Accepted: 02/13/2023] [Indexed: 03/01/2023] Open
Abstract
The mortality rates of individuals with myelin oligodendrocyte glycoprotein antibody disease (MOGAD) are currently unknown. This study aimed to assess the mortality rate in a large cohort of patients with MOGAD. Since none of the patients in our cohort died, we estimated the upper limit of a 95% confidence interval of the crude mortality rate in the cohort to be 2.1%. These data suggest that mortality in MOGAD is lower than that reported in other neuroinflammatory diseases and comparable to the age-adjusted mortality rates of the general population in the United States. Additional studies are warranted to confirm this observation.
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Affiliation(s)
- Itay Lotan
- Neuroimmunology Clinic and Research Laboratory, Department of NeurologyMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Gabriela Romanow
- Neuroimmunology Clinic and Research Laboratory, Department of NeurologyMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Rebecca Salky
- Neuroimmunology Clinic and Research Laboratory, Department of NeurologyMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Negar Molazadeh
- Neuroimmunology Clinic and Research Laboratory, Department of NeurologyMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Anastasia Vishnevetsky
- Neuroimmunology Clinic and Research Laboratory, Department of NeurologyMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Monique Anderson
- Neuroimmunology Clinic and Research Laboratory, Department of NeurologyMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Philippe Antoine Bilodeau
- Neuroimmunology Clinic and Research Laboratory, Department of NeurologyMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Gary Cutter
- University of Alabama School of Public HealthBirminghamAlabamaUSA
| | - Michael Levy
- Neuroimmunology Clinic and Research Laboratory, Department of NeurologyMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
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Walz L, Brooks JC, Shavelle RM, Robertson N, Harding KE. Life expectancy in multiple sclerosis by EDSS score. Mult Scler Relat Disord 2022; 68:104219. [PMID: 36244189 DOI: 10.1016/j.msard.2022.104219] [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: 07/06/2022] [Revised: 09/24/2022] [Accepted: 10/04/2022] [Indexed: 11/27/2022]
Abstract
The median survival time of newly-diagnosed MS patients without severe disabilities is approximately 30-35 years. The prognosis after the onset of severe disability has not been reported. Based on Harding et al.'s 2018 study of the Southeast Wales MS registry, we calculated life expectancies according to the Expanded Disability Status Scale (EDSS). Upon loss of independent ambulation (EDSS 6-6.5; mean age 51.2) life expectancy was 13.3 additional years. At EDSS 9-9.5 (mean age 70.8) life expectancy was 1.1 additional years. These figures provide an empirical basis for discussions of advanced MS care planning.
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Affiliation(s)
- Lucas Walz
- Life Expectancy Project, 1439 17th Avenue San Francisco, CA 94122, USA
| | - Jordan C Brooks
- Life Expectancy Project, 1439 17th Avenue San Francisco, CA 94122, USA
| | - Robert M Shavelle
- Life Expectancy Project, 1439 17th Avenue San Francisco, CA 94122, USA
| | - Neil Robertson
- Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, University Hospital of Wales, Heath Park, Cardiff, United Kingdom; Helen Durham Centre for Neuroinflammatory Disease, Department of Neurology, University Hospital of Wales, Heath Park, Cardiff, United Kingdom
| | - Katharine E Harding
- Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, University Hospital of Wales, Heath Park, Cardiff, United Kingdom; Aneurin Bevan University Health Board, Department of Neurology, Royal Gwent Hospital, Cardiff Road, Newport NP20 2UB, United Kingdom.
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Incidence of malignant neoplasms and mortality in people affected by multiple sclerosis in the epoch of disease-modifying treatments: a population-based study on Tuscan residents. Mult Scler Relat Disord 2022; 60:103679. [DOI: 10.1016/j.msard.2022.103679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/29/2022] [Accepted: 02/07/2022] [Indexed: 11/21/2022]
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Howard CW, Zou G, Morrow SA, Fridman S, Racosta JM. Wilcoxon-Mann-Whitney odds ratio: A statistical measure for ordinal outcomes such as EDSS. Mult Scler Relat Disord 2022; 59:103516. [PMID: 35123291 DOI: 10.1016/j.msard.2022.103516] [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: 09/28/2021] [Revised: 12/13/2021] [Accepted: 01/08/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND In many clinical situations, ordinal scales afford the primary method of semi-quantifying patient outcomes. In the field of multiple sclerosis, the primary ordinal scale is the Expanded Disability Status Scale. Predominant methods of ordinal scale statistical analysis provide a p-value without effect size or rely heavily on the assumption of proportionality of odds, subjecting them to lack of power and error. The Wilcoxon-Manny-Whitney Odds is a statistical method which provides significant information such as p-value, effect size, number needed to treat, confidence intervals, and is largely assumption-free. However, its utility has not been demonstrated in the field of multiple sclerosis. METHODS Three clinical studies in the field of multiple sclerosis were selected which utilized ordinal scale outcomes at group or individual levels. Data from these studies was extracted using WebPlotDigitizer, and a custom Wilxocon-Mann-Whitney Odds software was applied to each dataset to re-analyze the main outcomes of the studies. RESULTS Re-analysis of the manuscript by Muraro et al., 2017 demonstrated that autologous stem cell transplantation for relapsing remitting multiple sclerosis resulted in a 65% chance of improving from any Expanded Disability Status Scale category, although not significant. Re-analysis of the manuscript by Songthammawat et al., 2019 demonstrated chance of improvement with intravenous methylprednisolone and concurrent plasma exchange was 185% versus 32% in intravenous methylprednisolone with add-on plasma exchange, although not significant. Re-analysis of Kister et al., 2012 demonstrated the chances of mobility or cognition scores generally favored decline at every 5-year increment of study, and although statistically significant, these were smaller effect sizes ranging from an 11% chance of improvement to a 66% chance of decline over a 5-year interval. DISCUSSION The Wilcoxon-Mann-Whitney Odds simplifies ordinal data analysis with its robust largely assumption-free nature. In the place of numerous statistical tests, this single test provides effect size estimate, number needed to treat, p-values, and confidence intervals. Importantly, the Wilcoxon-Mann-Whitney Odds effect size calculation is intuitively applicable to both individual and population-levels. Further, the Wilcoxon-Mann-Whitney Odds allows intuitive description of the progression of large cohorts over time, and we were able to clearly convey the odds of mobility and cognitive decline over 30 years in a large multiple sclerosis cohort. Overall, the Wilcoxon-Mann-Whitney Odds is a powerful and robust statistical test with significant promise within the field of multiple sclerosis.
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Affiliation(s)
- C W Howard
- Section of Neurology, Department of Internal Medicine, University of Manitoba, Manitoba, Canada.
| | - G Zou
- Dept of Epidemiology and Biostatistics, Western University, London, Canada; Robarts Research Institute, Western University, London, Canada
| | - S A Morrow
- Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada
| | - S Fridman
- Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada
| | - J M Racosta
- Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada; The London MS Epidemiology Laboratory. London, Ontario, Canada
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Sadeghi-Bahmani D, Kidwell A, Bollaert R, Motl RW. Resilience among older adults with multiple sclerosis: Pattern and correlates. Mult Scler Relat Disord 2022; 57:103360. [PMID: 35158431 DOI: 10.1016/j.msard.2021.103360] [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: 05/28/2021] [Revised: 10/26/2021] [Accepted: 10/29/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is an increasing number of older adults with multiple sclerosis (MS) who present with significant challenges associated with aging in conjunction with a chronic, disabling disease. Resilience has been associated with healthy aging in the general population, yet there is limited research on resilience and its correlates among older adults with MS. The current study investigated the difference in resilience between older adults with MS and demographically matched healthy controls. We then examined the associations between resilience and functional, symptomatic, socio-behavioral, and QOL outcomes, along with demographic and clinical characteristics, among only older adults with MS. METHOD The sample included 40 older adults with MS and 40 sex and age matched healthy controls who completed measures of resilience and a battery of demographic, clinical, functional, symptomatic, socio-behavioral, and QOL outcomes. RESULT There were no differences between older adults with MS and healthy controls regarding overall resilience scores and resilience subscale scores. Resilience was significantly associated with neurological disability, depression, walking performance, self-efficacy, and purpose in life. CONCLUSION This study suggests that resilience in older adults with MS was comparable with healthy older adults, and positively associated with walking performance, self-efficacy, and purpose of life, and negatively associated with depression and neurological disability. We believe the time is ripe for developing and delivering interventions among those with lower resilience for improving resilience and associated secondary outcomes.
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Affiliation(s)
| | - Ariel Kidwell
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rachel Bollaert
- Program in Exercise Science, Department of Physical Therapy, Marquette University, Wisconsin, WI, USA
| | - Robert W Motl
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
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Moccia M, Haider L, Eshaghi A, van de Pavert SHP, Brescia Morra V, Patel A, Wheeler-Kingshott CAM, Barkhof F, Ciccarelli O. B Cells in the CNS at Postmortem Are Associated With Worse Outcome and Cell Types in Multiple Sclerosis. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2022; 9:e1108. [PMID: 34759021 PMCID: PMC8587731 DOI: 10.1212/nxi.0000000000001108] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 09/08/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES To define the clinical and pathologic correlations of compartmentalized perivascular B cells in postmortem progressive multiple sclerosis (MS) brains. METHODS Brain slices were acquired from 11 people with secondary progressive (SP) MS, 5 people with primary progressive (PP) MS, and 4 controls. Brain slices were immunostained for B lymphocytes (CD20), T lymphocytes (CD3), cytotoxic T lymphocytes (CD8), neuronal neurofilaments (NF200), myelin (SMI94), macrophages/microglia (CD68 and IBA1), astrocytes (glial fibrillary acidic protein [GFAP]), and mitochondria (voltage-dependent anion channel and cytochrome c oxidase subunit 4). Differences in CD20 immunostaining intensity between disease groups and associations between CD20 immunostaining intensity and both clinical variables and other immunostaining intensities were explored with linear mixed regression models and Cox regression models, as appropriate. RESULTS CD20 immunostaining intensity was higher in PPMS (Coeff = 0.410; 95% confidence interval [CI] = 0.046, 0.774; p = 0.027) and SPMS (Coeff = 0.302; 95% CI = 0.020, 0.585; p = 0.036) compared with controls. CD20 immunostaining intensity was higher in cerebellar, spinal cord, and pyramidal onset (Coeff = 0.274; 95% CI = 0.039, 0.510; p = 0.022) compared with optic neuritis and sensory onset. Higher CD20 immunostaining intensity was associated with younger age at onset (hazard ratio [HR] = 1.033; 95% CI = 1.013, 1.053; p = 0.001), SP conversion (HR = 1.056; 95% CI = 1.022, 1.091; p = 0.001), wheelchair dependence (HR = 1.472; 95% CI = 1.108, 1.954; p = 0.008), and death (HR = 1.684; 95% CI = 1.238, 2.291; p = 0.001). Higher immunostaining intensity for CD20 was associated with higher immunostaining intensity for CD3 (Coeff = 0.114; 95% CI = 0.005, 0.224; p = 0.040), CD8 (Coeff = 0.275; 95% CI = 0.200, 0.350; p < 0.001), CD68 (Coeff = 0.084; 95% CI = 0.023, 0.144; p = 0.006), GFAP (Coeff = 0.002; 95% CI = 0.001, 0.004; p = 0.030), and damaged mitochondria (Coeff = 3.902; 95% CI = 0.891, 6.914; p = 0.011). DISCUSSION Perivascular B cells were associated with worse clinical outcomes and CNS-compartmentalized inflammation. Our findings further support the concept of targeting compartmentalized B-cell inflammation in progressive MS.
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Affiliation(s)
- Marcello Moccia
- From the Queen Square MS Centre (M.M., L.H., A.E., S.H.P.v.d.P., A.P., C.A.M.W.-K., O.C.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, United Kingdom; Multiple Sclerosis Clinical Care and Research Unit (M.M., V.B.M.), Department of Neurosciences, Federico II University, Naples, Italy; Department of Biomedical Imaging and Image Guided Therapy (L.H.), Medical University of Vienna, Austria; Translational Imaging Group F.B., UCL Institute of Healthcare Engineering, University College London, United Kingdom; Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Center, Amsterdam, the Netherlands; and National Institute for Health Research (O.C.), University College London Hospitals Biomedical Research Centre, United Kingdom
| | - Lukas Haider
- From the Queen Square MS Centre (M.M., L.H., A.E., S.H.P.v.d.P., A.P., C.A.M.W.-K., O.C.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, United Kingdom; Multiple Sclerosis Clinical Care and Research Unit (M.M., V.B.M.), Department of Neurosciences, Federico II University, Naples, Italy; Department of Biomedical Imaging and Image Guided Therapy (L.H.), Medical University of Vienna, Austria; Translational Imaging Group F.B., UCL Institute of Healthcare Engineering, University College London, United Kingdom; Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Center, Amsterdam, the Netherlands; and National Institute for Health Research (O.C.), University College London Hospitals Biomedical Research Centre, United Kingdom
| | - Arman Eshaghi
- From the Queen Square MS Centre (M.M., L.H., A.E., S.H.P.v.d.P., A.P., C.A.M.W.-K., O.C.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, United Kingdom; Multiple Sclerosis Clinical Care and Research Unit (M.M., V.B.M.), Department of Neurosciences, Federico II University, Naples, Italy; Department of Biomedical Imaging and Image Guided Therapy (L.H.), Medical University of Vienna, Austria; Translational Imaging Group F.B., UCL Institute of Healthcare Engineering, University College London, United Kingdom; Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Center, Amsterdam, the Netherlands; and National Institute for Health Research (O.C.), University College London Hospitals Biomedical Research Centre, United Kingdom
| | - Steven Harry Pieter van de Pavert
- From the Queen Square MS Centre (M.M., L.H., A.E., S.H.P.v.d.P., A.P., C.A.M.W.-K., O.C.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, United Kingdom; Multiple Sclerosis Clinical Care and Research Unit (M.M., V.B.M.), Department of Neurosciences, Federico II University, Naples, Italy; Department of Biomedical Imaging and Image Guided Therapy (L.H.), Medical University of Vienna, Austria; Translational Imaging Group F.B., UCL Institute of Healthcare Engineering, University College London, United Kingdom; Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Center, Amsterdam, the Netherlands; and National Institute for Health Research (O.C.), University College London Hospitals Biomedical Research Centre, United Kingdom
| | - Vincenzo Brescia Morra
- From the Queen Square MS Centre (M.M., L.H., A.E., S.H.P.v.d.P., A.P., C.A.M.W.-K., O.C.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, United Kingdom; Multiple Sclerosis Clinical Care and Research Unit (M.M., V.B.M.), Department of Neurosciences, Federico II University, Naples, Italy; Department of Biomedical Imaging and Image Guided Therapy (L.H.), Medical University of Vienna, Austria; Translational Imaging Group F.B., UCL Institute of Healthcare Engineering, University College London, United Kingdom; Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Center, Amsterdam, the Netherlands; and National Institute for Health Research (O.C.), University College London Hospitals Biomedical Research Centre, United Kingdom
| | - Amy Patel
- From the Queen Square MS Centre (M.M., L.H., A.E., S.H.P.v.d.P., A.P., C.A.M.W.-K., O.C.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, United Kingdom; Multiple Sclerosis Clinical Care and Research Unit (M.M., V.B.M.), Department of Neurosciences, Federico II University, Naples, Italy; Department of Biomedical Imaging and Image Guided Therapy (L.H.), Medical University of Vienna, Austria; Translational Imaging Group F.B., UCL Institute of Healthcare Engineering, University College London, United Kingdom; Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Center, Amsterdam, the Netherlands; and National Institute for Health Research (O.C.), University College London Hospitals Biomedical Research Centre, United Kingdom
| | - Claudia Angela Michela Wheeler-Kingshott
- From the Queen Square MS Centre (M.M., L.H., A.E., S.H.P.v.d.P., A.P., C.A.M.W.-K., O.C.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, United Kingdom; Multiple Sclerosis Clinical Care and Research Unit (M.M., V.B.M.), Department of Neurosciences, Federico II University, Naples, Italy; Department of Biomedical Imaging and Image Guided Therapy (L.H.), Medical University of Vienna, Austria; Translational Imaging Group F.B., UCL Institute of Healthcare Engineering, University College London, United Kingdom; Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Center, Amsterdam, the Netherlands; and National Institute for Health Research (O.C.), University College London Hospitals Biomedical Research Centre, United Kingdom
| | - Frederik Barkhof
- From the Queen Square MS Centre (M.M., L.H., A.E., S.H.P.v.d.P., A.P., C.A.M.W.-K., O.C.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, United Kingdom; Multiple Sclerosis Clinical Care and Research Unit (M.M., V.B.M.), Department of Neurosciences, Federico II University, Naples, Italy; Department of Biomedical Imaging and Image Guided Therapy (L.H.), Medical University of Vienna, Austria; Translational Imaging Group F.B., UCL Institute of Healthcare Engineering, University College London, United Kingdom; Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Center, Amsterdam, the Netherlands; and National Institute for Health Research (O.C.), University College London Hospitals Biomedical Research Centre, United Kingdom
| | - Olga Ciccarelli
- From the Queen Square MS Centre (M.M., L.H., A.E., S.H.P.v.d.P., A.P., C.A.M.W.-K., O.C.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, United Kingdom; Multiple Sclerosis Clinical Care and Research Unit (M.M., V.B.M.), Department of Neurosciences, Federico II University, Naples, Italy; Department of Biomedical Imaging and Image Guided Therapy (L.H.), Medical University of Vienna, Austria; Translational Imaging Group F.B., UCL Institute of Healthcare Engineering, University College London, United Kingdom; Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Center, Amsterdam, the Netherlands; and National Institute for Health Research (O.C.), University College London Hospitals Biomedical Research Centre, United Kingdom
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Wiyani A, Badgujar L, Khurana V, Adlard N. How have Economic Evaluations in Relapsing Multiple Sclerosis Evolved Over Time? A Systematic Literature Review. Neurol Ther 2021; 10:557-583. [PMID: 34279847 PMCID: PMC8571458 DOI: 10.1007/s40120-021-00264-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/06/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The introduction of disease-modifying therapies (DMTs) for relapsing multiple sclerosis (RMS) over the last two decades has prompted the economic assessments of these treatments by reimbursement authorities. The aim of this systematic literature review was to evaluate the modeling approach and data sources used in economic evaluations of DMTs for RMS, identify differences and similarities, and explore how economic evaluation models have evolved over time. METHODS MEDLINE®, Embase®, and EBM Reviews databases were searched using Ovid® Platform from database inception on 25 December 2019 and subsequently updated on 17 February 2021. In addition, health technology assessment agency websites, key conference proceedings, and gray literature from relevant websites were screened. The quality of included studies was assessed using the Drummond and Philips checklists. RESULTS A total 155 publications and 30 Health Technology Assessment (HTA) reports were included. Most of these were cost-utility analysis (73 studies and 25 HTA reports) and funded by medicines manufacturers (n = 65). The top three countries where studies were conducted were the USA (n = 29), the UK (n = 16), and Spain (n = 10). Studies predominantly used Markov cohort models (94 studies; 25 HTAs) structured based on the Expanded Disability Status Scale (EDSS) with 21 health states (20 studies; 12 HTA reports). The London Ontario and British Columbia data sets were commonly used sources for natural history data (n = 33; n = 13). Twelve studies and ten HTAs from the UK assumed a waning of DMT effect over the long term, while this was uncommon in studies from other countries. Nineteen studies adjusted for multiple sclerosis (MS)-specific mortality estimates, while 18 studies used data from the national life table without adjustment. Studies prominently referred to mortality data that were about two decades old. The data on treatment effect was generally obtained from randomized controlled trials (43 studies; 7 HTAs) or from published evidence synthesis (23 studies; 24 HTAs). Utility estimates were derived from either published studies and/or supplemented with data from RCTs. Most of the models used the lifetime horizon (n = 37) with a 1-year cycle length (n = 63). CONCLUSION As expected, similarities as well as differences were observed across the different economic models. Available evidence suggests models should continue using the Markov cohort model with 21 EDSS-based states, however, allowing the transition to a lower EDSS state and assuming a sustained treatment effect. With reference to the data sources, models should consider using a contemporary MS-specific mortality data, recent natural history data, and country-specific utility data if available. In case of data unavailability, a sensitivity analysis using multiple sources of data should be conducted. In addition, future models should incorporate other clinically relevant outcomes, such as the cognition, vision, and psychological aspects of RMS, to be able to present the comprehensive value of DMTs.
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Affiliation(s)
- Anggie Wiyani
- Novartis Corporation (Malaysia) Sdn. Bhd., Petaling Jaya, Malaysia.
| | | | - Vivek Khurana
- Novartis Corporation (Malaysia) Sdn. Bhd., Petaling Jaya, Malaysia
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Marrie RA, Maxwell C, Mahar A, Ekuma O, McClintock C, Seitz D, Groome P. Colorectal Cancer Survival in Multiple Sclerosis: A Matched Cohort Study. Neurology 2021; 97:e1447-e1456. [PMID: 34526374 PMCID: PMC8520388 DOI: 10.1212/wnl.0000000000012634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 07/16/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND AND OBJECTIVES We tested the hypothesis that overall and cancer-specific survival after a colorectal cancer diagnosis is lower in persons with multiple sclerosis (MS) than in those without MS using a retrospective matched cohort design. METHODS Using population-based administrative data in Manitoba and Ontario, we identified persons with MS from a validated case definition and linked these cohorts to cancer registries to identify those with colorectal cancer. We selected persons with colorectal cancer and without MS, matching 4:1 on birth year, sex, cancer diagnosis year, and region. We used Cox proportional hazards regression to compare all-cause survival between cohorts, adjusting for age at cancer diagnosis, cancer diagnosis year, income, region, and Elixhauser comorbidity score. We compared cancer-specific survival between cohorts using a cause-specific hazards model. We pooled findings across provinces using random-effects meta-analysis. Complementary analyses using a subcohort from Ontario, adjusted for cancer stage and disability status, as measured from the use of home care or long-term care services. RESULTS We included 338 MS cases and 1,352 controls with colorectal cancer. The mean (SD) age at cancer diagnosis was 64.7 (11.1) years. After adjustment, MS was associated with an increased hazard for all-cause death that was highest 6 months after diagnosis (hazard ratio [HR] 1.45, 95% confidence interval [CI] 1.19-1.76) and then declined over time (HR [95% CI] at 1 year 1.34 [1.09-1.63], 2 years 1.24 [0.99-1.56], 5 years 1.10 [0.80-1.50]). MS was associated with increased cancer-specific death at 6 months after diagnosis only (HR 1.29, 95% CI 1.04-1.61). After adjustment for cancer stage, MS was associated with an increased hazard of death due to any cause (1.60, 95% CI 1.16-2.21) and with cancer-specific death (HR 1.47, 95% CI 1.02-2.12). The association of MS and all-cause death was partially attenuated after adjustment for disability status (HR 1.37, 95% CI 0.97-1.92), as was the association with cancer-specific death (HR 1.34, 95% CI 0.91-1.97). DISCUSSION Overall and cancer-specific survival was lower in persons with than without MS in the early period after colorectal cancer diagnosis. Further study is warranted to determine what factors underlie these worse outcomes.
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Affiliation(s)
- Ruth Ann Marrie
- From the Department of Internal Medicine (R.A.M.), Department of Community Health Sciences (R.A.M., A.M.), and Manitoba Centre for Health Policy (A.M., O.E.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; ICES (C. Maxwell), Toronto; Schools of Pharmacy and Public Health and Health Systems (C. Maxwell), University of Waterloo; ICES Queen's (A.M., C. McClintock, D.S., P.G.) and Division of Cancer Care and Epidemiology (P.G.), Cancer Research Institute, Queen's University, Kingston, Ontario; and Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary, Alberta, Canada.
| | - Colleen Maxwell
- From the Department of Internal Medicine (R.A.M.), Department of Community Health Sciences (R.A.M., A.M.), and Manitoba Centre for Health Policy (A.M., O.E.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; ICES (C. Maxwell), Toronto; Schools of Pharmacy and Public Health and Health Systems (C. Maxwell), University of Waterloo; ICES Queen's (A.M., C. McClintock, D.S., P.G.) and Division of Cancer Care and Epidemiology (P.G.), Cancer Research Institute, Queen's University, Kingston, Ontario; and Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Alyson Mahar
- From the Department of Internal Medicine (R.A.M.), Department of Community Health Sciences (R.A.M., A.M.), and Manitoba Centre for Health Policy (A.M., O.E.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; ICES (C. Maxwell), Toronto; Schools of Pharmacy and Public Health and Health Systems (C. Maxwell), University of Waterloo; ICES Queen's (A.M., C. McClintock, D.S., P.G.) and Division of Cancer Care and Epidemiology (P.G.), Cancer Research Institute, Queen's University, Kingston, Ontario; and Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Okechukwu Ekuma
- From the Department of Internal Medicine (R.A.M.), Department of Community Health Sciences (R.A.M., A.M.), and Manitoba Centre for Health Policy (A.M., O.E.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; ICES (C. Maxwell), Toronto; Schools of Pharmacy and Public Health and Health Systems (C. Maxwell), University of Waterloo; ICES Queen's (A.M., C. McClintock, D.S., P.G.) and Division of Cancer Care and Epidemiology (P.G.), Cancer Research Institute, Queen's University, Kingston, Ontario; and Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Chad McClintock
- From the Department of Internal Medicine (R.A.M.), Department of Community Health Sciences (R.A.M., A.M.), and Manitoba Centre for Health Policy (A.M., O.E.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; ICES (C. Maxwell), Toronto; Schools of Pharmacy and Public Health and Health Systems (C. Maxwell), University of Waterloo; ICES Queen's (A.M., C. McClintock, D.S., P.G.) and Division of Cancer Care and Epidemiology (P.G.), Cancer Research Institute, Queen's University, Kingston, Ontario; and Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Dallasl Seitz
- From the Department of Internal Medicine (R.A.M.), Department of Community Health Sciences (R.A.M., A.M.), and Manitoba Centre for Health Policy (A.M., O.E.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; ICES (C. Maxwell), Toronto; Schools of Pharmacy and Public Health and Health Systems (C. Maxwell), University of Waterloo; ICES Queen's (A.M., C. McClintock, D.S., P.G.) and Division of Cancer Care and Epidemiology (P.G.), Cancer Research Institute, Queen's University, Kingston, Ontario; and Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Patti Groome
- From the Department of Internal Medicine (R.A.M.), Department of Community Health Sciences (R.A.M., A.M.), and Manitoba Centre for Health Policy (A.M., O.E.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; ICES (C. Maxwell), Toronto; Schools of Pharmacy and Public Health and Health Systems (C. Maxwell), University of Waterloo; ICES Queen's (A.M., C. McClintock, D.S., P.G.) and Division of Cancer Care and Epidemiology (P.G.), Cancer Research Institute, Queen's University, Kingston, Ontario; and Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary, Alberta, Canada
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9
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Eren F, Ozkan B, Demir A. The relationship between dysphagia, respiratory functions and anthropometry in patients with multiple sclerosis. Mult Scler Relat Disord 2021; 55:103192. [PMID: 34371272 DOI: 10.1016/j.msard.2021.103192] [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: 06/14/2021] [Revised: 07/08/2021] [Accepted: 08/01/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND It is known that many body systems are affected as a result of dysphagia. The aim of this study is to investigate the relationship between clinical features, respiratory functions, anthropometric measurements and dysphagia in patients with multiple sclerosis (MS). METHOD Seventy-five MS patients and 50 healthy controls were included in this prospective case-control study. Disability was assessed with expanded disability status scale (EDSS), and swallowing was assessed with questionnaire for the assessment of dysphagia (solid, liquid and total) for disease. Respiratory functions were demonstrated with computerized spirometry device. Body weight, height, waist, hip, and mid-arm circumference are measured. Body mass index and body fat percentage were calculated. The relationship of all these parameters with disease activity and dysphagia was investigated. RESULTS There were 75 MS patients with a mean age of 38.40 ± 11.27 years, and 50 (66.70%) were female in the study. The all type of dysphagia scores were higher in MS patients than control group (p = 0.001). Many respiratory function test scores and only hip circumference were lower in MS patients. However, especially low forced expiratory volume-1st second (FEV1), forced vital capacity (FVC) and peak expiratory flow (PEF) values were associated with disability. In addition, dysphagia scores were higher in progressive MS patients with severe disability and high frequency attacks (p = 0.001). Increased severity of dysphagia are associated with many lower anthropometric measurements (not height-especially mid-arm circumference) and respiratory function test scores. CONCLUSION MS affects swallowing and respiratory systems functions. They are associated with MS disease activity. Dysphagia and its severity are associated with many anthropometric measurements and respiratory functions test scores.
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Affiliation(s)
- Fettah Eren
- Department of Neurology, Selcuk University Faculty of Medicine, Seven street & Number 1B, Konya 42700, Turkey.
| | - Bengu Ozkan
- Konya City Hospital, Chest Diseases Clinic, University of Health Sciences Turkey, Konya 42700, Turkey.
| | - Aysegul Demir
- Konya City Hospital, Neurology Clinic, University of Health Sciences Turkey, Konya 42700, Turkey.
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10
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Francalancia J, Mavrogiorgou P, Juckel G, Mitrovic T, Kuhle J, Naegelin Y, Kappos L, Calabrese P. Death Anxiety and Attitudes towards Death in Patients with Multiple Sclerosis: An Exploratory Study. Brain Sci 2021; 11:brainsci11080964. [PMID: 34439584 PMCID: PMC8391402 DOI: 10.3390/brainsci11080964] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Death and the anxiety of it becomes more apparent when confronted with a chronic disease. Even though multiple sclerosis (MS) is a treatable condition today, it is still accompanied by a multitude of impairments, which in turn may intensify of death anxiety. Objective: The aim of this study is to explore the relationship between depression, anxiety and death anxiety in individuals with MS. Methods: Fifty-six MS patients were recruited at the Department of Neurology of the University Clinic in Basel. Death anxiety was assessed using the Bochumer Questionnaire on attitude to death and death anxiety 2.0 (BOFRETTA 2.0). Results: Scores of death anxiety towards it in MS patients were low. Only disability (EDSS) was moderately correlated with death anxiety. Depression in MS was significantly correlated with fatigue and disability, but not with the BOFRETTA 2.0. Conclusion: Scores of death anxiety and the attitude towards death are low in this MS cohort. It was shown that both psychopathological and neurological deficits impact the subject of death with respect to multiple sclerosis.
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Affiliation(s)
- Jara Francalancia
- Neuropsychology and Behavioral Neurology Unit, Division of Molecular and Cognitive Neuroscience, Department of Psychology, University of Basel, Birmannsgasse 8, 4055 Basel, Switzerland; (J.F.); (T.M.)
| | - Paraskevi Mavrogiorgou
- Department of Psychiatry, Ruhr University Bochum, Alexandrinenstr. 1, 44791 Bochum, Germany; (P.M.); (G.J.)
| | - Georg Juckel
- Department of Psychiatry, Ruhr University Bochum, Alexandrinenstr. 1, 44791 Bochum, Germany; (P.M.); (G.J.)
| | - Tina Mitrovic
- Neuropsychology and Behavioral Neurology Unit, Division of Molecular and Cognitive Neuroscience, Department of Psychology, University of Basel, Birmannsgasse 8, 4055 Basel, Switzerland; (J.F.); (T.M.)
- Department of Neurology, University Clinic Basel, Petersgraben 4, 4031 Basel, Switzerland; (J.K.); (Y.N.); (L.K.)
| | - Jens Kuhle
- Department of Neurology, University Clinic Basel, Petersgraben 4, 4031 Basel, Switzerland; (J.K.); (Y.N.); (L.K.)
| | - Yvonne Naegelin
- Department of Neurology, University Clinic Basel, Petersgraben 4, 4031 Basel, Switzerland; (J.K.); (Y.N.); (L.K.)
| | - Ludwig Kappos
- Department of Neurology, University Clinic Basel, Petersgraben 4, 4031 Basel, Switzerland; (J.K.); (Y.N.); (L.K.)
| | - Pasquale Calabrese
- Neuropsychology and Behavioral Neurology Unit, Division of Molecular and Cognitive Neuroscience, Department of Psychology, University of Basel, Birmannsgasse 8, 4055 Basel, Switzerland; (J.F.); (T.M.)
- Department of Neurology, University Clinic Basel, Petersgraben 4, 4031 Basel, Switzerland; (J.K.); (Y.N.); (L.K.)
- Correspondence:
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11
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Murtonen A, Lehto JT, Sumelahti ML. End of life in multiple sclerosis: Disability, causes and place of death among cases diagnosed from 1981 to 2010 in Pirkanmaa hospital district in Western Finland. Mult Scler Relat Disord 2021; 54:103139. [PMID: 34273609 DOI: 10.1016/j.msard.2021.103139] [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: 05/03/2021] [Revised: 06/29/2021] [Accepted: 07/04/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Mortality risk and causes of death have been widely studied in MS. Surveys on conditions related to approaching death have not been conducted before in Finland. OBJECTIVE Our aim was to sort out the possible needs for end of life (EOL) care in MS by examining causes, place of death and level of hospitalization by age and MS related disability before approaching death. MATERIALS Data included information for MS patients diagnosed from 1981 to 2010 in a Finnish university hospital district. Information on place and causes of death and care prior to death was based on death certificates from Statistics Finland. Decedents initial disease course, disease modifying treatment (DMT) use and MS related disability status by using EDSS were achieved from hospital records. RESULTS Data included 113 decedents. Level of disability showed EDSS 6.0 or higher in 54% of the patients. In relapsing onset MS (N 93, 80%) DMTs were used in 11%. Infections, respiratory or other, were the main immediate cause of death (51.3%, n 58) among cases with varying disability. Central or university hospital (42.5%) or community hospital ward (28.3%) were places of death in majority of cases and nursing home (13.3%), home (9.7%) or hospice (3.7%) less often. Place of death did not significantly differ between age-groups (Chi square p = 0.86). Mean age at death was 57 years (range 28-90, SD 13.86). Cardiovascular causes of death were reported mainly in age group 60 years or more and suicide in age group younger than 50 years. CONCLUSION The level of hospitalization was high at end of life in all age-groups. High MS related disability and immobility among decedents likely relates to infections as the most common cause of death. Along with our and earlier surveys in this field, we showed that places of death and level of disability before death share similarities in both younger and older age groups highlighting the need of palliative care and end of life care plans in all MS patients with triggers of poor survival. The recently published consensus definition featuring palliative care guideline in MS is aimed at improving end of life care in MS. Our results point at need for future studies in order to assess the impact of palliative care treatment guidelines in MS.
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Affiliation(s)
- Annukka Murtonen
- Faculty of Medicine and Health Technology, Tampere University, 33014 Finland.
| | - Juho T Lehto
- Faculty of Medicine and Health Technology, Tampere University, 33014 Finland; Palliative Care Centre and Department of Oncology, Tampere University Hospital, Tampere, Finland
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12
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Tinelli M, Pugliatti M, Antonovici A, Hausmann B, Hellwig K, Quoidbach V, Sørensen PS. Averting multiple sclerosis long-term societal and healthcare costs: The Value of Treatment (VoT) project. Mult Scler Relat Disord 2021; 54:103107. [PMID: 34237560 DOI: 10.1016/j.msard.2021.103107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 04/21/2021] [Accepted: 06/19/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND PURPOSE The recent report on Value-of-Treatment (VoT) project highlights the need for early diagnosis-intervention, integrated, seamless care underpinning timely care pathways and access to best treatments. The VoT-multiple-sclerosis (MS) economic case study analysis aimed to estimate the effectiveness/cost-effectiveness of both early treatment and reducing MS risk factors (e.g. smoking and vitamin D insufficiency). METHODS A series of decision analytical modellings were developed and applied to estimate the cost-effectiveness of: (1) reducing the conversion from clinically-isolated-syndrome (CIS) to clinically-definite-MS (CDMS); (2) smoking cessation and increase of 25 hydroxyvitamin D (25(OH)D) serum level. Both (1) and (2) considered socioeconomic impact on averted MS disability progression. Costs were reported for societal and healthcare provider perspectives (pending on data across nations; Euros). Effectiveness was expressed as Quality-Adjusted-Life-Years (QALYs) gains. Long term (25, 30, 40,50-years) and short (one-year) timelines were considered for (1) and (2), respectively. RESULTS Early treatment was cost-effective for the health care provider and both cost-effective/cost-saving for the society across time-horizons and nations. Smoking cessation and an increase of 25(OH)D in MS patients were both cost-effective/cost-saving across nations. CONCLUSIONS To the best of our knowledge, our work provides the first economic evidence to base appropriate public health interventions to reduce the MS burden in Europe.
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Affiliation(s)
- Michela Tinelli
- Care policy and Evaluation Centre, London School of Economics and Political Science, Houghton St, London WC2A 2AE, United Kingdom.
| | - Maura Pugliatti
- Department of Neuroscience and Rehabilitation, University of Ferrara, Italy
| | | | | | - Kerstin Hellwig
- Department of Neurology, St. Josef Hospital Ruhr University Bochum, Germany
| | | | - Per Soelberg Sørensen
- University of Copenhagen, Copenhagen, Denmark and European Academy of Neurology (EAN), Europe
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13
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Motl RW, Cutter G, Bamman MM, Brown CJ, Rinker J. The Importance and Opportunity for Healthy Aging Through Lifestyle, Behavior Medicine Among Older Adults With Multiple Sclerosis: the Case Based on Physical Activity. Curr Treat Options Neurol 2021. [DOI: 10.1007/s11940-021-00680-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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14
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Marrie RA, Maxwell C, Mahar A, Ekuma O, McClintock C, Seitz D, Groome P. Breast Cancer Survival in Multiple Sclerosis: A Matched Cohort Study. Neurology 2021; 97:e13-e22. [PMID: 34011575 DOI: 10.1212/wnl.0000000000012127] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 03/19/2021] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To test the hypotheses that overall survival and cancer-specific survival after breast cancer diagnosis would be lower in persons with multiple sclerosis (MS) as compared to persons without MS using a retrospective matched cohort design. METHODS We applied a validated case definition to population-based administrative data in Manitoba and Ontario, Canada, to identify women with MS. We linked the MS cohorts to cancer registries to identify women with breast cancer. Then we selected 4 breast cancer controls without MS matched on birth year, cancer diagnosis year, and region. We compared all-cause survival between cohorts using Cox proportional hazards regression adjusting for age at cancer diagnosis, cancer diagnosis period, income quintile, region, and Elixhauser comorbidity score. We compared cancer-specific survival between cohorts using a multivariable cause-specific hazards model. We pooled findings between provinces using meta-analysis. RESULTS We included 779 patients with MS and 3,116 controls with breast cancer. Most patients with stage data (1,976/2,822 [70.0%]) were diagnosed with stage I or II breast cancer and the mean (SD) age at diagnosis was 57.8 (10.7) years. After adjustment for covariates, MS was associated with a 28% increased hazard for all-cause mortality (hazard ratio [HR] 1.28; 95% confidence interval [CI] 1.08-1.53), but was not associated with altered cancer-specific survival (HR 0.98; 95% CI 0.65-1.46). CONCLUSION Women with MS have lower all-cause survival after breast cancer diagnosis than women without MS. Future studies should confirm these findings in other populations and identify MS-specific factors associated with worse prognosis.
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Affiliation(s)
- Ruth Ann Marrie
- From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M., A.M.) and Manitoba Centre for Health Policy (A.M., O.E.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Schools of Pharmacy and Public Health & Health Systems (C.M.), University of Waterloo; ICES (C.M.), Toronto; ICES Queens (A.M., C.M., D.S., P.G.), Queens University, Kingston; Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary; and Division of Cancer Care and Epidemiology (P.G.), Cancer Research Institute, Queen's University, Kingston, Canada.
| | - Colleen Maxwell
- From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M., A.M.) and Manitoba Centre for Health Policy (A.M., O.E.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Schools of Pharmacy and Public Health & Health Systems (C.M.), University of Waterloo; ICES (C.M.), Toronto; ICES Queens (A.M., C.M., D.S., P.G.), Queens University, Kingston; Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary; and Division of Cancer Care and Epidemiology (P.G.), Cancer Research Institute, Queen's University, Kingston, Canada
| | - Alyson Mahar
- From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M., A.M.) and Manitoba Centre for Health Policy (A.M., O.E.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Schools of Pharmacy and Public Health & Health Systems (C.M.), University of Waterloo; ICES (C.M.), Toronto; ICES Queens (A.M., C.M., D.S., P.G.), Queens University, Kingston; Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary; and Division of Cancer Care and Epidemiology (P.G.), Cancer Research Institute, Queen's University, Kingston, Canada
| | - Okechukwu Ekuma
- From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M., A.M.) and Manitoba Centre for Health Policy (A.M., O.E.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Schools of Pharmacy and Public Health & Health Systems (C.M.), University of Waterloo; ICES (C.M.), Toronto; ICES Queens (A.M., C.M., D.S., P.G.), Queens University, Kingston; Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary; and Division of Cancer Care and Epidemiology (P.G.), Cancer Research Institute, Queen's University, Kingston, Canada
| | - Chad McClintock
- From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M., A.M.) and Manitoba Centre for Health Policy (A.M., O.E.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Schools of Pharmacy and Public Health & Health Systems (C.M.), University of Waterloo; ICES (C.M.), Toronto; ICES Queens (A.M., C.M., D.S., P.G.), Queens University, Kingston; Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary; and Division of Cancer Care and Epidemiology (P.G.), Cancer Research Institute, Queen's University, Kingston, Canada
| | - Dallas Seitz
- From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M., A.M.) and Manitoba Centre for Health Policy (A.M., O.E.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Schools of Pharmacy and Public Health & Health Systems (C.M.), University of Waterloo; ICES (C.M.), Toronto; ICES Queens (A.M., C.M., D.S., P.G.), Queens University, Kingston; Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary; and Division of Cancer Care and Epidemiology (P.G.), Cancer Research Institute, Queen's University, Kingston, Canada
| | - Patti Groome
- From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M., A.M.) and Manitoba Centre for Health Policy (A.M., O.E.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Schools of Pharmacy and Public Health & Health Systems (C.M.), University of Waterloo; ICES (C.M.), Toronto; ICES Queens (A.M., C.M., D.S., P.G.), Queens University, Kingston; Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary; and Division of Cancer Care and Epidemiology (P.G.), Cancer Research Institute, Queen's University, Kingston, Canada
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15
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Muhtaroglu M, Ertugrul Mut S, Selcuk F, Malkoc M. Evaluation of respiratory functions and quality of life in multiple sclerosis patients. Acta Neurol Belg 2020; 120:1107-1113. [PMID: 29974389 DOI: 10.1007/s13760-018-0967-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 06/17/2018] [Indexed: 10/28/2022]
Abstract
The aim of this study was to evaluate respiratory muscle strength, respiratory functions and quality of life in multiple sclerosis (MS) patients and compare the results with the healthy volunteers. The study included a group of 24 patients diagnosed with MS (16 women, 8 men) with an EDSS score of ≤ 5, who were without clinical respiratory impairment. MS patients were compared with the healthy volunteer group (16 women, 8 men). Respiratory muscle strength and respiratory functions were evaluated with specific devices. Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) parameters were measured for the muscle strength. Forced vital capacity (FVC), forced expiratory volume (FEV1), FEV1/FVC, peak expiratory flow, and forced expiratory flow (FEF25-75) parameters were measured for the respiratory functions. Questionnaire SF-36 was applied to evaluate health-related quality of life. A total of 24 MS patients' respiratory function test results were compared with healthy volunteers and significant changes were found at MIP, MEP, and FEV1 parameters. Quality of life was compared between the groups and there was a significant difference in parameters related with physical performance and physical-health-related role limitations. There is an early involvement of the respiratory muscles in patients with MS, yet clinical symptoms appear in later stages. Respiratory functions should be evaluated at the earlier stage of the disease so that rehabilitation can be planned in order to reduce respiratory complications and improve the quality of life in patients.
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Klotz L, Havla J, Schwab N, Hohlfeld R, Barnett M, Reddel S, Wiendl H. Risks and risk management in modern multiple sclerosis immunotherapeutic treatment. Ther Adv Neurol Disord 2019; 12:1756286419836571. [PMID: 30967901 PMCID: PMC6444778 DOI: 10.1177/1756286419836571] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 02/14/2019] [Indexed: 12/13/2022] Open
Abstract
In recent years, there has been a paradigm shift in the treatment of multiple
sclerosis (MS) owing to the approval of a number of new drugs with very distinct
mechanisms of action. All approved disease-modifying drugs primarily work
directly on the immune system. However, the identification of an ‘optimal
choice’ for individual patients with regard to treatment efficacy, treatment
adherence and side-effect profile has become increasingly complex including
conceptual as well as practical considerations. Similarly, there are
peculiarities and specific requirements with regard to treatment monitoring,
especially in relation to immunosuppression, the development of secondary
immune-related complications, as well as the existence of drug-specific on- and
off-target effects. Both classical immunosuppression and selective immune
interventions generate a spectrum of potential therapy-related complications.
This article provides a comprehensive overview of available immunotherapeutics
for MS and their risks, detailing individual mechanisms of action and
side-effect profiles. Furthermore, practical recommendations for patients
treated with modern MS immunotherapeutics are provided.
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Affiliation(s)
- Luisa Klotz
- Department of Neurology with Institute of Translational Neurology, University of Münster, Building A1, Albert Schweitzer Campus 1, 48149 Münster, Germany
| | - Joachim Havla
- Institute of Clinical Neuroimmunology, University Hospital; Data Integration for Future Medicine consortium (DIFUTURE), Ludwig-Maximilians University, Munich, Germany
| | - Nicholas Schwab
- Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Reinhard Hohlfeld
- Institute of Clinical Neuroimmunology, University Hospital, Ludwig-Maximilians University, Munich, Germany Munich Cluster for Systems Neurology, Ludwig-Maximilians University, Munich, Germany
| | | | - Stephen Reddel
- Brain and Mind Centre, University of Sydney, NSW, Australia
| | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, University of Münster, Building A1, Albert Schweitzer Campus 1, 48149 Münster, Germany
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Roddam H, Rog D, Janssen J, Wilson N, Cross L, Olajide O, Dey P. Inequalities in access to health and social care among adults with multiple sclerosis: A scoping review of the literature. Mult Scler Relat Disord 2019; 28:290-304. [DOI: 10.1016/j.msard.2018.12.043] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 12/11/2018] [Accepted: 12/31/2018] [Indexed: 11/30/2022]
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Coulter EH, Bond S, Dalgas U, Paul L. The effectiveness of interventions targeting physical activity and/or sedentary behaviour in people with Multiple Sclerosis: a systematic review. Disabil Rehabil 2018; 42:594-612. [PMID: 30290702 DOI: 10.1080/09638288.2018.1503737] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: Remaining physically active is important to maintain functional ability and reduce the incidence of co-morbidities in people with Multiple Sclerosis. The aim of this review was to evaluate the effectiveness of interventions on physical activity or sedentary behaviour in people with Multiple Sclerosis.Methods: A systematic search was conducted in May 2018 of the following databases: Web of Science Core Collections, Embase and Medline. Included studies were randomised controlled trials involving people with Multiple Sclerosis who completed an intervention, compared to any comparator. Outcomes included subjective or objective measures of physical activity or sedentary behaviour. Quality assessment was performed using the Physiotherapy Evidence Database scale.Results: Twenty-five trials were included covering 1697 participants, the majority of which had mild-moderate disability (average Physiotherapy Evidence Database score 6.2 ± 1.5). Experimental interventions included exercise prescription (n = 5), behaviour change interventions (n = 10), combined exercise, and behaviour change techniques (n = 7) and education (n = 3). Generally, subjective but not objective physical activity improved in those with mild-moderate disability. Insufficient data existed on the effectiveness on sedentary behaviour.Conclusions: A discrepancy seems to exists between the effectiveness of physical activity interventions in people with Multiple Sclerosis depending on whether physical activity was assessed objectively or subjectively, with the latter indicating effects. Effects on sedentary behaviour remain to be elucidated.Implications for RehabilitationRemaining physically active is important to maintain functional ability, independence, quality of life, and to reduce the incidence of co-morbidity.Exercise prescription, behaviour change interventions, combined exercise and behaviour change interventions, and health promotion education appear to subjectively improve physical activity in people with Multiple Sclerosis with mild-moderate disability, yet this is often not the case when measured objectively.There is a lack of evidence to support the effectiveness of these interventions on sedentary behaviour.
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Affiliation(s)
- Elaine H Coulter
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.,School of Health Sciences, Queen Margaret University, Edinburgh, UK
| | - Sarah Bond
- School of Health Sciences, Queen Margaret University, Edinburgh, UK
| | - Ulrik Dalgas
- Section of Sport Science, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Lorna Paul
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
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Amezcua L, Rivas E, Joseph S, Zhang J, Liu L. Multiple Sclerosis Mortality by Race/Ethnicity, Age, Sex, and Time Period in the United States, 1999–2015. Neuroepidemiology 2018; 50:35-40. [DOI: 10.1159/000484213] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 10/14/2017] [Indexed: 11/19/2022] Open
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Frasco MA, Shih T, Incerti D, Diaz Espinosa O, Vania DK, Thomas N. Incremental net monetary benefit of ocrelizumab relative to subcutaneous interferon β-1a. J Med Econ 2017; 20:1074-1082. [PMID: 28726530 DOI: 10.1080/13696998.2017.1357564] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIM Disease-modifying therapies (DMTs) impact the natural history of relapsing forms of multiple sclerosis (RRMS) by reducing annual relapse rates and slowing disability progression. The effect of DMTs on indirect costs has not been consistently explored in cost-effectiveness studies thus far. The value to patients of an emerging DMT, ocrelizumab, was quantified in comparison to subcutaneous interferon beta-1a (IFNβSC) for the prevalent RRMS population with mild-to-moderate disability in the US, based on two Phase 3 trials, OPERA I and OPERA II, of ocrelizumab vs IFNβSC in RRMS. MATERIALS AND METHODS A Markov model was developed to compare disability progression as measured by Expanded Disability Status Scale (EDSS) and relapse outcomes over a 30-year horizon for ocrelizumab vs IFNβSC. Direct, indirect, and informal costs (2016 US dollars) and utilities for EDSS health states were obtained from the literature. Hazard ratios for disability progression and relapse rates were estimated from clinical trials. Value was assessed by calculating the net monetary benefit (NMB), defined as the monetary value of discounted quality-adjusted life years (QALYs) minus total costs, where the value of a QALY was $150,000. One-way sensitivity analyses were conducted. RESULTS Ocrelizumab was associated with an incremental gain of 0.84 QALYs and cost savings of $287,713 relative to IFNβSC, resulting in an incremental NMB (INMB) of $413,611 per person over 30 years. The INMB increased by $151,763 for those initiating ocrelizumab at EDSS level 1 vs level 4. Influential parameters were QALY value, treatment costs, and disability progression; however, all sensitivity analyses indicated that the INMB for ocrelizumab relative to IFNβSC was ≥$300,000 per person. CONCLUSIONS Ocrelizumab provides greater value to RRMS patients compared with IFNβSC. Initiating ocrelizumab at lower EDSS levels leads to a greater cumulative value due to slower disability progression, which extends years with higher quality-of-life.
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Affiliation(s)
| | - Tiffany Shih
- a Precision Health Economics , Los Angeles , CA , USA
| | - Devin Incerti
- a Precision Health Economics , Los Angeles , CA , USA
| | | | - Diana K Vania
- a Precision Health Economics , Los Angeles , CA , USA
| | - Nina Thomas
- b Genentech, Inc. , South San Francisco , CA , USA
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Putnam M. Extending the Promise of the Older Americans Act to Persons Aging With Long-Term Disability. Res Aging 2017; 39:799-820. [DOI: 10.1177/0164027516681052] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article discusses the need for Older Americans Act (OAA) programs to evaluate and develop where needed the capacity to serve persons aging with long-term disabilities such as intellectual and/or developmental disabilities and physical disabilities including polio, spinal cord injury, and multiple sclerosis. The rationale for this work is the universal access to OAA programs for all adults over 60, regardless of the disability type, age of onset, or severity, acknowledging that other needs-based criteria often need to be met to receive services. Recommendations for increasing OAA and aging network capacity include addressing long-standing divisions between the fields of aging and disability, a comprehensive review of all Administration for Community Living programs and policies, engaging in program adaptation to build capacity, advancing knowledge and skills of the professional workforce, creating new knowledge to support delivery of evidence-based interventions to all older adults including those with lifelong and early and midlife onset of disability.
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Newsome SD, Aliotta PJ, Bainbridge J, Bennett SE, Cutter G, Fenton K, Lublin F, Northrop D, Rintell D, Walker BD, Weigel M, Zackowski K, Jones DE. A Framework of Care in Multiple Sclerosis, Part 2: Symptomatic Care and Beyond. Int J MS Care 2017; 19:42-56. [PMID: 28243186 PMCID: PMC5315323 DOI: 10.7224/1537-2073.2016-062] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The Consortium of Multiple Sclerosis Centers (CMSC) convened a Framework Taskforce composed of a multidisciplinary group of clinicians and researchers to examine and evaluate the current models of care in multiple sclerosis (MS). The methodology of this project included analysis of a needs assessment survey and an extensive literature review. The outcome of this work is a two-part continuing education series of articles. Part 1, published previously, covered the updated disease phenotypes of MS along with recommendations for the use of disease-modifying therapies. Part 2, presented herein, reviews the variety of symptoms and potential complications of MS. Mobility impairment, spasticity, pain, fatigue, bladder/bowel/sexual dysfunction, cognitive dysfunction, and neuropsychiatric issues are examined, and both pharmacologic and nonpharmacologic interventions are described. Because bladder and bowel symptoms substantially affect health-related quality of life, detailed information about elimination dysfunction is provided. In addition, a detailed discussion about mental health and cognitive dysfunction in people with MS is presented. Part 2 concludes with a focus on the role of rehabilitation in MS. The goal of this work is to facilitate the highest levels of independence or interdependence, function, and quality of life for people with MS.
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Grigoriadis N, Linnebank M, Alexandri N, Muehl S, Hofbauer GFL. Considerations on long-term immuno-intervention in the treatment of multiple sclerosis: an expert opinion. Expert Opin Pharmacother 2016; 17:2085-95. [PMID: 27594523 DOI: 10.1080/14656566.2016.1232712] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION As management of multiple sclerosis (MS) requires life-long treatment with disease-modifying agents, any risks associated with long-term use should be considered when evaluating therapeutic options. AREAS COVERED Immune cells of the innate and adaptive immune systems play various roles in the pathogenesis of MS. MS therapies affect the immune system, each with a unique mode of action, and consequently possess different long-term safety profiles. Rare, but serious safety concerns, including an increased risk of infection and cancer, have been associated with immunosuppressant use. The risks associated with newer immunosuppressive agents, which target specific elements of MS disease pathophysiology, are not yet fully established as the duration of clinical trials is relatively short and post-marketing experience is limited. Non-immunosuppressants used to treat MS have well-defined safety profiles established over a large number of patient-years demonstrating them to be well-tolerated long-term treatment options. When considering the long-term use of disease-modifying agents for treating MS, classification as immunosuppressants or non-immunosuppressants can be useful when evaluating potential risks associated with chronic use. EXPERT OPINION A successful therapeutic strategy for any serious, chronic disease such as MS should weigh effectiveness versus long-term safety of available treatments.
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Affiliation(s)
- Nikolaos Grigoriadis
- a B' Department of Neurology, Laboratory of Experimental Neurology and Neuroimmunology , AHEPA University Hospital, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Michael Linnebank
- b Klinik für Neurologie Universitätsspital Zürich , Zürich , Switzerland.,c Department of Neurology , Helios-Klinik, Hagen-Ambrock , Hagen , Germany
| | | | - Sarah Muehl
- e Merck (Schweiz) AG, Zug, Switzerland, a subsidiary of Merck KGaA Darmstadt , Germany
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Cutter GR, Salter A, Marrie RA. Declines in the diagnosis of primary progressive MS: A critical change in phenotype or critical measurement error? Mult Scler 2016; 22:983-5. [DOI: 10.1177/1352458516655218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Gary R Cutter
- Department of Biostatistics, School of Public Health, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amber Salter
- Department of Biostatistics, Washington University in St. Louis, Saint Louis, MO, USA
| | - Ruth Ann Marrie
- Departments of Internal Medicine and Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Multiple Sclerosis Clinic, Winnipeg, MB, Canada
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Salter A, Tyry T, Wang G, Fox RJ, Cutter G, Marrie RA. Examining the joint effect of disability, health behaviors, and comorbidity on mortality in MS. Neurol Clin Pract 2016; 6:397-408. [PMID: 27847682 DOI: 10.1212/cpj.0000000000000269] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND In multiple sclerosis (MS), comorbidities have been associated with disability progression and an increased risk of mortality. We investigated the association between comorbidities and mortality in MS after accounting for disability and health behaviors. METHODS We followed North American Research Committee on Multiple Sclerosis (NARCOMS) Registry participants who completed the Fall 2006 survey on comorbidities until death (reported or matched in the National Death Index) or date of last follow-up in 2014. We used proportional hazards regression to investigate the association between comorbidities and mortality, controlling for demographic, clinical, health behavior, and disability factors. RESULTS Of 9,496 participants meeting the inclusion criteria, 502 (5.3%) were deceased. Most participants reported having ≤3 comorbid conditions (70.9% survivors, 76.9% decedents). In individual regression models, vascular, visual, and mental comorbidities were associated with increased mortality risk after adjustment for factors associated with survival. When combined into a single model, vascular (hazard ratio 1.269; 1.041-1.547), visual (1.490; 1.199-1.852), and mental comorbidities (excluding anxiety, 1.239; 1.024-1.499) remained independently associated with an increased risk of mortality. CONCLUSIONS Presence of comorbidities was independently associated with an increased risk of mortality as compared to absence of comorbidities after adjusting for factors associated with survival. Specifically, vascular, visual, and mental comorbidities increased the risk of mortality. This highlights the need for clinicians to attend to these comorbidities, which can be modified by treatments or other interventions, and potentially reduce the risk of mortality in persons with MS who have these conditions.
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Affiliation(s)
- Amber Salter
- Division of Biostatistics (AS, GW), Washington University in St. Louis, MO; Division of Neurology (TT), Dignity Health, St. Joseph's Hospital and Medical Center, Phoenix, AZ; Department of Neurology and Neurological Institute (RJF), Cleveland Clinic, OH; Department of Biostatistics (GC), University of Alabama at Birmingham; and Departments of Internal Medicine and Community Health Sciences (RAM), University of Manitoba, Winnipeg, Canada
| | - Tuula Tyry
- Division of Biostatistics (AS, GW), Washington University in St. Louis, MO; Division of Neurology (TT), Dignity Health, St. Joseph's Hospital and Medical Center, Phoenix, AZ; Department of Neurology and Neurological Institute (RJF), Cleveland Clinic, OH; Department of Biostatistics (GC), University of Alabama at Birmingham; and Departments of Internal Medicine and Community Health Sciences (RAM), University of Manitoba, Winnipeg, Canada
| | - Guoqiao Wang
- Division of Biostatistics (AS, GW), Washington University in St. Louis, MO; Division of Neurology (TT), Dignity Health, St. Joseph's Hospital and Medical Center, Phoenix, AZ; Department of Neurology and Neurological Institute (RJF), Cleveland Clinic, OH; Department of Biostatistics (GC), University of Alabama at Birmingham; and Departments of Internal Medicine and Community Health Sciences (RAM), University of Manitoba, Winnipeg, Canada
| | - Robert J Fox
- Division of Biostatistics (AS, GW), Washington University in St. Louis, MO; Division of Neurology (TT), Dignity Health, St. Joseph's Hospital and Medical Center, Phoenix, AZ; Department of Neurology and Neurological Institute (RJF), Cleveland Clinic, OH; Department of Biostatistics (GC), University of Alabama at Birmingham; and Departments of Internal Medicine and Community Health Sciences (RAM), University of Manitoba, Winnipeg, Canada
| | - Gary Cutter
- Division of Biostatistics (AS, GW), Washington University in St. Louis, MO; Division of Neurology (TT), Dignity Health, St. Joseph's Hospital and Medical Center, Phoenix, AZ; Department of Neurology and Neurological Institute (RJF), Cleveland Clinic, OH; Department of Biostatistics (GC), University of Alabama at Birmingham; and Departments of Internal Medicine and Community Health Sciences (RAM), University of Manitoba, Winnipeg, Canada
| | - Ruth Ann Marrie
- Division of Biostatistics (AS, GW), Washington University in St. Louis, MO; Division of Neurology (TT), Dignity Health, St. Joseph's Hospital and Medical Center, Phoenix, AZ; Department of Neurology and Neurological Institute (RJF), Cleveland Clinic, OH; Department of Biostatistics (GC), University of Alabama at Birmingham; and Departments of Internal Medicine and Community Health Sciences (RAM), University of Manitoba, Winnipeg, Canada
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Sanai SA, Saini V, Benedict RHB, Zivadinov R, Teter BE, Ramanathan M, Weinstock-Guttman B. Aging and multiple sclerosis. Mult Scler 2016; 22:717-25. [DOI: 10.1177/1352458516634871] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 02/01/2015] [Indexed: 01/30/2023]
Abstract
The life expectancy and average age of persons with multiple sclerosis (MS) have increased significantly during the last two decades. The introduction of disease-modifying therapies and a better delineation and understanding of the superimposed comorbidities often diagnosed in MS patients are probably the most important factors accountable for the increase in aging MS population worldwide. Healthcare teams must therefore address the problems arising due to advancing age superimposed on this chronic neurologic disease. In this review, we focus on the physiology of aging, its effects on MS disease course, and the pathological and immunological changes associated with aging and disease progression. Additionally, we discuss the common comorbidities that occur in aging persons with MS that may arise either as a result of the aging process or from relentless chronic MS disease progression as well as the challenges on differentiating the two processes for a more appropriate therapeutic approach.
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Affiliation(s)
- Shaik Ahmed Sanai
- Jacobs Comprehensive MS Treatment and Research Center, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Vasu Saini
- Jacobs Comprehensive MS Treatment and Research Center, University at Buffalo, The State University of New York, Buffalo, NY, USA/New York State MS Consortium, University at Buffalo, The State University of New York, Buffalo, NY, USA/Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Ralph HB Benedict
- Jacobs Comprehensive MS Treatment and Research Center, University at Buffalo, The State University of New York, Buffalo, NY, USA/New York State MS Consortium, University at Buffalo, The State University of New York, Buffalo, NY, USA/Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Robert Zivadinov
- Jacobs Comprehensive MS Treatment and Research Center, University at Buffalo, The State University of New York, Buffalo, NY, USA/New York State MS Consortium, University at Buffalo, The State University of New York, Buffalo, NY, USA/Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Barbara E Teter
- Jacobs Comprehensive MS Treatment and Research Center, University at Buffalo, The State University of New York, Buffalo, NY, USA/New York State MS Consortium, University at Buffalo, The State University of New York, Buffalo, NY, USA/Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Murali Ramanathan
- Jacobs Comprehensive MS Treatment and Research Center, University at Buffalo, The State University of New York, Buffalo, NY, USA/New York State MS Consortium, University at Buffalo, The State University of New York, Buffalo, NY, USA/Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Bianca Weinstock-Guttman
- Jacobs Comprehensive MS Treatment and Research Center, University at Buffalo, The State University of New York, Buffalo, NY, USA/New York State MS Consortium, University at Buffalo, The State University of New York, Buffalo, NY, USA/Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
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