1
|
Mikkelsen AP, Egerup P, Kolte AM, Westergaard D, Nielsen HS, Lidegaard Ø. Pregnancy loss and risk of multiple sclerosis and autoimmune neurological disorder: A nationwide cohort study. PLoS One 2022; 17:e0266203. [PMID: 35358256 PMCID: PMC8970484 DOI: 10.1371/journal.pone.0266203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/16/2022] [Indexed: 11/18/2022] Open
Abstract
Background
The loss of one or more pregnancies before viability (i.e. pregnancy loss or miscarriage), has been linked to an increased risk of diseases later in life such as myocardial infarction and stroke. Recurrent pregnancy loss (i.e. three consecutive pregnancy losses) and multiple sclerosis have both been linked to immunological traits, which could predispose to both occurrences. The objective of the current study was to investigate if pregnancy loss is associated with later autoimmune neurological disease.
Methods
This register-based cohort study, included the Danish female population age 12 or older between 1977–2017. Women were grouped hierarchically: 0, 1, 2, ≥3 pregnancy losses, primary recurrent pregnancy loss (i.e. not preceded by a delivery), and secondary recurrent pregnancy loss (i.e. preceded by a delivery). The main outcome was multiple sclerosis and additional outcomes were amyotrophic lateral sclerosis, Guillain-Barré syndrome, and myasthenia gravis. Bayesian Poisson regression estimated incidence rate ratios [IRR] and 95% credible intervals [CI] adjusted for year, age, live births, family history of an outcome, and education.
Results
After 40,380,194 years of follow-up, multiple sclerosis was diagnosed among 7,667 out of 1,513,544 included women (0.5%), median age at diagnosis 34.2 years (IQR 27.4–41.4 years), and median age at symptom onset 31.2 years (IQR 24.8–38.2). The adjusted IRR of multiple sclerosis after 1 pregnancy loss was: 1.03 (95% CI 0.95–1.11), 2 losses: 1.02 (95% CI 0.86–1.20), ≥3 non-consecutive losses: 0.81 (95% CI 0.51–1.24), primary recurrent pregnancy loss: 1.18 (95% CI 0.84–1.60), secondary recurrent pregnancy loss: 1.16 (95% CI 0.81–1.63), as compared to women with no pregnancy losses. Seven sensitivity analyses and analyses for additional outcomes did not show significantly elevated adjusted risk estimates.
Conclusions
In this nationwide study, pregnancy loss was not significantly associated with autoimmune neurological disorder.
Collapse
Affiliation(s)
- Anders Pretzmann Mikkelsen
- Department of Gynaecology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- * E-mail:
| | - Pia Egerup
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Obstetrics and Gynaecology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
- The Recurrent Pregnancy Loss Unit, The Capital Region, Copenhagen University Hospitals Rigshospitalet and Hvidovre, Copenhagen, Denmark
| | - Astrid Marie Kolte
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- The Recurrent Pregnancy Loss Unit, The Capital Region, Copenhagen University Hospitals Rigshospitalet and Hvidovre, Copenhagen, Denmark
| | - David Westergaard
- The Recurrent Pregnancy Loss Unit, The Capital Region, Copenhagen University Hospitals Rigshospitalet and Hvidovre, Copenhagen, Denmark
- Novo Nordisk Foundation Center for Protein Research, University of Copenhagen, Copenhagen, Denmark
- Methods and Analysis, Statistics Denmark, Copenhagen, Denmark
| | - Henriette Svarre Nielsen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Obstetrics and Gynaecology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
- The Recurrent Pregnancy Loss Unit, The Capital Region, Copenhagen University Hospitals Rigshospitalet and Hvidovre, Copenhagen, Denmark
| | - Øjvind Lidegaard
- Department of Gynaecology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
2
|
Factors influencing harmonized health data collection, sharing and linkage in Denmark and Switzerland: A systematic review. PLoS One 2019; 14:e0226015. [PMID: 31830124 PMCID: PMC6907832 DOI: 10.1371/journal.pone.0226015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 11/18/2019] [Indexed: 02/06/2023] Open
Abstract
Introduction The digitalization of medicine has led to a considerable growth of heterogeneous health datasets, which could improve healthcare research if integrated into the clinical life cycle. This process requires, amongst other things, the harmonization of these datasets, which is a prerequisite to improve their quality, re-usability and interoperability. However, there is a wide range of factors that either hinder or favor the harmonized collection, sharing and linkage of health data. Objective This systematic review aims to identify barriers and facilitators to health data harmonization—including data sharing and linkage—by a comparative analysis of studies from Denmark and Switzerland. Methods Publications from PubMed, Web of Science, EMBASE and CINAHL involving cross-institutional or cross-border collection, sharing or linkage of health data from Denmark or Switzerland were searched to identify the reported barriers and facilitators to data harmonization. Results Of the 345 projects included, 240 were single-country and 105 were multinational studies. Regarding national projects, a Swiss study reported on average more barriers and facilitators than a Danish study. Barriers and facilitators of a technical nature were most frequently reported. Conclusion This systematic review gathered evidence from Denmark and Switzerland on barriers and facilitators concerning data harmonization, sharing and linkage. Barriers and facilitators were strictly interrelated with the national context where projects were carried out. Structural changes, such as legislation implemented at the national level, were mirrored in the projects. This underlines the impact of national strategies in the field of health data. Our findings also suggest that more openness and clarity in the reporting of both barriers and facilitators to data harmonization constitute a key element to promote the successful management of new projects using health data and the implementation of proper policies in this field. Our study findings are thus meaningful beyond these two countries.
Collapse
|
3
|
Pedersen EG, Hallas J, Pottegård A, Hald SM, Jensen PEH, Gaist D. Oral Immunosuppressive Treatment of Myasthenia Gravis in Denmark: A Nationwide Drug Utilization Study, 1996-2013. Basic Clin Pharmacol Toxicol 2018; 123:486-493. [PMID: 29732733 DOI: 10.1111/bcpt.13034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 04/23/2018] [Indexed: 11/29/2022]
Abstract
Although immunosuppressants in the treatment of myasthenia have been available for several decades, population-based studies describing drug utilization in myasthenia patients are scarce. We aimed in this study to describe the treatment of myasthenia in Denmark in more recent years with emphasis on use of oral immunosuppressant agents. We identified a nationwide cohort of incident myasthenia patients in Denmark from 1996 to 2013 and tracked their use of drugs over the entire period using data from nationwide registers. Patients with myasthenia were classified according to utilization of specific immunosuppressants (e.g. prednisolone) as 'never user' or 'ever user'. We used Kaplan-Meier (K-M) and proportion of patients covered (PPC) curves to describe treatment onset and termination. We identified 928 patients (52% female) with incident myasthenia in the study period. Overall, 638 (69%) were treated with prednisolone and 506 (55%) with azathioprine. Treatment with prednisolone and azathioprine within 2 years of myasthenia diagnosis was initiated in 462 (56%) and 366 (45%). Only one of four myasthenia patients (n = 231) did not receive oral immunosuppressive treatment at any time in the study period. Prednisolone was stopped in most patients, whereas treatment with azathioprine was often continued throughout follow-up. In conclusion, we found that treatment of myasthenia in Denmark in recent years corresponded well to the expected clinical course of myasthenia and that most patients underwent long-term immunosuppression.
Collapse
Affiliation(s)
- Emil Greve Pedersen
- Department of Neurology, Odense University Hospital & Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark (SDU), Odense, Denmark
| | - Jesper Hallas
- Department of Public Health, Clinical Pharmacology, SDU, Odense, Denmark
| | - Anton Pottegård
- Department of Public Health, Clinical Pharmacology, SDU, Odense, Denmark
| | - Stine Munk Hald
- Department of Neurology, Odense University Hospital & Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark (SDU), Odense, Denmark
| | - Poul Erik Hyldgaard Jensen
- Neuroimmunology Laboratory, DMSC, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - David Gaist
- Department of Neurology, Odense University Hospital & Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark (SDU), Odense, Denmark
| |
Collapse
|
4
|
Abstract
OBJECTIVE The aim of this study was to examine risk of self-harm, hospitalization for depression and death by suicide after gastric bypass surgery (GBP). SUMMARY OF BACKGROUND DATA Concerns regarding severe adverse psychiatric outcomes after GBP have been raised. METHODS This nationwide, longitudinal, self-matched cohort encompassed 22,539 patients who underwent GBP during 2008 to 2012. They were identified through the Swedish National Patient Register, the Prescribed Drug Register, and the Causes of Death Register. Follow-up time was up to 2 years. Main outcome measures were hazard ratios (HRs) for post-surgery self-harm or hospitalization for depression in patients with presurgery self-harm and/or depression compared to patients without this exposure; and standardized mortality ratio (SMR) for suicide post-surgery. RESULTS A diagnosis of self-harm in the 2 years preceding surgery was associated with an HR of 36.6 (95% confidence interval [CI] 25.5-52.4) for self-harm during the 2 years of follow up, compared to GBP patients who had no self-harm diagnosis before surgery. Patients with a diagnosis of depression preceding GBP surgery had an HR of 52.3 (95% CI 30.6-89.2) for hospitalization owing to depression after GBP, compared to GBP patients without a previous diagnosis of depression. The SMR for suicide after GBP was increased among females (n = 13), 4.50 (95% CI 2.50-7.50). The SMR among males (n = 4), was 1.71 (95% CI 0.54-4.12). CONCLUSIONS The increased risk of post-surgery self-harm and hospitalization for depression is mainly attributable to patients who have a diagnosis of self-harm or depression before surgery. Raised awareness is needed to identify vulnerable patients with history of self-harm or depression, which may be in need of psychiatric support after GBP.
Collapse
|
5
|
Frost A, Svendsen ML, Rahbek J, Stapelfeldt CM, Nielsen CV, Lund T. Labour market participation and sick leave among patients diagnosed with myasthenia gravis in Denmark 1997-2011: a Danish nationwide cohort study. BMC Neurol 2016; 16:224. [PMID: 27855651 PMCID: PMC5114816 DOI: 10.1186/s12883-016-0757-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 11/13/2016] [Indexed: 11/10/2022] Open
Abstract
Background To examine labour market participation and long-term sick leave following a diagnosis with myasthenia gravis (MG) compared with the general Danish population and for specific subgroups of MG patients. Methods A nationwide matched cohort study from 1997 to 2011 using data from population-based medical and social registries. The study includes 330 MG patients aged 18 to 65 years old identified from hospital diagnoses and dispensed prescriptions, and twenty references from the Danish population matching each MG patient on age, gender, and profession. Main outcome measures are labour market participation (yes/no) and long-term sick leave ≥9 weeks (yes/no) with follow-up at 1- and 2 years after the time of MG diagnosis or match. Based on complete person-level information on all public transfer payments in Denmark, persons having no labour market participation are defined as individuals receiving social benefits for severely reduced workability, flexijob, and disability pension. Results MG is consistently associated with higher odds of having no labour market participation and long-term sick leave compared with the general Danish population (no labour market participation & ≥9 weeks sick leave at 2-year follow-up, adjusted OR (95% CI): 5.76 (4.13 to 8.04) & 8.60 (6.60 to 11.23)). Among MG patients, females and patients treated with both acetylcholinesterase inhibitors and immunosuppression have higher odds of lost labour market participation and long-term sick leave. Conclusions This study suggests that MG patients have almost 6 times higher odds of no labour market participation and almost 9 times higher odds of long-term sick leave 2 years after diagnosis compared with the general Danish population. In particular female MG patients and patients treated with both acetylcholinesterase and immunosuppression have high odds of a negative labour market outcome. Future research should focus on predictors in workplace and labour market policy of labour market participation among MG patients.
Collapse
Affiliation(s)
- Asger Frost
- The National Rehabilitation Centre for Neuromuscular Disorders, Kongsvang Allé 23, DK-8000, Aarhus, Denmark
| | | | - Jes Rahbek
- The National Rehabilitation Centre for Neuromuscular Disorders, Kongsvang Allé 23, DK-8000, Aarhus, Denmark
| | | | - Claus Vinther Nielsen
- DEFACTUM and Section of Clinical Social Medicine and Rehabilitation, Department of Public Health, Aarhus University, P.P. Oerums Gade 11, Building 1B, DK-8000, Aarhus C, Denmark
| | - Thomas Lund
- DEFACTUM, Olof Palmes Allé 15, DK-8200, Aarhus N, Denmark. .,Danish Ramazzini Centre, Department of Occupational Medicine, University Research Clinic, Regional Hospital West Jutland, Gl. Landevej 61, DK-7400, Herning, Denmark.
| |
Collapse
|
6
|
Santos E, Coutinho E, Moreira I, Silva AM, Lopes D, Costa H, Silveira F, Nadais G, Morais H, Martins J, Branco MC, Veiga A, Silva RS, Ferreira A, Sousa F, Freijo M, Matos I, André R, Negrão L, Fraga C, Santos M, Sampaio M, Lopes C, Leite MI, Gonçalves G. Epidemiology of myasthenia gravis in Northern Portugal: Frequency estimates and clinical epidemiological distribution of cases. Muscle Nerve 2016; 54:413-21. [PMID: 26851892 DOI: 10.1002/mus.25068] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 01/25/2016] [Accepted: 02/01/2016] [Indexed: 12/22/2022]
Abstract
INTRODUCTION In this study we estimated the prevalence, incidence, and mortality of myasthenia gravis (MG) in northern Portugal and characterized the clinical features of the patients identified. METHODS We used 2 data sources: clinical records from the hospitals and pyridostigmine prescription registers. RESULTS On December 31, 2013, we estimated a point prevalence of 111.7 patients per million population. The highest prevalence was observed in the group >65 years of age, especially in men (288.1 per million). During 2013, we estimated an incidence rate of 6.3 per million per year. Among women, the incidence rate was highest in the 15-49-year age group; in men, incidence increased with age up to 22.1 per million in those >65 years old. The MG-related mortality rate was 0.5 per million. CONCLUSIONS These figures are in keeping with similar studies and emphasize the importance of diagnosis and management of MG in elderly populations. Muscle Nerve 54: 413-421, 2016.
Collapse
Affiliation(s)
- Ernestina Santos
- Neurology Department, Hospital Santo Antonio, Centro Hospitalar Porto, Porto, Portugal.,Unit for Multidisciplinary Research in Biomedicine, Instituto de Ciencias Biomedicas de Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Ester Coutinho
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, University of Oxford, UK
| | - Isabel Moreira
- Neurology Department, Hospital Santo Antonio, Centro Hospitalar Porto, Porto, Portugal
| | - Ana Martins Silva
- Neurology Department, Hospital Santo Antonio, Centro Hospitalar Porto, Porto, Portugal.,Unit for Multidisciplinary Research in Biomedicine, Instituto de Ciencias Biomedicas de Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Dina Lopes
- Centro Hospitalar do Porto, Porto, Portugal
| | - Henrique Costa
- Neurology Department, Hospital Sao Joao, Porto, Portugal
| | | | - Goreti Nadais
- Neurology Department, Hospital Sao Joao, Porto, Portugal
| | - Hugo Morais
- Neurology Department, Centro Hospitalar de Vila Nova de Gaia e Espinho, Gaia, Portugal
| | - João Martins
- Neurology Department, Hospital Pedro Hispano, Matosinhos, Portugal
| | - Maria Ceu Branco
- Neurology Department, Hospital Pedro Hispano, Matosinhos, Portugal.,Neurology Department, Hospital de Sao Pedro, Centro Hospitalar do Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Andreia Veiga
- Neurology Department, Hospital de Sao Pedro, Centro Hospitalar do Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Rosa Santos Silva
- Neurology Department, Centro Hospitalar do Alto Minho, Viana do Castelo, Portugal
| | - Augusto Ferreira
- Neurology Department, Centro Hospitalar Entre Douro e Vouga, Feira, Portugal
| | - Filipa Sousa
- Neurology Department, Hospital de Braga, Braga, Portugal
| | - Marta Freijo
- Neurology Department, Centro Hospitalar do Nordeste, Mirandela, Portugal
| | - Ilda Matos
- Neurology Department, Centro Hospitalar do Nordeste, Mirandela, Portugal
| | - Rui André
- Neurology Department, Hospital de São Teotonio, Viseu, Portugal
| | - Luís Negrão
- Neurology Department, Centro Hospitalar Universitario de Coimbra, Coimbra, Portugal
| | - Carla Fraga
- Neurology Department, Centro Hospitalar do Vale do Sousa, Penafiel, Portugal
| | - Manuela Santos
- Neuropediatrics Department, Centro Materno Infantil Norte, Centro Hospitalar Porto, Porto, Portugal
| | - Mafalda Sampaio
- Neuropediatrics Department, Hospital de Sao Joao, Porto, Portugal
| | - Carlos Lopes
- Instituto de Ciencias Biomedicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Maria Isabel Leite
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, University of Oxford, UK
| | - Guilherme Gonçalves
- Unit for Multidisciplinary Research in Biomedicine, Instituto de Ciencias Biomedicas de Abel Salazar, Universidade do Porto, Porto, Portugal
| |
Collapse
|
7
|
Rasmussen ER, Lykke E, Wagner N, Nielsen T, Waersted S, Arndal H. The introduction of sialendoscopy has significantly contributed to a decreased number of excised salivary glands in Denmark. Eur Arch Otorhinolaryngol 2015; 273:2223-30. [DOI: 10.1007/s00405-015-3755-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 08/13/2015] [Indexed: 10/23/2022]
|
8
|
Breiner A, Young J, Green D, Katzberg HD, Barnett C, Bril V, Tu K. Canadian Administrative Health Data Can Identify Patients with Myasthenia Gravis. Neuroepidemiology 2015; 44:108-13. [DOI: 10.1159/000375463] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 01/22/2015] [Indexed: 11/19/2022] Open
Abstract
Introduction: Incidence and prevalence estimates for myasthenia gravis (MG) have varied widely, and the ability of administrative health data (AHD) records to accurately identify cases of MG is yet to be ascertained. The goal of the current study was to validate an algorithm to identify patients with MG in Ontario, Canada using AHD - thereby enabling future disease surveillance. Methods: A reference standard population was established using automated key word searching within EMRALD (Electronic Medical Record Administrative data Linked Database) and chart review of potential cases. AHD algorithms were generated and tested against the reference standard. The data was used to calculate MG prevalence rates. Results: There were 123,997 eligible adult patients, and 49 patients had definite MG (forming the reference standard). An algorithm requiring: (1 hospital discharge abstract with MG listed as a reason for hospitalization or a comorbid condition), or (5 outpatient MG visits and 1 relevant diagnostic test, within 1 year), or (3 pyridostigmine prescriptions, within 1 year) identified MG with sensitivity = 81.6%, specificity = 100%, positive predictive value = 80.0% and negative predictive value = 100%. The population prevalence within our cohort was 0.04%. Conclusions: This novel validation method demonstrates the feasibility of using administrative health data to identify patients with myasthenia gravis among the Ontario population.
Collapse
|
9
|
Andersen JB, Heldal AT, Engeland A, Gilhus NE. Myasthenia gravis epidemiology in a national cohort; combining multiple disease registries. Acta Neurol Scand 2014:26-31. [PMID: 24588503 DOI: 10.1111/ane.12233] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES There is a wide variation in reported prevalence and incidence of myasthenia gravis (MG). In this study, we aimed to evaluate the validity of two nationwide databases by comparing prevalence and incidence rates reported from three recent studies using the two databases as case-finding method. MATERIALS AND METHODS Two different Norwegian nationwide databases were used: the acetylcholine receptor antibody database (reference cohort) and the Norwegian Prescription Database (NorPD) (study cohort). Presence of acetylcholine receptor antibodies (AChR) is specific for MG. Up to 85% of MG patients are AChR antibody-positive. All samples from the whole country were tested at one laboratory. NorPD contains patient information on all prescriptions of pyridostigmine. RESULTS Prevalence was 131 per million in the study cohort and 145 per million estimated from the reference cohort (Jan 1, 2008). No significant difference in prevalence between the study cohort and the reference cohort was found (SIR 1.1, 95% CI 1.0-1.2). The annual incidence rate was 16.0 per million in the study cohort and 8.8 per million estimated from the reference cohort, twofold more new MG patients were found in the study cohort compared to estimated figures from the reference cohort (SIR 1.8; 1.4-2.3). CONCLUSIONS This study confirms an optimal and unbiased case finding in both databases. Our calculated prevalence and incidence rates are in line with previous population-based studies. There was good agreement in prevalence reported from the two databases. The discrepancy in incidence is expected to diminish as years of study are increasing in NorPD.
Collapse
Affiliation(s)
- J. B. Andersen
- Department of Clinical Medicine; University of Bergen; Bergen Norway
| | - A. T. Heldal
- Department of Clinical Medicine; University of Bergen; Bergen Norway
| | - A. Engeland
- Division for Epidemiology; Department of Pharmacoepidemiology; Norwegian Institute of Public Health; Bergen Norway
- Department of Global Public Health and Primary Care; University of Bergen; Bergen Norway
| | - N. E. Gilhus
- Department of Clinical Medicine; University of Bergen; Bergen Norway
- Department of Neurology; Haukeland University Hospital; Bergen Norway
| |
Collapse
|
10
|
Andersen JB, Owe JF, Engeland A, Gilhus NE. Total drug treatment and comorbidity in myasthenia gravis: a population-based cohort study. Eur J Neurol 2014; 21:948-55. [PMID: 24712740 PMCID: PMC4238850 DOI: 10.1111/ene.12439] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 03/06/2014] [Indexed: 11/29/2022]
Abstract
Background and purpose Comorbidity in myasthenia gravis (MG) is important for diagnosis, treatment and prognosis. Disease complexity was assessed by examining total drug treatment, immune therapy and comorbidity in a complete national MG cohort. Methods All recipients of the MG-specific drug pyridostigmine 2004–2010 registered in the compulsory Norwegian Prescription Database who met the inclusion criteria were included. The pyridostigmine group was compared with the general Norwegian population. Results Myasthenia gravis patients received co-medication more often than the controls for nearly all groups of medication, including insulins (95% confidence interval 2.0–3.7), thyroid therapy (1.7–2.5), antidepressants (1.3–1.7), anti-infectives (1.2–1.4), lipid-modifying agents (1.1–1.4) and immunomodulating agents (6.8–8.8). Conclusions Myasthenia gravis patients are more often treated with non-MG prescription drugs than controls, reflecting frequent co-medication and comorbidity.
Collapse
Affiliation(s)
- J B Andersen
- Department of Clinical Medicine, Section for Neurology, University of Bergen, Bergen, Norway
| | | | | | | |
Collapse
|
11
|
Pedersen EG, Pottegård A, Hallas J, Friis S, Hansen K, Jensen PEH, Gaist D. Myasthenia and risk of cancer: a population-based case-control study. Eur J Neurol 2014; 21:773-8. [DOI: 10.1111/ene.12383] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 01/10/2014] [Indexed: 01/22/2023]
Affiliation(s)
- E. G. Pedersen
- Department of Neurology; Odense University Hospital and Institute of Clinical Research; Faculty of Health Sciences; University of Southern Denmark (SDU); Odense Denmark
| | - A. Pottegård
- Institute of Public Health, Clinical Pharmacology; University of Southern Denmark; Odense Denmark
| | - J. Hallas
- Institute of Public Health, Clinical Pharmacology; University of Southern Denmark; Odense Denmark
| | - S. Friis
- Danish Cancer Society Research Centre and Department of Public Health; University of Copenhagen; Copenhagen Denmark
| | - K. Hansen
- Department of Neurology; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - P. E. H. Jensen
- Neuroimmunology Laboratory; DMSC; Department of Neurology; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - D. Gaist
- Department of Neurology; Odense University Hospital and Institute of Clinical Research; Faculty of Health Sciences; University of Southern Denmark (SDU); Odense Denmark
| |
Collapse
|
12
|
Pedersen EG, Pottegård A, Hallas J, Friis S, Hansen K, Jensen PEH, Gaist D. Risk of non-melanoma skin cancer in myasthenia patients treated with azathioprine. Eur J Neurol 2013; 21:454-8. [DOI: 10.1111/ene.12329] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 11/18/2013] [Indexed: 02/03/2023]
Affiliation(s)
- E. G. Pedersen
- Department of Neurology; Faculty of Health Sciences; Odense University Hospital and Institute of Clinical Research; University of Southern Denmark (SDU); Odense Denmark
| | - A. Pottegård
- Institute of Public Health, Clinical Pharmacology; SDU; Odense Denmark
| | - J. Hallas
- Institute of Public Health, Clinical Pharmacology; SDU; Odense Denmark
| | - S. Friis
- Danish Cancer Society Research Centre and Department of Public Health; University of Copenhagen; Copenhagen Denmark
| | - K. Hansen
- Department of Neurology; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - P. E. H. Jensen
- Neuroimmunology Laboratory; DMSC; Department of Neurology; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - D. Gaist
- Department of Neurology; Faculty of Health Sciences; Odense University Hospital and Institute of Clinical Research; University of Southern Denmark (SDU); Odense Denmark
| |
Collapse
|
13
|
Pedersen EG, Pottegård A, Hallas J, Friis S, Hansen K, Jensen PEH, Gaist D. Use of azathioprine for non-thymoma myasthenia and risk of cancer: a nationwide case-control study in Denmark. Eur J Neurol 2013; 20:942-8. [DOI: 10.1111/ene.12108] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 12/19/2012] [Indexed: 01/10/2023]
Affiliation(s)
- E. G. Pedersen
- Department of Neurology; Faculty of Health Sciences; Institute of Clinical Research; Odense University Hospital; University of Southern Denmark (SDU); Odense; Denmark
| | - A. Pottegård
- Clinical Pharmacology Unit; Institute of Public Health; SDU; Odense; Denmark
| | - J. Hallas
- Clinical Pharmacology Unit; Institute of Public Health; SDU; Odense; Denmark
| | - S. Friis
- Danish Cancer Society Research Centre; Department of Public Health; University of Copenhagen; Copenhagen; Denmark
| | - K. Hansen
- Department of Neurology; Rigshospitalet; Copenhagen University Hospital; Copenhagen; Denmark
| | - P. E. H. Jensen
- Neuroimmunology Laboratory; Department of Neurology; Rigshospitalet; Copenhagen University Hospital; DMSC; Copenhagen; Denmark
| | - D. Gaist
- Department of Neurology; Faculty of Health Sciences; Institute of Clinical Research; Odense University Hospital; University of Southern Denmark (SDU); Odense; Denmark
| |
Collapse
|
14
|
Pedersen EG, Hallas J, Hansen K, Jensen PEH, Gaist D. Late-onset myasthenia not on the increase: a nationwide register study in Denmark, 1996-2009. Eur J Neurol 2012; 20:309-14. [DOI: 10.1111/j.1468-1331.2012.03850.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Accepted: 07/05/2012] [Indexed: 11/29/2022]
Affiliation(s)
| | - J. Hallas
- Institute of Public Health; Clinical Pharmacology Unit; SDU; Odense; Denmark
| | - K. Hansen
- Department of Neurology, Rigshospitalet; Copenhagen University Hospital; Copenhagen; Denmark
| | - P. E. H. Jensen
- Neuroimmunology Laboratory; DMSC; Department of Neurology, Rigshospitalet; Copenhagen University Hospital; Copenhagen; Denmark
| | | |
Collapse
|