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Sumelahti ML, Verkko A, Kytö V, Sipilä JOT. Stable excess mortality in a multiple sclerosis cohort diagnosed 1970-2010. Eur J Neurol 2024:e16480. [PMID: 39258870 DOI: 10.1111/ene.16480] [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: 05/21/2024] [Revised: 07/29/2024] [Accepted: 08/28/2024] [Indexed: 09/12/2024]
Abstract
BACKGROUND AND PURPOSE Multiple sclerosis (MS) is associated with excess mortality. The use of disease-modifying treatments (DMTs) has recently been associated with survival benefits. METHODS A regional MS database was linked with national registries. People with MS (pwMS) diagnosed in 1971-2010 were included and followed up until the end of the year 2019. Five matched controls were acquired for every person with MS. DMTs included in the analyses were interferon and glatiramer acetate. RESULTS Median follow-up time of the 1795 pwMS was 20.0 years (range 0.1-48.7 years). Survival did not differ between decades of diagnosis (p = 0.20). Amongst pwMS, male sex (adjusted hazard ratio [aHR] 1.70; 95% confidence interval [CI] 1.41-2.06), higher age at diagnosis (aHR 1.83; 95% CI 1.65-2.03 per 10-year increment) and primary progressive disease course (aHR 1.29; 95% CI 1.04-1.60) were independently associated with poorer survival. DMT use was associated with better survival (p < 0.0001) and better survival during follow-up (aHR 0.56; 95% CI 0.38-0.81). Compared to matched controls, median life expectancy was 8-9 years shorter in pwMS with survival diverging from controls during the first decade after diagnosis, more clearly in men than women. CONCLUSION Despite DMT use being associated with better survival, relative life expectancy of pwMS did not change over five decades in Western Finland. Male sex was an independent risk factor for death amongst pwMS, but excess mortality was higher in women. More work and methods are needed to improve survival in pwMS.
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Affiliation(s)
- M-L Sumelahti
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - A Verkko
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - V Kytö
- Research Services, Turku University Hospital and Heart Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - J O T Sipilä
- Department of Neurology, North Karelia Central Hospital, Siun Sote, Joensuu, Finland, and Clinical Neurosciences, University of Turku, Turku, Finland
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Baginski K, Voeltz D, Hoyer A. Projected number of people with multiple sclerosis in Germany between 2015 and 2040. Mult Scler Relat Disord 2024; 89:105774. [PMID: 39032398 DOI: 10.1016/j.msard.2024.105774] [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: 04/22/2024] [Revised: 06/03/2024] [Accepted: 07/15/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND The global prevalence of multiple sclerosis has shown a marked rise in recent decades, with Germany reporting the highest prevalence among European countries. This study aims to project the future number of people with multiple sclerosis in Germany until 2040 which is necessary for effective resource allocation and health care planning. METHODS Based on data from the German statutory health insurance, the age- and sex-specific prevalence of multiple sclerosis was estimated applying mathematical relations between prevalence, incidence rate, and mortality rate. Subsequently, the projected prevalence was applied to the age structure of the German population between 2015 and 2040 to calculate the future number of people with multiple sclerosis. Several temporal trend scenarios pertaining to the incidence and mortality rate were compared. RESULTS Application of current age-specific prevalence estimates combined with the projected population structure in 2040, results in a decline of 8% in the number of people with multiple sclerosis. More realistic scenarios that reflect on trends in mortality and incidence rates, project between 453,000 (+75%) and 477,000 (+85%) multiple sclerosis cases in 2040. It is expected that females will be affected nearly 2.5 times more frequently than males in 2040. CONCLUSION The findings indicate a substantial rise in the prevalence of multiple sclerosis, ranging from 75% to 85% in 2040 compared to 2015. Assuming a constant age-specific prevalence between 2015 and 2040 without any temporal trends in mortality and incidence rates may underestimate the actual number of cases and consequently, future requirements for healthcare resources.
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Affiliation(s)
- Kira Baginski
- Biostatistics and Medical Biometry, Medical School OWL, Bielefeld University, Bielefeld.
| | - Dina Voeltz
- Biostatistics and Medical Biometry, Medical School OWL, Bielefeld University, Bielefeld
| | - Annika Hoyer
- Biostatistics and Medical Biometry, Medical School OWL, Bielefeld University, Bielefeld
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3
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Pierret C, Mainguy M, Leray E. Prevalence of multiple sclerosis in France in 2021: Data from the French health insurance database. Rev Neurol (Paris) 2024; 180:429-437. [PMID: 38423846 DOI: 10.1016/j.neurol.2023.12.007] [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: 10/20/2023] [Revised: 11/30/2023] [Accepted: 12/05/2023] [Indexed: 03/02/2024]
Abstract
BACKGROUND France is among the countries with high prevalence of multiple sclerosis (MS). The most recent estimates are from 2012 and need to be updated because MS prevalence has increased worldwide. OBJECTIVE To estimate MS prevalence in France on December 31, 2021 and to describe the characteristics of the French MS population using data from the French national health insurance database (SNDS). MATERIAL AND METHODS Persons with MS (PwMS) were identified in the SNDS database (99% of national coverage) using an algorithm with three criteria: long-term disease status, hospitalizations, and MS-specific drug reimbursements. Crude and sex- and age-stratified prevalence rates were calculated with their 95% confidence intervals as well as the standardized prevalence stratified on the region of residence. RESULTS In total, 134,062 PwMS were identified (71.8% of women, median age 53.0±14.8years) yielding a prevalence of 197.6 per 100,000 (95% CI [196.5-198.7]). Prevalence rates in women and men were respectively 274.9 (95% CI [273.2-276.6]) and 115.2 (95% CI [114.0-116.4]). In metropolitan France, the highest prevalence rates were observed in the northeastern regions (e.g.>230 PwMS per 100,000 in Grand Est and Hauts-de-France), and the lowest rates in the southwestern regions (∼180 PwMS per 100,000 in Nouvelle-Aquitaine and Occitanie). Overall, 32.1% of PwMS had another long-term disease and 51.8% received at least one MS-specific drug in 2021. CONCLUSION MS prevalence in France has increased by ∼30% in the last 10years. This increase is probably linked to population ageing, longer survival of PwMS, and the long observation period. The part attributable to a possible increase in MS risk remains to be determined with incidence studies.
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Affiliation(s)
- C Pierret
- Rennes University, EHESP, CNRS, Inserm, ARENES UMR 6051, RSMS U 1309, Rennes, France.
| | - M Mainguy
- Rennes University, EHESP, CNRS, Inserm, ARENES UMR 6051, RSMS U 1309, Rennes, France
| | - E Leray
- Rennes University, EHESP, CNRS, Inserm, ARENES UMR 6051, RSMS U 1309, Rennes, France
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4
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Khedr EM, Mahmoud DM, Hussein HB, Malky IEL, Mostafa SS, Gamea A. Treatment satisfaction with disease-modifying therapy is the only predictor of Adherence among multiple sclerosis patients from Upper Egypt. Sci Rep 2024; 14:7027. [PMID: 38528018 DOI: 10.1038/s41598-024-57116-9] [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: 10/13/2023] [Accepted: 03/14/2024] [Indexed: 03/27/2024] Open
Abstract
Despite the proven efficacy of the disease-modifying therapy (DMT) for multiple sclerosis (MS), the rates of non-adherence are frequently high. We aimed to evaluate the rate of non-adherence to the first DMT in Upper Egypt and identify different contributing factors. Out of 310 patients, ninety-seven adult patients with RRMS were recruited from three MS units located in Upper Egypt and were subjected to the following: complete clinical history, expanded disability status score (EDSS), Eight-item Morisky Medication Adherence Scale (MMAS-8), abbreviated Treatment Satisfaction Questionnaire for Medication-9 (TSQM-9), Hamilton depression scale, Fatigue Severity Scale (FSS) and the Pittsburgh Sleep Quality Index (PSQI). According to MMAS-8 scores, 63 (64.9%) of patients were non-adherent to their first DMT. Non-adherent patients are more likely to have longer disease duration (p = 0.002), longer duration on first DMT (p = 0.030), first DMT-start date before 2019 (p = 0.040), and lower treatment satisfaction scores (p = 0.016). However, there was no significant relation with physical disability, depression, fatigue, or sleep quality. On the regression analysis model, a lower treatment satisfaction score was the only predictor of DMT non-adherence (p = 0.012). Despite expanding DMT options, non-adherence among MS patients in Upper Egypt is high. Treatment satisfaction with DMT is the only predictor of adherence among MS patients of Upper Egypt. Adherence and satisfaction with the prescribed DMT should be assessed carefully to maximize DMT benefits.
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Affiliation(s)
- Eman M Khedr
- Department of Neuropsychiatry, Faculty of Medicine, Assiut University Hospital, Asyût, Egypt.
- Neuropsychiatric Department, Faculty of Medicine, Aswan University Hospital, Aswân, Egypt.
| | - Doaa M Mahmoud
- Department of Neuropsychiatry, Faculty of Medicine, Assiut University Hospital, Asyût, Egypt
| | - Hussein B Hussein
- Neuropsychiatric Department, Faculty of Medicine, South Valley University, Qena University Hospital, Qena, Egypt
| | - Islam E L Malky
- Neuropsychiatric Department, Faculty of Medicine, South Valley University, Qena University Hospital, Qena, Egypt
| | - Sarah S Mostafa
- Department of Neuropsychiatry, Faculty of Medicine, Assiut University Hospital, Asyût, Egypt
| | - Ayman Gamea
- Neuropsychiatric Department, Faculty of Medicine, South Valley University, Qena University Hospital, Qena, Egypt
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5
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Giordano A, De Panfilis L, Veronese S, Bruzzone M, Cascioli M, Farinotti M, Giovannetti AM, Grasso MG, Kruger P, Lugaresi A, Manson L, Perin M, Pucci E, Solaro C, Ghirotto L, Solari A. User appraisal of a booklet for advance care planning in multiple sclerosis: a multicenter, qualitative Italian study. Neurol Sci 2024; 45:1145-1154. [PMID: 37816932 PMCID: PMC10858142 DOI: 10.1007/s10072-023-07087-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 09/25/2023] [Indexed: 10/12/2023]
Abstract
OBJECTIVES Implementation of advance care planning (ACP) in people with progressive multiple sclerosis (PwPMS) is limited. We aimed to involve users (PwPMS, significant others, and healthcare professionals involved in PwPMS care) in the evaluation and refinement of a booklet to be used during the ACP conversations. METHODS This qualitative study consisted of cognitive interviews with PwPMS and significant others and a focus group with healthcare professionals from three Italian centers. We analyzed the interviews using the framework method and the focus group using thematic analysis. RESULTS We interviewed 10 PwPMS (3 women; median age 54 years; median Expanded Disability Status Scale score 6.0) and three significant others (2 women; 2 spouses and one daughter). The analysis yielded three themes: booklet comprehensibility and clarity, content acceptability and emotional impact, and suggestions for improvement. Twelve healthcare professionals (7 neurologists, 3 psychologists, one nurse, and one physiotherapist) participated in the focus group, whose analysis identified two themes: booklet's content importance and clarity and challenges to ACP implementation. Based on analysis results, we revised the booklet (text, layout, and pictures) and held a second-round interviews with two PwPMS and one significant other. The interviewees agreed on the revisions but reaffirmed their difficulty in dealing with the topic and the need for a physician when using the booklet. CONCLUSIONS Appraisal of the booklet was instrumental in improving its acceptability and understandability before using it in the ConCure-SM feasibility trial. Furthermore, our data reveal a lack of familiarity with ACP practice in the Italian context.
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Affiliation(s)
- Andrea Giordano
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy.
| | - Ludovica De Panfilis
- Bioethics Unit - Scientific Directorate, Azienda USL-IRCCS di Reggio Emilia, 42100, Reggio Emilia, Italy
| | | | | | - Marta Cascioli
- Hospice 'La Torre Sul Colle, Azienda USL Umbria 2, 06049, Spoleto, Italy
| | - Mariangela Farinotti
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
| | - Ambra Mara Giovannetti
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
| | | | - Paola Kruger
- The European Patients' Academy (EUPATI), 00165, Rome, Italy
| | - Alessandra Lugaresi
- UOSI Riabilitazione Sclerosi Multipla, IRCCS Istituto delle Scienze Neurologiche di Bologna, 40121, Bologna, Italy
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, 40121, Bologna, Italy
| | - Leigh Manson
- Health Quality & Safety Commission New Zealand, 7045, Nelson, New Zealand
| | - Marta Perin
- Bioethics Unit - Scientific Directorate, Azienda USL-IRCCS di Reggio Emilia, 42100, Reggio Emilia, Italy
- Doctoral Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 41100, Modena, Italy
| | - Eugenio Pucci
- UOC Neurologia AV4, ASUR Marche, 63900, Fermo, Italy
| | - Claudio Solaro
- Department of Rehabilitation, CRRF "Mons. L. Novarese", Loc. Trompone, 13040, Moncrivello, Italy
| | - Luca Ghirotto
- Qualitative Research Unit, Azienda USL-IRCCS di Reggio Emilia, 42100, Reggio Emilia, Italy
| | - Alessandra Solari
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
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Fleming NH, Bahorik A, Xia F, Yaffe K. Risk of dementia in older veterans with multiple sclerosis. Mult Scler Relat Disord 2024; 82:105372. [PMID: 38104510 PMCID: PMC11001267 DOI: 10.1016/j.msard.2023.105372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/29/2023] [Accepted: 12/10/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND While it is widely accepted that multiple sclerosis (MS) often causes cognitive dysfunction, it is thought that these cognitive symptoms rarely progress to dementia. However, this has not been thoroughly investigated. The objectives of this cohort study are to determine whether people with MS have an increased risk of dementia compared to the general population and to identify factors, such as geographic latitude, which may modify this association. METHODS We studied data from a random sample of US veterans aged ≥ 55 years followed at Veterans Affairs Health Care Systems nationwide from 1999 to 2019. We identified all patients diagnosed with MS using ICD codes over a two-year baseline period. We then identified a comparison cohort of patients without MS matched 1:1 on sex, age, race, and first encounter date. We constructed Cox proportional hazards regression models to determine the association between MS and dementia while controlling for demographic factors and comorbidities, with additional models to examine subgroup effects. We used Fine-Gray subdistribution hazard models accounting for competing risk of death to evaluate the sensitivity of the findings. RESULTS The study included 4084 MS patients and a matched group of 4084 non-MS patients. Overall, patients had mean age 66, were 93.6% male, and 88.1% non-Hispanic White, with mean follow-up time 9.5 years (MS) and 10.8 years (non-MS). In unadjusted models, veterans with MS had greater risk of dementia compared to matched controls (cumulative incidence 16.7% vs 12.4%; Cox HR 1.58, 95% CI 1.41-1.78). The increased risk remained after adjustment for potential confounders (adjusted HR 1.56, 95% CI 1.39-1.76) and when considering death as a competing risk (Fine-Gray HR 1.36, 95% CI 1.21-1.53). The magnitude of the MS-dementia association increased with rising geographic latitude (North HR 1.86, 1.51-2.30; Central HR 1.61, 1.42-1.82; South HR 1.39, 1.18-1.64; interaction p = 0.04) and younger baseline age (interaction p<0.001). CONCLUSIONS Among older veterans with MS, risk of dementia diagnosis was higher compared to matched controls even after controlling for comorbidities. The risk difference was highest in northern regions and in younger patients. Clinicians caring for older MS patients should be aware of this risk and offer screening and treatment accordingly.
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Affiliation(s)
- Nathaniel H Fleming
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, 505 Parnassus Ave, Box 0114, San Francisco, CA 94143, United States; San Francisco Veterans Affairs Health Care System, 4150 Clement Street, San Francisco, CA 94121, United States.
| | - Amber Bahorik
- San Francisco Veterans Affairs Health Care System, 4150 Clement Street, San Francisco, CA 94121, United States; Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, 1651 4th Street, San Francisco, CA 94143, United States
| | - Feng Xia
- San Francisco Veterans Affairs Health Care System, 4150 Clement Street, San Francisco, CA 94121, United States; Northern California Institute for Research and Education, 4150 Clement Street, San Francisco, CA 94121, United States
| | - Kristine Yaffe
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, 505 Parnassus Ave, Box 0114, San Francisco, CA 94143, United States; San Francisco Veterans Affairs Health Care System, 4150 Clement Street, San Francisco, CA 94121, United States; Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, 1651 4th Street, San Francisco, CA 94143, United States; Northern California Institute for Research and Education, 4150 Clement Street, San Francisco, CA 94121, United States; Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th Street, San Francisco, CA 94143, United States
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Asmis R, Medrano MT, Chase Huizar C, Griffith WP, Forsthuber TG. Dietary Supplementation with 23-Hydroxy Ursolic Acid Reduces the Severity and Incidence of Acute Experimental Autoimmune Encephalomyelitis (EAE) in a Murine Model of Multiple Sclerosis. Nutrients 2024; 16:348. [PMID: 38337633 PMCID: PMC10856865 DOI: 10.3390/nu16030348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/15/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
23-Hydroxy ursolic acid (23-OH UA) is a potent atheroprotective and anti-obesogenic phytochemical, with anti-inflammatory and inflammation-resolving properties. In this study, we examined whether dietary 23-OH UA protects mice against the acute onset and progression of experimental autoimmune encephalomyelitis (EAE), a mouse model of multiple sclerosis (MS). Female C57BL/6 mice were fed either a defined low-calorie maintenance diet (MD) or an MD supplemented with 0.2% wgt/wgt 23-OH UA for 5 weeks prior to actively inducing EAE and during the 30 days post-immunization. We observed no difference in the onset of EAE between the groups of mice, but ataxia and EAE disease severity were suppressed by 52% and 48%, respectively, and disease incidence was reduced by over 49% in mice that received 23-OH UA in their diet. Furthermore, disease-associated weight loss was strikingly ameliorated in 23-OH UA-fed mice. ELISPOT analysis showed no significant differences in frequencies of T cells producing IL-17 or IFN-γ between 23-OH UA-fed mice and control mice, suggesting that 23-OH UA does not appear to regulate peripheral T cell responses. In summary, our findings in EAE mice strongly suggest that dietary 23-OH UA may represent an effective oral adjunct therapy for the prevention and treatment of relapsing-remitting MS.
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Affiliation(s)
- Reto Asmis
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Megan T. Medrano
- Department of Molecular Microbiology and Immunology, University of Texas at San Antonio, San Antonio, TX 78249, USA; (M.T.M.)
| | - Carol Chase Huizar
- Department of Molecular Microbiology and Immunology, University of Texas at San Antonio, San Antonio, TX 78249, USA; (M.T.M.)
| | - Wendell P. Griffith
- Department of Chemistry, University of Texas at San Antonio, San Antonio, TX 78249, USA
| | - Thomas G. Forsthuber
- Department of Molecular Microbiology and Immunology, University of Texas at San Antonio, San Antonio, TX 78249, USA; (M.T.M.)
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Rollot F, Uhry Z, Dantony E, Vukusic S, Debouverie M, Le Page E, Ciron J, Ruet A, De Sèze J, Zéphir H, Labauge P, Defer G, Lebrun-Frenay C, Moreau T, Laplaud DA, Berger E, Clavelou P, Pelletier J, Thouvenot E, Heinzlef O, Camdessanche JP, Fauvernier M, Remontet L, Leray E. Comparison of 2 Methods for Estimating Multiple Sclerosis-Related Mortality. Neurology 2023; 101:e2483-e2496. [PMID: 37827849 PMCID: PMC10791051 DOI: 10.1212/wnl.0000000000207925] [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: 07/17/2023] [Accepted: 09/11/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Determining whether multiple sclerosis (MS) causes death is challenging. Our objective was to contrast 2 frameworks to estimate probabilities of death attributed to MS (PMS) and other causes (Pother): the cause-specific framework (CSF), which requires the causes of death, and the excess mortality framework (EMF), which does not. METHODS We used data from the Observatoire Français de la Sclérose en Plaques (OFSEP, n = 37,524) and from a comparative subset where causes of death were available (4,004 women with relapsing-onset MS [R-MS]). In CSF, the probabilities were estimated using the Aalen-Johansen method. In EMF, they were estimated from the excess mortality hazard, which is the additional mortality among patients with MS as compared with the expected mortality in the matched general population. PMS values were estimated at 30 years of follow-up, (1) with both frameworks in the comparative subset, by age group at onset, and (2) with EMF only in the OFSEP population, by initial phenotype, sex, and age at onset. RESULTS In the comparative subset, the estimated 30-year PMS values were greater using EMF than CSF: 10.9% (95% CI 8.3-13.6) vs 8.7% (6.4-11.8) among the youngest and 20.4% (11.3-29.5) vs 16.2% (8.7-30.2) for the oldest groups, respectively. In the CSF, probabilities of death from unknown causes ranged from 1.5% (0.7-3.0) to 6.4% (2.5-16.4), and even after their reallocation, PMS values remained lower with CSF than with EMF. The estimated probabilities of being alive were close using the 2 frameworks, and the estimated POther (EMF vs CSF) was 2.6% (2.5-2.6) vs 2.1% (1.2-3.9) and 18.1% (16.9-19.3) vs 26.4% (16.5-42.2), respectively, for the youngest and oldest groups. In the OFSEP population, the estimated 30-year PMS values ranged from 7.5% (6.4-8.7) to 24.0% (19.1-28.9) in patients with R-MS and from 25.4% (21.1-29.7) to 36.8% (28.3-45.3) in primary progressive patients, depending on sex and age. DISCUSSION EMF has the great advantage of not requiring death certificates, their quality being less than optimal. Conceptually, it also seems more relevant because it avoids having to state, for each individual, whether death was directly or indirectly caused by MS or whether it would have occurred anyway, which is especially difficult in such chronic diseases.
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Affiliation(s)
- Fabien Rollot
- From the Université de Lyon (F.R., S.V.), Université Claude Bernard Lyon 1; Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuroinflammation (F.R., S.V.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Observatoire Français de la Sclérose en Plaques (F.R., S.V.), Centre de Recherche en Neurosciences de Lyon, INSERM 1028 et CNRS UMR 5292; EUGENE DEVIC EDMUS Foundation Against Multiple Sclerosis (F.R., S.V.), State-Approved Foundation, Bron; Direction des Maladies non Transmissible et des Traumatismes (Z.U.), Santé Publique France, Saint-Maurice; Service de Biostatistique-Bioinformatique (Z.U., E.D., M.F., L.R.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Evolutive UMR 5558 (E.D., M.F., L.R.), Université Lyon 1 and CNRS, Villeurbanne; Service de Neurologie (M.D.), Centre Hospitalier Régional et Universitaire de Nancy, Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Neurology Department (E.L.P.), CRCSEP Rennes, Clinical Investigation Centre CIC-P 1414, Rennes University Hospital; Service de Neurologie (J.C.), CHU de Toulouse, Hôpital Pierre-Paul Riquet, CRC-SEP; Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity) (J.C.), INSERM UMR 1291, CNRS UMR 5051, Université Toulouse III; Service de Neurologie (A.R.), CRC SEP, CHU de Bordeaux; U1215 INSERM (A.R.), Neurocentre Magendie, Université de Bordeaux; Service de Neurologie et Centre d'Investigation Clinique (J.D.S.), CHU de Strasbourg, INSERM 1434; Pôle des Neurosciences et de l'Appareil Locomoteur (H.Z.), CRC-SEP, Hôpital Roger Salengro, Université de Lille, Inserm U1172; CRC SEP (P.L.), Service de Neurologie, CHU de Montpellier; Service de Neurologie (G.D.), CRC-SEP Normandie, CHU de Caen, Université Normandie; Service de Neurologie (C.L.-F.), Neurologie Pasteur 2, CHU de Nice, Université Nice Cote d'Azur UR2CA-URRIS; Service de Neurologie (T.M.), CHU de Dijon; Service de Neurologie (D.A.L.), CHU Nantes; INSERM (D.A.L.), CIC 0004, CRTI-INSERM UMR U1064, Nantes; Service de Neurologie (E.B.), CHU de Besançon; Service de Neurologie (P.C.), CHU de Clermont-Ferrand, INSERM 1107 NeuroDol, Clermont-Ferrand; Aix Marseille University (J.P.), APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, CEMEREM; Service de Neurologie (E.T.), CHU de Nîmes; Institut de Génomique Fonctionnelle (E.T.), Université de Montpellier, CNRS, INSERM; Service de Neurologie (O.H.), CH de Poissy; Service de Neurologie (J.-P.C.), Hôpital Nord, CHU Saint-Étienne; and Univ Rennes (E.L.), EHESP, CNRS, Inserm, ARENES UMR 6051, RSMS U 1309, France
| | - Zoé Uhry
- From the Université de Lyon (F.R., S.V.), Université Claude Bernard Lyon 1; Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuroinflammation (F.R., S.V.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Observatoire Français de la Sclérose en Plaques (F.R., S.V.), Centre de Recherche en Neurosciences de Lyon, INSERM 1028 et CNRS UMR 5292; EUGENE DEVIC EDMUS Foundation Against Multiple Sclerosis (F.R., S.V.), State-Approved Foundation, Bron; Direction des Maladies non Transmissible et des Traumatismes (Z.U.), Santé Publique France, Saint-Maurice; Service de Biostatistique-Bioinformatique (Z.U., E.D., M.F., L.R.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Evolutive UMR 5558 (E.D., M.F., L.R.), Université Lyon 1 and CNRS, Villeurbanne; Service de Neurologie (M.D.), Centre Hospitalier Régional et Universitaire de Nancy, Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Neurology Department (E.L.P.), CRCSEP Rennes, Clinical Investigation Centre CIC-P 1414, Rennes University Hospital; Service de Neurologie (J.C.), CHU de Toulouse, Hôpital Pierre-Paul Riquet, CRC-SEP; Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity) (J.C.), INSERM UMR 1291, CNRS UMR 5051, Université Toulouse III; Service de Neurologie (A.R.), CRC SEP, CHU de Bordeaux; U1215 INSERM (A.R.), Neurocentre Magendie, Université de Bordeaux; Service de Neurologie et Centre d'Investigation Clinique (J.D.S.), CHU de Strasbourg, INSERM 1434; Pôle des Neurosciences et de l'Appareil Locomoteur (H.Z.), CRC-SEP, Hôpital Roger Salengro, Université de Lille, Inserm U1172; CRC SEP (P.L.), Service de Neurologie, CHU de Montpellier; Service de Neurologie (G.D.), CRC-SEP Normandie, CHU de Caen, Université Normandie; Service de Neurologie (C.L.-F.), Neurologie Pasteur 2, CHU de Nice, Université Nice Cote d'Azur UR2CA-URRIS; Service de Neurologie (T.M.), CHU de Dijon; Service de Neurologie (D.A.L.), CHU Nantes; INSERM (D.A.L.), CIC 0004, CRTI-INSERM UMR U1064, Nantes; Service de Neurologie (E.B.), CHU de Besançon; Service de Neurologie (P.C.), CHU de Clermont-Ferrand, INSERM 1107 NeuroDol, Clermont-Ferrand; Aix Marseille University (J.P.), APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, CEMEREM; Service de Neurologie (E.T.), CHU de Nîmes; Institut de Génomique Fonctionnelle (E.T.), Université de Montpellier, CNRS, INSERM; Service de Neurologie (O.H.), CH de Poissy; Service de Neurologie (J.-P.C.), Hôpital Nord, CHU Saint-Étienne; and Univ Rennes (E.L.), EHESP, CNRS, Inserm, ARENES UMR 6051, RSMS U 1309, France
| | - Emmanuelle Dantony
- From the Université de Lyon (F.R., S.V.), Université Claude Bernard Lyon 1; Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuroinflammation (F.R., S.V.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Observatoire Français de la Sclérose en Plaques (F.R., S.V.), Centre de Recherche en Neurosciences de Lyon, INSERM 1028 et CNRS UMR 5292; EUGENE DEVIC EDMUS Foundation Against Multiple Sclerosis (F.R., S.V.), State-Approved Foundation, Bron; Direction des Maladies non Transmissible et des Traumatismes (Z.U.), Santé Publique France, Saint-Maurice; Service de Biostatistique-Bioinformatique (Z.U., E.D., M.F., L.R.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Evolutive UMR 5558 (E.D., M.F., L.R.), Université Lyon 1 and CNRS, Villeurbanne; Service de Neurologie (M.D.), Centre Hospitalier Régional et Universitaire de Nancy, Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Neurology Department (E.L.P.), CRCSEP Rennes, Clinical Investigation Centre CIC-P 1414, Rennes University Hospital; Service de Neurologie (J.C.), CHU de Toulouse, Hôpital Pierre-Paul Riquet, CRC-SEP; Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity) (J.C.), INSERM UMR 1291, CNRS UMR 5051, Université Toulouse III; Service de Neurologie (A.R.), CRC SEP, CHU de Bordeaux; U1215 INSERM (A.R.), Neurocentre Magendie, Université de Bordeaux; Service de Neurologie et Centre d'Investigation Clinique (J.D.S.), CHU de Strasbourg, INSERM 1434; Pôle des Neurosciences et de l'Appareil Locomoteur (H.Z.), CRC-SEP, Hôpital Roger Salengro, Université de Lille, Inserm U1172; CRC SEP (P.L.), Service de Neurologie, CHU de Montpellier; Service de Neurologie (G.D.), CRC-SEP Normandie, CHU de Caen, Université Normandie; Service de Neurologie (C.L.-F.), Neurologie Pasteur 2, CHU de Nice, Université Nice Cote d'Azur UR2CA-URRIS; Service de Neurologie (T.M.), CHU de Dijon; Service de Neurologie (D.A.L.), CHU Nantes; INSERM (D.A.L.), CIC 0004, CRTI-INSERM UMR U1064, Nantes; Service de Neurologie (E.B.), CHU de Besançon; Service de Neurologie (P.C.), CHU de Clermont-Ferrand, INSERM 1107 NeuroDol, Clermont-Ferrand; Aix Marseille University (J.P.), APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, CEMEREM; Service de Neurologie (E.T.), CHU de Nîmes; Institut de Génomique Fonctionnelle (E.T.), Université de Montpellier, CNRS, INSERM; Service de Neurologie (O.H.), CH de Poissy; Service de Neurologie (J.-P.C.), Hôpital Nord, CHU Saint-Étienne; and Univ Rennes (E.L.), EHESP, CNRS, Inserm, ARENES UMR 6051, RSMS U 1309, France
| | - Sandra Vukusic
- From the Université de Lyon (F.R., S.V.), Université Claude Bernard Lyon 1; Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuroinflammation (F.R., S.V.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Observatoire Français de la Sclérose en Plaques (F.R., S.V.), Centre de Recherche en Neurosciences de Lyon, INSERM 1028 et CNRS UMR 5292; EUGENE DEVIC EDMUS Foundation Against Multiple Sclerosis (F.R., S.V.), State-Approved Foundation, Bron; Direction des Maladies non Transmissible et des Traumatismes (Z.U.), Santé Publique France, Saint-Maurice; Service de Biostatistique-Bioinformatique (Z.U., E.D., M.F., L.R.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Evolutive UMR 5558 (E.D., M.F., L.R.), Université Lyon 1 and CNRS, Villeurbanne; Service de Neurologie (M.D.), Centre Hospitalier Régional et Universitaire de Nancy, Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Neurology Department (E.L.P.), CRCSEP Rennes, Clinical Investigation Centre CIC-P 1414, Rennes University Hospital; Service de Neurologie (J.C.), CHU de Toulouse, Hôpital Pierre-Paul Riquet, CRC-SEP; Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity) (J.C.), INSERM UMR 1291, CNRS UMR 5051, Université Toulouse III; Service de Neurologie (A.R.), CRC SEP, CHU de Bordeaux; U1215 INSERM (A.R.), Neurocentre Magendie, Université de Bordeaux; Service de Neurologie et Centre d'Investigation Clinique (J.D.S.), CHU de Strasbourg, INSERM 1434; Pôle des Neurosciences et de l'Appareil Locomoteur (H.Z.), CRC-SEP, Hôpital Roger Salengro, Université de Lille, Inserm U1172; CRC SEP (P.L.), Service de Neurologie, CHU de Montpellier; Service de Neurologie (G.D.), CRC-SEP Normandie, CHU de Caen, Université Normandie; Service de Neurologie (C.L.-F.), Neurologie Pasteur 2, CHU de Nice, Université Nice Cote d'Azur UR2CA-URRIS; Service de Neurologie (T.M.), CHU de Dijon; Service de Neurologie (D.A.L.), CHU Nantes; INSERM (D.A.L.), CIC 0004, CRTI-INSERM UMR U1064, Nantes; Service de Neurologie (E.B.), CHU de Besançon; Service de Neurologie (P.C.), CHU de Clermont-Ferrand, INSERM 1107 NeuroDol, Clermont-Ferrand; Aix Marseille University (J.P.), APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, CEMEREM; Service de Neurologie (E.T.), CHU de Nîmes; Institut de Génomique Fonctionnelle (E.T.), Université de Montpellier, CNRS, INSERM; Service de Neurologie (O.H.), CH de Poissy; Service de Neurologie (J.-P.C.), Hôpital Nord, CHU Saint-Étienne; and Univ Rennes (E.L.), EHESP, CNRS, Inserm, ARENES UMR 6051, RSMS U 1309, France
| | - Marc Debouverie
- From the Université de Lyon (F.R., S.V.), Université Claude Bernard Lyon 1; Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuroinflammation (F.R., S.V.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Observatoire Français de la Sclérose en Plaques (F.R., S.V.), Centre de Recherche en Neurosciences de Lyon, INSERM 1028 et CNRS UMR 5292; EUGENE DEVIC EDMUS Foundation Against Multiple Sclerosis (F.R., S.V.), State-Approved Foundation, Bron; Direction des Maladies non Transmissible et des Traumatismes (Z.U.), Santé Publique France, Saint-Maurice; Service de Biostatistique-Bioinformatique (Z.U., E.D., M.F., L.R.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Evolutive UMR 5558 (E.D., M.F., L.R.), Université Lyon 1 and CNRS, Villeurbanne; Service de Neurologie (M.D.), Centre Hospitalier Régional et Universitaire de Nancy, Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Neurology Department (E.L.P.), CRCSEP Rennes, Clinical Investigation Centre CIC-P 1414, Rennes University Hospital; Service de Neurologie (J.C.), CHU de Toulouse, Hôpital Pierre-Paul Riquet, CRC-SEP; Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity) (J.C.), INSERM UMR 1291, CNRS UMR 5051, Université Toulouse III; Service de Neurologie (A.R.), CRC SEP, CHU de Bordeaux; U1215 INSERM (A.R.), Neurocentre Magendie, Université de Bordeaux; Service de Neurologie et Centre d'Investigation Clinique (J.D.S.), CHU de Strasbourg, INSERM 1434; Pôle des Neurosciences et de l'Appareil Locomoteur (H.Z.), CRC-SEP, Hôpital Roger Salengro, Université de Lille, Inserm U1172; CRC SEP (P.L.), Service de Neurologie, CHU de Montpellier; Service de Neurologie (G.D.), CRC-SEP Normandie, CHU de Caen, Université Normandie; Service de Neurologie (C.L.-F.), Neurologie Pasteur 2, CHU de Nice, Université Nice Cote d'Azur UR2CA-URRIS; Service de Neurologie (T.M.), CHU de Dijon; Service de Neurologie (D.A.L.), CHU Nantes; INSERM (D.A.L.), CIC 0004, CRTI-INSERM UMR U1064, Nantes; Service de Neurologie (E.B.), CHU de Besançon; Service de Neurologie (P.C.), CHU de Clermont-Ferrand, INSERM 1107 NeuroDol, Clermont-Ferrand; Aix Marseille University (J.P.), APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, CEMEREM; Service de Neurologie (E.T.), CHU de Nîmes; Institut de Génomique Fonctionnelle (E.T.), Université de Montpellier, CNRS, INSERM; Service de Neurologie (O.H.), CH de Poissy; Service de Neurologie (J.-P.C.), Hôpital Nord, CHU Saint-Étienne; and Univ Rennes (E.L.), EHESP, CNRS, Inserm, ARENES UMR 6051, RSMS U 1309, France
| | - Emmanuelle Le Page
- From the Université de Lyon (F.R., S.V.), Université Claude Bernard Lyon 1; Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuroinflammation (F.R., S.V.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Observatoire Français de la Sclérose en Plaques (F.R., S.V.), Centre de Recherche en Neurosciences de Lyon, INSERM 1028 et CNRS UMR 5292; EUGENE DEVIC EDMUS Foundation Against Multiple Sclerosis (F.R., S.V.), State-Approved Foundation, Bron; Direction des Maladies non Transmissible et des Traumatismes (Z.U.), Santé Publique France, Saint-Maurice; Service de Biostatistique-Bioinformatique (Z.U., E.D., M.F., L.R.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Evolutive UMR 5558 (E.D., M.F., L.R.), Université Lyon 1 and CNRS, Villeurbanne; Service de Neurologie (M.D.), Centre Hospitalier Régional et Universitaire de Nancy, Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Neurology Department (E.L.P.), CRCSEP Rennes, Clinical Investigation Centre CIC-P 1414, Rennes University Hospital; Service de Neurologie (J.C.), CHU de Toulouse, Hôpital Pierre-Paul Riquet, CRC-SEP; Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity) (J.C.), INSERM UMR 1291, CNRS UMR 5051, Université Toulouse III; Service de Neurologie (A.R.), CRC SEP, CHU de Bordeaux; U1215 INSERM (A.R.), Neurocentre Magendie, Université de Bordeaux; Service de Neurologie et Centre d'Investigation Clinique (J.D.S.), CHU de Strasbourg, INSERM 1434; Pôle des Neurosciences et de l'Appareil Locomoteur (H.Z.), CRC-SEP, Hôpital Roger Salengro, Université de Lille, Inserm U1172; CRC SEP (P.L.), Service de Neurologie, CHU de Montpellier; Service de Neurologie (G.D.), CRC-SEP Normandie, CHU de Caen, Université Normandie; Service de Neurologie (C.L.-F.), Neurologie Pasteur 2, CHU de Nice, Université Nice Cote d'Azur UR2CA-URRIS; Service de Neurologie (T.M.), CHU de Dijon; Service de Neurologie (D.A.L.), CHU Nantes; INSERM (D.A.L.), CIC 0004, CRTI-INSERM UMR U1064, Nantes; Service de Neurologie (E.B.), CHU de Besançon; Service de Neurologie (P.C.), CHU de Clermont-Ferrand, INSERM 1107 NeuroDol, Clermont-Ferrand; Aix Marseille University (J.P.), APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, CEMEREM; Service de Neurologie (E.T.), CHU de Nîmes; Institut de Génomique Fonctionnelle (E.T.), Université de Montpellier, CNRS, INSERM; Service de Neurologie (O.H.), CH de Poissy; Service de Neurologie (J.-P.C.), Hôpital Nord, CHU Saint-Étienne; and Univ Rennes (E.L.), EHESP, CNRS, Inserm, ARENES UMR 6051, RSMS U 1309, France
| | - Jonathan Ciron
- From the Université de Lyon (F.R., S.V.), Université Claude Bernard Lyon 1; Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuroinflammation (F.R., S.V.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Observatoire Français de la Sclérose en Plaques (F.R., S.V.), Centre de Recherche en Neurosciences de Lyon, INSERM 1028 et CNRS UMR 5292; EUGENE DEVIC EDMUS Foundation Against Multiple Sclerosis (F.R., S.V.), State-Approved Foundation, Bron; Direction des Maladies non Transmissible et des Traumatismes (Z.U.), Santé Publique France, Saint-Maurice; Service de Biostatistique-Bioinformatique (Z.U., E.D., M.F., L.R.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Evolutive UMR 5558 (E.D., M.F., L.R.), Université Lyon 1 and CNRS, Villeurbanne; Service de Neurologie (M.D.), Centre Hospitalier Régional et Universitaire de Nancy, Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Neurology Department (E.L.P.), CRCSEP Rennes, Clinical Investigation Centre CIC-P 1414, Rennes University Hospital; Service de Neurologie (J.C.), CHU de Toulouse, Hôpital Pierre-Paul Riquet, CRC-SEP; Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity) (J.C.), INSERM UMR 1291, CNRS UMR 5051, Université Toulouse III; Service de Neurologie (A.R.), CRC SEP, CHU de Bordeaux; U1215 INSERM (A.R.), Neurocentre Magendie, Université de Bordeaux; Service de Neurologie et Centre d'Investigation Clinique (J.D.S.), CHU de Strasbourg, INSERM 1434; Pôle des Neurosciences et de l'Appareil Locomoteur (H.Z.), CRC-SEP, Hôpital Roger Salengro, Université de Lille, Inserm U1172; CRC SEP (P.L.), Service de Neurologie, CHU de Montpellier; Service de Neurologie (G.D.), CRC-SEP Normandie, CHU de Caen, Université Normandie; Service de Neurologie (C.L.-F.), Neurologie Pasteur 2, CHU de Nice, Université Nice Cote d'Azur UR2CA-URRIS; Service de Neurologie (T.M.), CHU de Dijon; Service de Neurologie (D.A.L.), CHU Nantes; INSERM (D.A.L.), CIC 0004, CRTI-INSERM UMR U1064, Nantes; Service de Neurologie (E.B.), CHU de Besançon; Service de Neurologie (P.C.), CHU de Clermont-Ferrand, INSERM 1107 NeuroDol, Clermont-Ferrand; Aix Marseille University (J.P.), APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, CEMEREM; Service de Neurologie (E.T.), CHU de Nîmes; Institut de Génomique Fonctionnelle (E.T.), Université de Montpellier, CNRS, INSERM; Service de Neurologie (O.H.), CH de Poissy; Service de Neurologie (J.-P.C.), Hôpital Nord, CHU Saint-Étienne; and Univ Rennes (E.L.), EHESP, CNRS, Inserm, ARENES UMR 6051, RSMS U 1309, France
| | - Aurélie Ruet
- From the Université de Lyon (F.R., S.V.), Université Claude Bernard Lyon 1; Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuroinflammation (F.R., S.V.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Observatoire Français de la Sclérose en Plaques (F.R., S.V.), Centre de Recherche en Neurosciences de Lyon, INSERM 1028 et CNRS UMR 5292; EUGENE DEVIC EDMUS Foundation Against Multiple Sclerosis (F.R., S.V.), State-Approved Foundation, Bron; Direction des Maladies non Transmissible et des Traumatismes (Z.U.), Santé Publique France, Saint-Maurice; Service de Biostatistique-Bioinformatique (Z.U., E.D., M.F., L.R.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Evolutive UMR 5558 (E.D., M.F., L.R.), Université Lyon 1 and CNRS, Villeurbanne; Service de Neurologie (M.D.), Centre Hospitalier Régional et Universitaire de Nancy, Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Neurology Department (E.L.P.), CRCSEP Rennes, Clinical Investigation Centre CIC-P 1414, Rennes University Hospital; Service de Neurologie (J.C.), CHU de Toulouse, Hôpital Pierre-Paul Riquet, CRC-SEP; Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity) (J.C.), INSERM UMR 1291, CNRS UMR 5051, Université Toulouse III; Service de Neurologie (A.R.), CRC SEP, CHU de Bordeaux; U1215 INSERM (A.R.), Neurocentre Magendie, Université de Bordeaux; Service de Neurologie et Centre d'Investigation Clinique (J.D.S.), CHU de Strasbourg, INSERM 1434; Pôle des Neurosciences et de l'Appareil Locomoteur (H.Z.), CRC-SEP, Hôpital Roger Salengro, Université de Lille, Inserm U1172; CRC SEP (P.L.), Service de Neurologie, CHU de Montpellier; Service de Neurologie (G.D.), CRC-SEP Normandie, CHU de Caen, Université Normandie; Service de Neurologie (C.L.-F.), Neurologie Pasteur 2, CHU de Nice, Université Nice Cote d'Azur UR2CA-URRIS; Service de Neurologie (T.M.), CHU de Dijon; Service de Neurologie (D.A.L.), CHU Nantes; INSERM (D.A.L.), CIC 0004, CRTI-INSERM UMR U1064, Nantes; Service de Neurologie (E.B.), CHU de Besançon; Service de Neurologie (P.C.), CHU de Clermont-Ferrand, INSERM 1107 NeuroDol, Clermont-Ferrand; Aix Marseille University (J.P.), APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, CEMEREM; Service de Neurologie (E.T.), CHU de Nîmes; Institut de Génomique Fonctionnelle (E.T.), Université de Montpellier, CNRS, INSERM; Service de Neurologie (O.H.), CH de Poissy; Service de Neurologie (J.-P.C.), Hôpital Nord, CHU Saint-Étienne; and Univ Rennes (E.L.), EHESP, CNRS, Inserm, ARENES UMR 6051, RSMS U 1309, France
| | - Jérome De Sèze
- From the Université de Lyon (F.R., S.V.), Université Claude Bernard Lyon 1; Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuroinflammation (F.R., S.V.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Observatoire Français de la Sclérose en Plaques (F.R., S.V.), Centre de Recherche en Neurosciences de Lyon, INSERM 1028 et CNRS UMR 5292; EUGENE DEVIC EDMUS Foundation Against Multiple Sclerosis (F.R., S.V.), State-Approved Foundation, Bron; Direction des Maladies non Transmissible et des Traumatismes (Z.U.), Santé Publique France, Saint-Maurice; Service de Biostatistique-Bioinformatique (Z.U., E.D., M.F., L.R.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Evolutive UMR 5558 (E.D., M.F., L.R.), Université Lyon 1 and CNRS, Villeurbanne; Service de Neurologie (M.D.), Centre Hospitalier Régional et Universitaire de Nancy, Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Neurology Department (E.L.P.), CRCSEP Rennes, Clinical Investigation Centre CIC-P 1414, Rennes University Hospital; Service de Neurologie (J.C.), CHU de Toulouse, Hôpital Pierre-Paul Riquet, CRC-SEP; Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity) (J.C.), INSERM UMR 1291, CNRS UMR 5051, Université Toulouse III; Service de Neurologie (A.R.), CRC SEP, CHU de Bordeaux; U1215 INSERM (A.R.), Neurocentre Magendie, Université de Bordeaux; Service de Neurologie et Centre d'Investigation Clinique (J.D.S.), CHU de Strasbourg, INSERM 1434; Pôle des Neurosciences et de l'Appareil Locomoteur (H.Z.), CRC-SEP, Hôpital Roger Salengro, Université de Lille, Inserm U1172; CRC SEP (P.L.), Service de Neurologie, CHU de Montpellier; Service de Neurologie (G.D.), CRC-SEP Normandie, CHU de Caen, Université Normandie; Service de Neurologie (C.L.-F.), Neurologie Pasteur 2, CHU de Nice, Université Nice Cote d'Azur UR2CA-URRIS; Service de Neurologie (T.M.), CHU de Dijon; Service de Neurologie (D.A.L.), CHU Nantes; INSERM (D.A.L.), CIC 0004, CRTI-INSERM UMR U1064, Nantes; Service de Neurologie (E.B.), CHU de Besançon; Service de Neurologie (P.C.), CHU de Clermont-Ferrand, INSERM 1107 NeuroDol, Clermont-Ferrand; Aix Marseille University (J.P.), APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, CEMEREM; Service de Neurologie (E.T.), CHU de Nîmes; Institut de Génomique Fonctionnelle (E.T.), Université de Montpellier, CNRS, INSERM; Service de Neurologie (O.H.), CH de Poissy; Service de Neurologie (J.-P.C.), Hôpital Nord, CHU Saint-Étienne; and Univ Rennes (E.L.), EHESP, CNRS, Inserm, ARENES UMR 6051, RSMS U 1309, France
| | - Hélène Zéphir
- From the Université de Lyon (F.R., S.V.), Université Claude Bernard Lyon 1; Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuroinflammation (F.R., S.V.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Observatoire Français de la Sclérose en Plaques (F.R., S.V.), Centre de Recherche en Neurosciences de Lyon, INSERM 1028 et CNRS UMR 5292; EUGENE DEVIC EDMUS Foundation Against Multiple Sclerosis (F.R., S.V.), State-Approved Foundation, Bron; Direction des Maladies non Transmissible et des Traumatismes (Z.U.), Santé Publique France, Saint-Maurice; Service de Biostatistique-Bioinformatique (Z.U., E.D., M.F., L.R.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Evolutive UMR 5558 (E.D., M.F., L.R.), Université Lyon 1 and CNRS, Villeurbanne; Service de Neurologie (M.D.), Centre Hospitalier Régional et Universitaire de Nancy, Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Neurology Department (E.L.P.), CRCSEP Rennes, Clinical Investigation Centre CIC-P 1414, Rennes University Hospital; Service de Neurologie (J.C.), CHU de Toulouse, Hôpital Pierre-Paul Riquet, CRC-SEP; Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity) (J.C.), INSERM UMR 1291, CNRS UMR 5051, Université Toulouse III; Service de Neurologie (A.R.), CRC SEP, CHU de Bordeaux; U1215 INSERM (A.R.), Neurocentre Magendie, Université de Bordeaux; Service de Neurologie et Centre d'Investigation Clinique (J.D.S.), CHU de Strasbourg, INSERM 1434; Pôle des Neurosciences et de l'Appareil Locomoteur (H.Z.), CRC-SEP, Hôpital Roger Salengro, Université de Lille, Inserm U1172; CRC SEP (P.L.), Service de Neurologie, CHU de Montpellier; Service de Neurologie (G.D.), CRC-SEP Normandie, CHU de Caen, Université Normandie; Service de Neurologie (C.L.-F.), Neurologie Pasteur 2, CHU de Nice, Université Nice Cote d'Azur UR2CA-URRIS; Service de Neurologie (T.M.), CHU de Dijon; Service de Neurologie (D.A.L.), CHU Nantes; INSERM (D.A.L.), CIC 0004, CRTI-INSERM UMR U1064, Nantes; Service de Neurologie (E.B.), CHU de Besançon; Service de Neurologie (P.C.), CHU de Clermont-Ferrand, INSERM 1107 NeuroDol, Clermont-Ferrand; Aix Marseille University (J.P.), APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, CEMEREM; Service de Neurologie (E.T.), CHU de Nîmes; Institut de Génomique Fonctionnelle (E.T.), Université de Montpellier, CNRS, INSERM; Service de Neurologie (O.H.), CH de Poissy; Service de Neurologie (J.-P.C.), Hôpital Nord, CHU Saint-Étienne; and Univ Rennes (E.L.), EHESP, CNRS, Inserm, ARENES UMR 6051, RSMS U 1309, France
| | - Pierre Labauge
- From the Université de Lyon (F.R., S.V.), Université Claude Bernard Lyon 1; Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuroinflammation (F.R., S.V.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Observatoire Français de la Sclérose en Plaques (F.R., S.V.), Centre de Recherche en Neurosciences de Lyon, INSERM 1028 et CNRS UMR 5292; EUGENE DEVIC EDMUS Foundation Against Multiple Sclerosis (F.R., S.V.), State-Approved Foundation, Bron; Direction des Maladies non Transmissible et des Traumatismes (Z.U.), Santé Publique France, Saint-Maurice; Service de Biostatistique-Bioinformatique (Z.U., E.D., M.F., L.R.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Evolutive UMR 5558 (E.D., M.F., L.R.), Université Lyon 1 and CNRS, Villeurbanne; Service de Neurologie (M.D.), Centre Hospitalier Régional et Universitaire de Nancy, Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Neurology Department (E.L.P.), CRCSEP Rennes, Clinical Investigation Centre CIC-P 1414, Rennes University Hospital; Service de Neurologie (J.C.), CHU de Toulouse, Hôpital Pierre-Paul Riquet, CRC-SEP; Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity) (J.C.), INSERM UMR 1291, CNRS UMR 5051, Université Toulouse III; Service de Neurologie (A.R.), CRC SEP, CHU de Bordeaux; U1215 INSERM (A.R.), Neurocentre Magendie, Université de Bordeaux; Service de Neurologie et Centre d'Investigation Clinique (J.D.S.), CHU de Strasbourg, INSERM 1434; Pôle des Neurosciences et de l'Appareil Locomoteur (H.Z.), CRC-SEP, Hôpital Roger Salengro, Université de Lille, Inserm U1172; CRC SEP (P.L.), Service de Neurologie, CHU de Montpellier; Service de Neurologie (G.D.), CRC-SEP Normandie, CHU de Caen, Université Normandie; Service de Neurologie (C.L.-F.), Neurologie Pasteur 2, CHU de Nice, Université Nice Cote d'Azur UR2CA-URRIS; Service de Neurologie (T.M.), CHU de Dijon; Service de Neurologie (D.A.L.), CHU Nantes; INSERM (D.A.L.), CIC 0004, CRTI-INSERM UMR U1064, Nantes; Service de Neurologie (E.B.), CHU de Besançon; Service de Neurologie (P.C.), CHU de Clermont-Ferrand, INSERM 1107 NeuroDol, Clermont-Ferrand; Aix Marseille University (J.P.), APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, CEMEREM; Service de Neurologie (E.T.), CHU de Nîmes; Institut de Génomique Fonctionnelle (E.T.), Université de Montpellier, CNRS, INSERM; Service de Neurologie (O.H.), CH de Poissy; Service de Neurologie (J.-P.C.), Hôpital Nord, CHU Saint-Étienne; and Univ Rennes (E.L.), EHESP, CNRS, Inserm, ARENES UMR 6051, RSMS U 1309, France
| | - Gilles Defer
- From the Université de Lyon (F.R., S.V.), Université Claude Bernard Lyon 1; Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuroinflammation (F.R., S.V.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Observatoire Français de la Sclérose en Plaques (F.R., S.V.), Centre de Recherche en Neurosciences de Lyon, INSERM 1028 et CNRS UMR 5292; EUGENE DEVIC EDMUS Foundation Against Multiple Sclerosis (F.R., S.V.), State-Approved Foundation, Bron; Direction des Maladies non Transmissible et des Traumatismes (Z.U.), Santé Publique France, Saint-Maurice; Service de Biostatistique-Bioinformatique (Z.U., E.D., M.F., L.R.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Evolutive UMR 5558 (E.D., M.F., L.R.), Université Lyon 1 and CNRS, Villeurbanne; Service de Neurologie (M.D.), Centre Hospitalier Régional et Universitaire de Nancy, Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Neurology Department (E.L.P.), CRCSEP Rennes, Clinical Investigation Centre CIC-P 1414, Rennes University Hospital; Service de Neurologie (J.C.), CHU de Toulouse, Hôpital Pierre-Paul Riquet, CRC-SEP; Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity) (J.C.), INSERM UMR 1291, CNRS UMR 5051, Université Toulouse III; Service de Neurologie (A.R.), CRC SEP, CHU de Bordeaux; U1215 INSERM (A.R.), Neurocentre Magendie, Université de Bordeaux; Service de Neurologie et Centre d'Investigation Clinique (J.D.S.), CHU de Strasbourg, INSERM 1434; Pôle des Neurosciences et de l'Appareil Locomoteur (H.Z.), CRC-SEP, Hôpital Roger Salengro, Université de Lille, Inserm U1172; CRC SEP (P.L.), Service de Neurologie, CHU de Montpellier; Service de Neurologie (G.D.), CRC-SEP Normandie, CHU de Caen, Université Normandie; Service de Neurologie (C.L.-F.), Neurologie Pasteur 2, CHU de Nice, Université Nice Cote d'Azur UR2CA-URRIS; Service de Neurologie (T.M.), CHU de Dijon; Service de Neurologie (D.A.L.), CHU Nantes; INSERM (D.A.L.), CIC 0004, CRTI-INSERM UMR U1064, Nantes; Service de Neurologie (E.B.), CHU de Besançon; Service de Neurologie (P.C.), CHU de Clermont-Ferrand, INSERM 1107 NeuroDol, Clermont-Ferrand; Aix Marseille University (J.P.), APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, CEMEREM; Service de Neurologie (E.T.), CHU de Nîmes; Institut de Génomique Fonctionnelle (E.T.), Université de Montpellier, CNRS, INSERM; Service de Neurologie (O.H.), CH de Poissy; Service de Neurologie (J.-P.C.), Hôpital Nord, CHU Saint-Étienne; and Univ Rennes (E.L.), EHESP, CNRS, Inserm, ARENES UMR 6051, RSMS U 1309, France
| | - Christine Lebrun-Frenay
- From the Université de Lyon (F.R., S.V.), Université Claude Bernard Lyon 1; Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuroinflammation (F.R., S.V.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Observatoire Français de la Sclérose en Plaques (F.R., S.V.), Centre de Recherche en Neurosciences de Lyon, INSERM 1028 et CNRS UMR 5292; EUGENE DEVIC EDMUS Foundation Against Multiple Sclerosis (F.R., S.V.), State-Approved Foundation, Bron; Direction des Maladies non Transmissible et des Traumatismes (Z.U.), Santé Publique France, Saint-Maurice; Service de Biostatistique-Bioinformatique (Z.U., E.D., M.F., L.R.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Evolutive UMR 5558 (E.D., M.F., L.R.), Université Lyon 1 and CNRS, Villeurbanne; Service de Neurologie (M.D.), Centre Hospitalier Régional et Universitaire de Nancy, Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Neurology Department (E.L.P.), CRCSEP Rennes, Clinical Investigation Centre CIC-P 1414, Rennes University Hospital; Service de Neurologie (J.C.), CHU de Toulouse, Hôpital Pierre-Paul Riquet, CRC-SEP; Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity) (J.C.), INSERM UMR 1291, CNRS UMR 5051, Université Toulouse III; Service de Neurologie (A.R.), CRC SEP, CHU de Bordeaux; U1215 INSERM (A.R.), Neurocentre Magendie, Université de Bordeaux; Service de Neurologie et Centre d'Investigation Clinique (J.D.S.), CHU de Strasbourg, INSERM 1434; Pôle des Neurosciences et de l'Appareil Locomoteur (H.Z.), CRC-SEP, Hôpital Roger Salengro, Université de Lille, Inserm U1172; CRC SEP (P.L.), Service de Neurologie, CHU de Montpellier; Service de Neurologie (G.D.), CRC-SEP Normandie, CHU de Caen, Université Normandie; Service de Neurologie (C.L.-F.), Neurologie Pasteur 2, CHU de Nice, Université Nice Cote d'Azur UR2CA-URRIS; Service de Neurologie (T.M.), CHU de Dijon; Service de Neurologie (D.A.L.), CHU Nantes; INSERM (D.A.L.), CIC 0004, CRTI-INSERM UMR U1064, Nantes; Service de Neurologie (E.B.), CHU de Besançon; Service de Neurologie (P.C.), CHU de Clermont-Ferrand, INSERM 1107 NeuroDol, Clermont-Ferrand; Aix Marseille University (J.P.), APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, CEMEREM; Service de Neurologie (E.T.), CHU de Nîmes; Institut de Génomique Fonctionnelle (E.T.), Université de Montpellier, CNRS, INSERM; Service de Neurologie (O.H.), CH de Poissy; Service de Neurologie (J.-P.C.), Hôpital Nord, CHU Saint-Étienne; and Univ Rennes (E.L.), EHESP, CNRS, Inserm, ARENES UMR 6051, RSMS U 1309, France
| | - Thibault Moreau
- From the Université de Lyon (F.R., S.V.), Université Claude Bernard Lyon 1; Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuroinflammation (F.R., S.V.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Observatoire Français de la Sclérose en Plaques (F.R., S.V.), Centre de Recherche en Neurosciences de Lyon, INSERM 1028 et CNRS UMR 5292; EUGENE DEVIC EDMUS Foundation Against Multiple Sclerosis (F.R., S.V.), State-Approved Foundation, Bron; Direction des Maladies non Transmissible et des Traumatismes (Z.U.), Santé Publique France, Saint-Maurice; Service de Biostatistique-Bioinformatique (Z.U., E.D., M.F., L.R.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Evolutive UMR 5558 (E.D., M.F., L.R.), Université Lyon 1 and CNRS, Villeurbanne; Service de Neurologie (M.D.), Centre Hospitalier Régional et Universitaire de Nancy, Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Neurology Department (E.L.P.), CRCSEP Rennes, Clinical Investigation Centre CIC-P 1414, Rennes University Hospital; Service de Neurologie (J.C.), CHU de Toulouse, Hôpital Pierre-Paul Riquet, CRC-SEP; Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity) (J.C.), INSERM UMR 1291, CNRS UMR 5051, Université Toulouse III; Service de Neurologie (A.R.), CRC SEP, CHU de Bordeaux; U1215 INSERM (A.R.), Neurocentre Magendie, Université de Bordeaux; Service de Neurologie et Centre d'Investigation Clinique (J.D.S.), CHU de Strasbourg, INSERM 1434; Pôle des Neurosciences et de l'Appareil Locomoteur (H.Z.), CRC-SEP, Hôpital Roger Salengro, Université de Lille, Inserm U1172; CRC SEP (P.L.), Service de Neurologie, CHU de Montpellier; Service de Neurologie (G.D.), CRC-SEP Normandie, CHU de Caen, Université Normandie; Service de Neurologie (C.L.-F.), Neurologie Pasteur 2, CHU de Nice, Université Nice Cote d'Azur UR2CA-URRIS; Service de Neurologie (T.M.), CHU de Dijon; Service de Neurologie (D.A.L.), CHU Nantes; INSERM (D.A.L.), CIC 0004, CRTI-INSERM UMR U1064, Nantes; Service de Neurologie (E.B.), CHU de Besançon; Service de Neurologie (P.C.), CHU de Clermont-Ferrand, INSERM 1107 NeuroDol, Clermont-Ferrand; Aix Marseille University (J.P.), APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, CEMEREM; Service de Neurologie (E.T.), CHU de Nîmes; Institut de Génomique Fonctionnelle (E.T.), Université de Montpellier, CNRS, INSERM; Service de Neurologie (O.H.), CH de Poissy; Service de Neurologie (J.-P.C.), Hôpital Nord, CHU Saint-Étienne; and Univ Rennes (E.L.), EHESP, CNRS, Inserm, ARENES UMR 6051, RSMS U 1309, France
| | - David A Laplaud
- From the Université de Lyon (F.R., S.V.), Université Claude Bernard Lyon 1; Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuroinflammation (F.R., S.V.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Observatoire Français de la Sclérose en Plaques (F.R., S.V.), Centre de Recherche en Neurosciences de Lyon, INSERM 1028 et CNRS UMR 5292; EUGENE DEVIC EDMUS Foundation Against Multiple Sclerosis (F.R., S.V.), State-Approved Foundation, Bron; Direction des Maladies non Transmissible et des Traumatismes (Z.U.), Santé Publique France, Saint-Maurice; Service de Biostatistique-Bioinformatique (Z.U., E.D., M.F., L.R.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Evolutive UMR 5558 (E.D., M.F., L.R.), Université Lyon 1 and CNRS, Villeurbanne; Service de Neurologie (M.D.), Centre Hospitalier Régional et Universitaire de Nancy, Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Neurology Department (E.L.P.), CRCSEP Rennes, Clinical Investigation Centre CIC-P 1414, Rennes University Hospital; Service de Neurologie (J.C.), CHU de Toulouse, Hôpital Pierre-Paul Riquet, CRC-SEP; Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity) (J.C.), INSERM UMR 1291, CNRS UMR 5051, Université Toulouse III; Service de Neurologie (A.R.), CRC SEP, CHU de Bordeaux; U1215 INSERM (A.R.), Neurocentre Magendie, Université de Bordeaux; Service de Neurologie et Centre d'Investigation Clinique (J.D.S.), CHU de Strasbourg, INSERM 1434; Pôle des Neurosciences et de l'Appareil Locomoteur (H.Z.), CRC-SEP, Hôpital Roger Salengro, Université de Lille, Inserm U1172; CRC SEP (P.L.), Service de Neurologie, CHU de Montpellier; Service de Neurologie (G.D.), CRC-SEP Normandie, CHU de Caen, Université Normandie; Service de Neurologie (C.L.-F.), Neurologie Pasteur 2, CHU de Nice, Université Nice Cote d'Azur UR2CA-URRIS; Service de Neurologie (T.M.), CHU de Dijon; Service de Neurologie (D.A.L.), CHU Nantes; INSERM (D.A.L.), CIC 0004, CRTI-INSERM UMR U1064, Nantes; Service de Neurologie (E.B.), CHU de Besançon; Service de Neurologie (P.C.), CHU de Clermont-Ferrand, INSERM 1107 NeuroDol, Clermont-Ferrand; Aix Marseille University (J.P.), APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, CEMEREM; Service de Neurologie (E.T.), CHU de Nîmes; Institut de Génomique Fonctionnelle (E.T.), Université de Montpellier, CNRS, INSERM; Service de Neurologie (O.H.), CH de Poissy; Service de Neurologie (J.-P.C.), Hôpital Nord, CHU Saint-Étienne; and Univ Rennes (E.L.), EHESP, CNRS, Inserm, ARENES UMR 6051, RSMS U 1309, France
| | - Eric Berger
- From the Université de Lyon (F.R., S.V.), Université Claude Bernard Lyon 1; Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuroinflammation (F.R., S.V.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Observatoire Français de la Sclérose en Plaques (F.R., S.V.), Centre de Recherche en Neurosciences de Lyon, INSERM 1028 et CNRS UMR 5292; EUGENE DEVIC EDMUS Foundation Against Multiple Sclerosis (F.R., S.V.), State-Approved Foundation, Bron; Direction des Maladies non Transmissible et des Traumatismes (Z.U.), Santé Publique France, Saint-Maurice; Service de Biostatistique-Bioinformatique (Z.U., E.D., M.F., L.R.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Evolutive UMR 5558 (E.D., M.F., L.R.), Université Lyon 1 and CNRS, Villeurbanne; Service de Neurologie (M.D.), Centre Hospitalier Régional et Universitaire de Nancy, Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Neurology Department (E.L.P.), CRCSEP Rennes, Clinical Investigation Centre CIC-P 1414, Rennes University Hospital; Service de Neurologie (J.C.), CHU de Toulouse, Hôpital Pierre-Paul Riquet, CRC-SEP; Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity) (J.C.), INSERM UMR 1291, CNRS UMR 5051, Université Toulouse III; Service de Neurologie (A.R.), CRC SEP, CHU de Bordeaux; U1215 INSERM (A.R.), Neurocentre Magendie, Université de Bordeaux; Service de Neurologie et Centre d'Investigation Clinique (J.D.S.), CHU de Strasbourg, INSERM 1434; Pôle des Neurosciences et de l'Appareil Locomoteur (H.Z.), CRC-SEP, Hôpital Roger Salengro, Université de Lille, Inserm U1172; CRC SEP (P.L.), Service de Neurologie, CHU de Montpellier; Service de Neurologie (G.D.), CRC-SEP Normandie, CHU de Caen, Université Normandie; Service de Neurologie (C.L.-F.), Neurologie Pasteur 2, CHU de Nice, Université Nice Cote d'Azur UR2CA-URRIS; Service de Neurologie (T.M.), CHU de Dijon; Service de Neurologie (D.A.L.), CHU Nantes; INSERM (D.A.L.), CIC 0004, CRTI-INSERM UMR U1064, Nantes; Service de Neurologie (E.B.), CHU de Besançon; Service de Neurologie (P.C.), CHU de Clermont-Ferrand, INSERM 1107 NeuroDol, Clermont-Ferrand; Aix Marseille University (J.P.), APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, CEMEREM; Service de Neurologie (E.T.), CHU de Nîmes; Institut de Génomique Fonctionnelle (E.T.), Université de Montpellier, CNRS, INSERM; Service de Neurologie (O.H.), CH de Poissy; Service de Neurologie (J.-P.C.), Hôpital Nord, CHU Saint-Étienne; and Univ Rennes (E.L.), EHESP, CNRS, Inserm, ARENES UMR 6051, RSMS U 1309, France
| | - Pierre Clavelou
- From the Université de Lyon (F.R., S.V.), Université Claude Bernard Lyon 1; Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuroinflammation (F.R., S.V.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Observatoire Français de la Sclérose en Plaques (F.R., S.V.), Centre de Recherche en Neurosciences de Lyon, INSERM 1028 et CNRS UMR 5292; EUGENE DEVIC EDMUS Foundation Against Multiple Sclerosis (F.R., S.V.), State-Approved Foundation, Bron; Direction des Maladies non Transmissible et des Traumatismes (Z.U.), Santé Publique France, Saint-Maurice; Service de Biostatistique-Bioinformatique (Z.U., E.D., M.F., L.R.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Evolutive UMR 5558 (E.D., M.F., L.R.), Université Lyon 1 and CNRS, Villeurbanne; Service de Neurologie (M.D.), Centre Hospitalier Régional et Universitaire de Nancy, Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Neurology Department (E.L.P.), CRCSEP Rennes, Clinical Investigation Centre CIC-P 1414, Rennes University Hospital; Service de Neurologie (J.C.), CHU de Toulouse, Hôpital Pierre-Paul Riquet, CRC-SEP; Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity) (J.C.), INSERM UMR 1291, CNRS UMR 5051, Université Toulouse III; Service de Neurologie (A.R.), CRC SEP, CHU de Bordeaux; U1215 INSERM (A.R.), Neurocentre Magendie, Université de Bordeaux; Service de Neurologie et Centre d'Investigation Clinique (J.D.S.), CHU de Strasbourg, INSERM 1434; Pôle des Neurosciences et de l'Appareil Locomoteur (H.Z.), CRC-SEP, Hôpital Roger Salengro, Université de Lille, Inserm U1172; CRC SEP (P.L.), Service de Neurologie, CHU de Montpellier; Service de Neurologie (G.D.), CRC-SEP Normandie, CHU de Caen, Université Normandie; Service de Neurologie (C.L.-F.), Neurologie Pasteur 2, CHU de Nice, Université Nice Cote d'Azur UR2CA-URRIS; Service de Neurologie (T.M.), CHU de Dijon; Service de Neurologie (D.A.L.), CHU Nantes; INSERM (D.A.L.), CIC 0004, CRTI-INSERM UMR U1064, Nantes; Service de Neurologie (E.B.), CHU de Besançon; Service de Neurologie (P.C.), CHU de Clermont-Ferrand, INSERM 1107 NeuroDol, Clermont-Ferrand; Aix Marseille University (J.P.), APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, CEMEREM; Service de Neurologie (E.T.), CHU de Nîmes; Institut de Génomique Fonctionnelle (E.T.), Université de Montpellier, CNRS, INSERM; Service de Neurologie (O.H.), CH de Poissy; Service de Neurologie (J.-P.C.), Hôpital Nord, CHU Saint-Étienne; and Univ Rennes (E.L.), EHESP, CNRS, Inserm, ARENES UMR 6051, RSMS U 1309, France
| | - Jean Pelletier
- From the Université de Lyon (F.R., S.V.), Université Claude Bernard Lyon 1; Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuroinflammation (F.R., S.V.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Observatoire Français de la Sclérose en Plaques (F.R., S.V.), Centre de Recherche en Neurosciences de Lyon, INSERM 1028 et CNRS UMR 5292; EUGENE DEVIC EDMUS Foundation Against Multiple Sclerosis (F.R., S.V.), State-Approved Foundation, Bron; Direction des Maladies non Transmissible et des Traumatismes (Z.U.), Santé Publique France, Saint-Maurice; Service de Biostatistique-Bioinformatique (Z.U., E.D., M.F., L.R.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Evolutive UMR 5558 (E.D., M.F., L.R.), Université Lyon 1 and CNRS, Villeurbanne; Service de Neurologie (M.D.), Centre Hospitalier Régional et Universitaire de Nancy, Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Neurology Department (E.L.P.), CRCSEP Rennes, Clinical Investigation Centre CIC-P 1414, Rennes University Hospital; Service de Neurologie (J.C.), CHU de Toulouse, Hôpital Pierre-Paul Riquet, CRC-SEP; Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity) (J.C.), INSERM UMR 1291, CNRS UMR 5051, Université Toulouse III; Service de Neurologie (A.R.), CRC SEP, CHU de Bordeaux; U1215 INSERM (A.R.), Neurocentre Magendie, Université de Bordeaux; Service de Neurologie et Centre d'Investigation Clinique (J.D.S.), CHU de Strasbourg, INSERM 1434; Pôle des Neurosciences et de l'Appareil Locomoteur (H.Z.), CRC-SEP, Hôpital Roger Salengro, Université de Lille, Inserm U1172; CRC SEP (P.L.), Service de Neurologie, CHU de Montpellier; Service de Neurologie (G.D.), CRC-SEP Normandie, CHU de Caen, Université Normandie; Service de Neurologie (C.L.-F.), Neurologie Pasteur 2, CHU de Nice, Université Nice Cote d'Azur UR2CA-URRIS; Service de Neurologie (T.M.), CHU de Dijon; Service de Neurologie (D.A.L.), CHU Nantes; INSERM (D.A.L.), CIC 0004, CRTI-INSERM UMR U1064, Nantes; Service de Neurologie (E.B.), CHU de Besançon; Service de Neurologie (P.C.), CHU de Clermont-Ferrand, INSERM 1107 NeuroDol, Clermont-Ferrand; Aix Marseille University (J.P.), APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, CEMEREM; Service de Neurologie (E.T.), CHU de Nîmes; Institut de Génomique Fonctionnelle (E.T.), Université de Montpellier, CNRS, INSERM; Service de Neurologie (O.H.), CH de Poissy; Service de Neurologie (J.-P.C.), Hôpital Nord, CHU Saint-Étienne; and Univ Rennes (E.L.), EHESP, CNRS, Inserm, ARENES UMR 6051, RSMS U 1309, France
| | - Eric Thouvenot
- From the Université de Lyon (F.R., S.V.), Université Claude Bernard Lyon 1; Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuroinflammation (F.R., S.V.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Observatoire Français de la Sclérose en Plaques (F.R., S.V.), Centre de Recherche en Neurosciences de Lyon, INSERM 1028 et CNRS UMR 5292; EUGENE DEVIC EDMUS Foundation Against Multiple Sclerosis (F.R., S.V.), State-Approved Foundation, Bron; Direction des Maladies non Transmissible et des Traumatismes (Z.U.), Santé Publique France, Saint-Maurice; Service de Biostatistique-Bioinformatique (Z.U., E.D., M.F., L.R.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Evolutive UMR 5558 (E.D., M.F., L.R.), Université Lyon 1 and CNRS, Villeurbanne; Service de Neurologie (M.D.), Centre Hospitalier Régional et Universitaire de Nancy, Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Neurology Department (E.L.P.), CRCSEP Rennes, Clinical Investigation Centre CIC-P 1414, Rennes University Hospital; Service de Neurologie (J.C.), CHU de Toulouse, Hôpital Pierre-Paul Riquet, CRC-SEP; Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity) (J.C.), INSERM UMR 1291, CNRS UMR 5051, Université Toulouse III; Service de Neurologie (A.R.), CRC SEP, CHU de Bordeaux; U1215 INSERM (A.R.), Neurocentre Magendie, Université de Bordeaux; Service de Neurologie et Centre d'Investigation Clinique (J.D.S.), CHU de Strasbourg, INSERM 1434; Pôle des Neurosciences et de l'Appareil Locomoteur (H.Z.), CRC-SEP, Hôpital Roger Salengro, Université de Lille, Inserm U1172; CRC SEP (P.L.), Service de Neurologie, CHU de Montpellier; Service de Neurologie (G.D.), CRC-SEP Normandie, CHU de Caen, Université Normandie; Service de Neurologie (C.L.-F.), Neurologie Pasteur 2, CHU de Nice, Université Nice Cote d'Azur UR2CA-URRIS; Service de Neurologie (T.M.), CHU de Dijon; Service de Neurologie (D.A.L.), CHU Nantes; INSERM (D.A.L.), CIC 0004, CRTI-INSERM UMR U1064, Nantes; Service de Neurologie (E.B.), CHU de Besançon; Service de Neurologie (P.C.), CHU de Clermont-Ferrand, INSERM 1107 NeuroDol, Clermont-Ferrand; Aix Marseille University (J.P.), APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, CEMEREM; Service de Neurologie (E.T.), CHU de Nîmes; Institut de Génomique Fonctionnelle (E.T.), Université de Montpellier, CNRS, INSERM; Service de Neurologie (O.H.), CH de Poissy; Service de Neurologie (J.-P.C.), Hôpital Nord, CHU Saint-Étienne; and Univ Rennes (E.L.), EHESP, CNRS, Inserm, ARENES UMR 6051, RSMS U 1309, France
| | - Olivier Heinzlef
- From the Université de Lyon (F.R., S.V.), Université Claude Bernard Lyon 1; Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuroinflammation (F.R., S.V.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Observatoire Français de la Sclérose en Plaques (F.R., S.V.), Centre de Recherche en Neurosciences de Lyon, INSERM 1028 et CNRS UMR 5292; EUGENE DEVIC EDMUS Foundation Against Multiple Sclerosis (F.R., S.V.), State-Approved Foundation, Bron; Direction des Maladies non Transmissible et des Traumatismes (Z.U.), Santé Publique France, Saint-Maurice; Service de Biostatistique-Bioinformatique (Z.U., E.D., M.F., L.R.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Evolutive UMR 5558 (E.D., M.F., L.R.), Université Lyon 1 and CNRS, Villeurbanne; Service de Neurologie (M.D.), Centre Hospitalier Régional et Universitaire de Nancy, Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Neurology Department (E.L.P.), CRCSEP Rennes, Clinical Investigation Centre CIC-P 1414, Rennes University Hospital; Service de Neurologie (J.C.), CHU de Toulouse, Hôpital Pierre-Paul Riquet, CRC-SEP; Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity) (J.C.), INSERM UMR 1291, CNRS UMR 5051, Université Toulouse III; Service de Neurologie (A.R.), CRC SEP, CHU de Bordeaux; U1215 INSERM (A.R.), Neurocentre Magendie, Université de Bordeaux; Service de Neurologie et Centre d'Investigation Clinique (J.D.S.), CHU de Strasbourg, INSERM 1434; Pôle des Neurosciences et de l'Appareil Locomoteur (H.Z.), CRC-SEP, Hôpital Roger Salengro, Université de Lille, Inserm U1172; CRC SEP (P.L.), Service de Neurologie, CHU de Montpellier; Service de Neurologie (G.D.), CRC-SEP Normandie, CHU de Caen, Université Normandie; Service de Neurologie (C.L.-F.), Neurologie Pasteur 2, CHU de Nice, Université Nice Cote d'Azur UR2CA-URRIS; Service de Neurologie (T.M.), CHU de Dijon; Service de Neurologie (D.A.L.), CHU Nantes; INSERM (D.A.L.), CIC 0004, CRTI-INSERM UMR U1064, Nantes; Service de Neurologie (E.B.), CHU de Besançon; Service de Neurologie (P.C.), CHU de Clermont-Ferrand, INSERM 1107 NeuroDol, Clermont-Ferrand; Aix Marseille University (J.P.), APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, CEMEREM; Service de Neurologie (E.T.), CHU de Nîmes; Institut de Génomique Fonctionnelle (E.T.), Université de Montpellier, CNRS, INSERM; Service de Neurologie (O.H.), CH de Poissy; Service de Neurologie (J.-P.C.), Hôpital Nord, CHU Saint-Étienne; and Univ Rennes (E.L.), EHESP, CNRS, Inserm, ARENES UMR 6051, RSMS U 1309, France
| | - Jean-Philippe Camdessanche
- From the Université de Lyon (F.R., S.V.), Université Claude Bernard Lyon 1; Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuroinflammation (F.R., S.V.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Observatoire Français de la Sclérose en Plaques (F.R., S.V.), Centre de Recherche en Neurosciences de Lyon, INSERM 1028 et CNRS UMR 5292; EUGENE DEVIC EDMUS Foundation Against Multiple Sclerosis (F.R., S.V.), State-Approved Foundation, Bron; Direction des Maladies non Transmissible et des Traumatismes (Z.U.), Santé Publique France, Saint-Maurice; Service de Biostatistique-Bioinformatique (Z.U., E.D., M.F., L.R.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Evolutive UMR 5558 (E.D., M.F., L.R.), Université Lyon 1 and CNRS, Villeurbanne; Service de Neurologie (M.D.), Centre Hospitalier Régional et Universitaire de Nancy, Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Neurology Department (E.L.P.), CRCSEP Rennes, Clinical Investigation Centre CIC-P 1414, Rennes University Hospital; Service de Neurologie (J.C.), CHU de Toulouse, Hôpital Pierre-Paul Riquet, CRC-SEP; Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity) (J.C.), INSERM UMR 1291, CNRS UMR 5051, Université Toulouse III; Service de Neurologie (A.R.), CRC SEP, CHU de Bordeaux; U1215 INSERM (A.R.), Neurocentre Magendie, Université de Bordeaux; Service de Neurologie et Centre d'Investigation Clinique (J.D.S.), CHU de Strasbourg, INSERM 1434; Pôle des Neurosciences et de l'Appareil Locomoteur (H.Z.), CRC-SEP, Hôpital Roger Salengro, Université de Lille, Inserm U1172; CRC SEP (P.L.), Service de Neurologie, CHU de Montpellier; Service de Neurologie (G.D.), CRC-SEP Normandie, CHU de Caen, Université Normandie; Service de Neurologie (C.L.-F.), Neurologie Pasteur 2, CHU de Nice, Université Nice Cote d'Azur UR2CA-URRIS; Service de Neurologie (T.M.), CHU de Dijon; Service de Neurologie (D.A.L.), CHU Nantes; INSERM (D.A.L.), CIC 0004, CRTI-INSERM UMR U1064, Nantes; Service de Neurologie (E.B.), CHU de Besançon; Service de Neurologie (P.C.), CHU de Clermont-Ferrand, INSERM 1107 NeuroDol, Clermont-Ferrand; Aix Marseille University (J.P.), APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, CEMEREM; Service de Neurologie (E.T.), CHU de Nîmes; Institut de Génomique Fonctionnelle (E.T.), Université de Montpellier, CNRS, INSERM; Service de Neurologie (O.H.), CH de Poissy; Service de Neurologie (J.-P.C.), Hôpital Nord, CHU Saint-Étienne; and Univ Rennes (E.L.), EHESP, CNRS, Inserm, ARENES UMR 6051, RSMS U 1309, France
| | - Mathieu Fauvernier
- From the Université de Lyon (F.R., S.V.), Université Claude Bernard Lyon 1; Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuroinflammation (F.R., S.V.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Observatoire Français de la Sclérose en Plaques (F.R., S.V.), Centre de Recherche en Neurosciences de Lyon, INSERM 1028 et CNRS UMR 5292; EUGENE DEVIC EDMUS Foundation Against Multiple Sclerosis (F.R., S.V.), State-Approved Foundation, Bron; Direction des Maladies non Transmissible et des Traumatismes (Z.U.), Santé Publique France, Saint-Maurice; Service de Biostatistique-Bioinformatique (Z.U., E.D., M.F., L.R.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Evolutive UMR 5558 (E.D., M.F., L.R.), Université Lyon 1 and CNRS, Villeurbanne; Service de Neurologie (M.D.), Centre Hospitalier Régional et Universitaire de Nancy, Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Neurology Department (E.L.P.), CRCSEP Rennes, Clinical Investigation Centre CIC-P 1414, Rennes University Hospital; Service de Neurologie (J.C.), CHU de Toulouse, Hôpital Pierre-Paul Riquet, CRC-SEP; Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity) (J.C.), INSERM UMR 1291, CNRS UMR 5051, Université Toulouse III; Service de Neurologie (A.R.), CRC SEP, CHU de Bordeaux; U1215 INSERM (A.R.), Neurocentre Magendie, Université de Bordeaux; Service de Neurologie et Centre d'Investigation Clinique (J.D.S.), CHU de Strasbourg, INSERM 1434; Pôle des Neurosciences et de l'Appareil Locomoteur (H.Z.), CRC-SEP, Hôpital Roger Salengro, Université de Lille, Inserm U1172; CRC SEP (P.L.), Service de Neurologie, CHU de Montpellier; Service de Neurologie (G.D.), CRC-SEP Normandie, CHU de Caen, Université Normandie; Service de Neurologie (C.L.-F.), Neurologie Pasteur 2, CHU de Nice, Université Nice Cote d'Azur UR2CA-URRIS; Service de Neurologie (T.M.), CHU de Dijon; Service de Neurologie (D.A.L.), CHU Nantes; INSERM (D.A.L.), CIC 0004, CRTI-INSERM UMR U1064, Nantes; Service de Neurologie (E.B.), CHU de Besançon; Service de Neurologie (P.C.), CHU de Clermont-Ferrand, INSERM 1107 NeuroDol, Clermont-Ferrand; Aix Marseille University (J.P.), APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, CEMEREM; Service de Neurologie (E.T.), CHU de Nîmes; Institut de Génomique Fonctionnelle (E.T.), Université de Montpellier, CNRS, INSERM; Service de Neurologie (O.H.), CH de Poissy; Service de Neurologie (J.-P.C.), Hôpital Nord, CHU Saint-Étienne; and Univ Rennes (E.L.), EHESP, CNRS, Inserm, ARENES UMR 6051, RSMS U 1309, France
| | - Laurent Remontet
- From the Université de Lyon (F.R., S.V.), Université Claude Bernard Lyon 1; Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuroinflammation (F.R., S.V.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Observatoire Français de la Sclérose en Plaques (F.R., S.V.), Centre de Recherche en Neurosciences de Lyon, INSERM 1028 et CNRS UMR 5292; EUGENE DEVIC EDMUS Foundation Against Multiple Sclerosis (F.R., S.V.), State-Approved Foundation, Bron; Direction des Maladies non Transmissible et des Traumatismes (Z.U.), Santé Publique France, Saint-Maurice; Service de Biostatistique-Bioinformatique (Z.U., E.D., M.F., L.R.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Evolutive UMR 5558 (E.D., M.F., L.R.), Université Lyon 1 and CNRS, Villeurbanne; Service de Neurologie (M.D.), Centre Hospitalier Régional et Universitaire de Nancy, Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Neurology Department (E.L.P.), CRCSEP Rennes, Clinical Investigation Centre CIC-P 1414, Rennes University Hospital; Service de Neurologie (J.C.), CHU de Toulouse, Hôpital Pierre-Paul Riquet, CRC-SEP; Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity) (J.C.), INSERM UMR 1291, CNRS UMR 5051, Université Toulouse III; Service de Neurologie (A.R.), CRC SEP, CHU de Bordeaux; U1215 INSERM (A.R.), Neurocentre Magendie, Université de Bordeaux; Service de Neurologie et Centre d'Investigation Clinique (J.D.S.), CHU de Strasbourg, INSERM 1434; Pôle des Neurosciences et de l'Appareil Locomoteur (H.Z.), CRC-SEP, Hôpital Roger Salengro, Université de Lille, Inserm U1172; CRC SEP (P.L.), Service de Neurologie, CHU de Montpellier; Service de Neurologie (G.D.), CRC-SEP Normandie, CHU de Caen, Université Normandie; Service de Neurologie (C.L.-F.), Neurologie Pasteur 2, CHU de Nice, Université Nice Cote d'Azur UR2CA-URRIS; Service de Neurologie (T.M.), CHU de Dijon; Service de Neurologie (D.A.L.), CHU Nantes; INSERM (D.A.L.), CIC 0004, CRTI-INSERM UMR U1064, Nantes; Service de Neurologie (E.B.), CHU de Besançon; Service de Neurologie (P.C.), CHU de Clermont-Ferrand, INSERM 1107 NeuroDol, Clermont-Ferrand; Aix Marseille University (J.P.), APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, CEMEREM; Service de Neurologie (E.T.), CHU de Nîmes; Institut de Génomique Fonctionnelle (E.T.), Université de Montpellier, CNRS, INSERM; Service de Neurologie (O.H.), CH de Poissy; Service de Neurologie (J.-P.C.), Hôpital Nord, CHU Saint-Étienne; and Univ Rennes (E.L.), EHESP, CNRS, Inserm, ARENES UMR 6051, RSMS U 1309, France
| | - Emmanuelle Leray
- From the Université de Lyon (F.R., S.V.), Université Claude Bernard Lyon 1; Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuroinflammation (F.R., S.V.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Observatoire Français de la Sclérose en Plaques (F.R., S.V.), Centre de Recherche en Neurosciences de Lyon, INSERM 1028 et CNRS UMR 5292; EUGENE DEVIC EDMUS Foundation Against Multiple Sclerosis (F.R., S.V.), State-Approved Foundation, Bron; Direction des Maladies non Transmissible et des Traumatismes (Z.U.), Santé Publique France, Saint-Maurice; Service de Biostatistique-Bioinformatique (Z.U., E.D., M.F., L.R.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Evolutive UMR 5558 (E.D., M.F., L.R.), Université Lyon 1 and CNRS, Villeurbanne; Service de Neurologie (M.D.), Centre Hospitalier Régional et Universitaire de Nancy, Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Neurology Department (E.L.P.), CRCSEP Rennes, Clinical Investigation Centre CIC-P 1414, Rennes University Hospital; Service de Neurologie (J.C.), CHU de Toulouse, Hôpital Pierre-Paul Riquet, CRC-SEP; Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity) (J.C.), INSERM UMR 1291, CNRS UMR 5051, Université Toulouse III; Service de Neurologie (A.R.), CRC SEP, CHU de Bordeaux; U1215 INSERM (A.R.), Neurocentre Magendie, Université de Bordeaux; Service de Neurologie et Centre d'Investigation Clinique (J.D.S.), CHU de Strasbourg, INSERM 1434; Pôle des Neurosciences et de l'Appareil Locomoteur (H.Z.), CRC-SEP, Hôpital Roger Salengro, Université de Lille, Inserm U1172; CRC SEP (P.L.), Service de Neurologie, CHU de Montpellier; Service de Neurologie (G.D.), CRC-SEP Normandie, CHU de Caen, Université Normandie; Service de Neurologie (C.L.-F.), Neurologie Pasteur 2, CHU de Nice, Université Nice Cote d'Azur UR2CA-URRIS; Service de Neurologie (T.M.), CHU de Dijon; Service de Neurologie (D.A.L.), CHU Nantes; INSERM (D.A.L.), CIC 0004, CRTI-INSERM UMR U1064, Nantes; Service de Neurologie (E.B.), CHU de Besançon; Service de Neurologie (P.C.), CHU de Clermont-Ferrand, INSERM 1107 NeuroDol, Clermont-Ferrand; Aix Marseille University (J.P.), APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, CEMEREM; Service de Neurologie (E.T.), CHU de Nîmes; Institut de Génomique Fonctionnelle (E.T.), Université de Montpellier, CNRS, INSERM; Service de Neurologie (O.H.), CH de Poissy; Service de Neurologie (J.-P.C.), Hôpital Nord, CHU Saint-Étienne; and Univ Rennes (E.L.), EHESP, CNRS, Inserm, ARENES UMR 6051, RSMS U 1309, France
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9
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Fedeli U, Barbiellini Amidei C, Avossa F, Schievano E, Kingwell E. Association of multiple-sclerosis-related mortality with COVID-19 and other common infections: a multiple causes of death analysis. Eur J Neurol 2023; 30:2870-2873. [PMID: 37306563 DOI: 10.1111/ene.15912] [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: 11/09/2022] [Revised: 05/26/2023] [Accepted: 06/05/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND PURPOSE People with multiple sclerosis (MS) suffer from higher infection-related mortality compared to the general population; however, sparse data are available on the increased risk of death associated with coronavirus disease 2019 (COVID-19) and other common types of infections. METHODS All mortality records and multiple-cause-of-death data in 2010-2021 of residents in the Veneto region (northeastern Italy) were extracted. Mention of specific infections was compared between death certificates reporting MS or not. Odds ratios (OR) with 95% confidence intervals (95% CI) were estimated by conditional logistic regression matching by age, sex and calendar year. The bimonthly averages of MS-related deaths in 2010-2019 were compared with those registered during the pandemic (2020-2021). RESULTS Of 580,015 deaths through 2010-2021, MS was mentioned in 850 cases (0.15%), 59.3% women. Influenza and pneumonia were reported in 18.4% of MS-related compared to 11.0% non-MS-related deaths (OR 2.72, 95% CI 2.28-3.25). The odds of mention of urinary tract infections was significantly greater in MS-related deaths of men (OR 8.16, 95% CI 5.23-12.7) than women (OR 3.03, 95% CI 1.82-5.02). Aspiration pneumonia, pressure ulcers/skin infections and sepsis were also significantly associated with MS-related deaths. Reporting of COVID-19 as a cause of death did not significantly differ between deaths with and without mention of MS (approximately 11% of both). However, compared to 2010-2019, peaks in MS-related deaths were observed during the pandemic waves. CONCLUSIONS Infections continue to play a significant role in MS-related deaths, underlying the need to improve prevention and management strategies.
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Affiliation(s)
- Ugo Fedeli
- Epidemiological Department, Azienda Zero, Veneto Region, Italy
| | | | | | - Elena Schievano
- Epidemiological Department, Azienda Zero, Veneto Region, Italy
| | - Elaine Kingwell
- Research Department of Primary Care and Population Health, University College London, London, UK
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10
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Baskaran AB, Grebenciucova E, Shoemaker T, Graham EL. Current Updates on the Diagnosis and Management of Multiple Sclerosis for the General Neurologist. J Clin Neurol 2023; 19:217-229. [PMID: 37151139 PMCID: PMC10169923 DOI: 10.3988/jcn.2022.0208] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 11/04/2022] [Accepted: 01/04/2023] [Indexed: 05/09/2023] Open
Abstract
Multiple sclerosis (MS) is an immune-driven disease that affects the central nervous system and is characterized by acute-on-chronic demyelination attacks. It is a major cause of global neurological disability, and its prevalence has increased in the United States. Conceptual understandings of MS have evolved over time, including the identification of B cells as key factors in its pathophysiology. The foundation of MS management involves preventing flares so as to avoid long-term functional decline. Treatments may be categorized into low-, middle-, and high-efficacy medications based on their efficacy in relapse prevention. With 24 FDA-approved treatments for MS, individual therapy is chosen based on distinct mechanisms and potential side effects. This review provides a detailed update on the epidemiology, diagnosis, treatment advances, and major ongoing research investigations in MS.
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Affiliation(s)
| | - Elena Grebenciucova
- Division of Neuroimmunology, Division of Neuroinfectious Diseases, Northwestern University, Chicago, IL, USA
| | | | - Edith L Graham
- Division of Neuroimmunology, Division of Neuroinfectious Diseases, Northwestern University, Chicago, IL, USA.
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11
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Eliasdottir O, Kjartansson Ó, Olafsson E. Mortality of multiple sclerosis in Iceland population-based mortality of MS in incidence and prevalence cohorts. Mult Scler J Exp Transl Clin 2023; 9:20552173231169467. [PMID: 37125266 PMCID: PMC10134140 DOI: 10.1177/20552173231169467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 03/23/2023] [Indexed: 05/02/2023] Open
Abstract
Introduction Mortality is an important feature of the natural history of multiple sclerosis (MS). We report the mortality of all individuals with MS in Iceland, identified in a nationwide population-based study. Patients and Methods The results are based on a prevalence cohort and an incidence cohort. The prevalence cohort consisted of all patients with MS (n = 526) living in Iceland on the 31 December 2007. The incidence cohort consisted of all residents of Iceland (n = 222) diagnosed with MS during 2002 to 2007. Mortality was determined by following both the incidence cohort (from diagnosis) and the prevalence cohort (from the prevalence day) until death or 31 December 2020. The mortality, associated with MS, was compared with that expected in the Icelandic population (standardized mortality ratio (SMR)). Results (a) Prevalence cohort (n = 526). The mean follow up was 12.0 years (range 0.3-13.0). The SMR was 1.6 (95% confidence interval (CI) 1.3-2.0). (b) Incidence cohort (n = 222). The mean follow up was 15.4 years (range 3.7-18.5). The SMR was 1.2 (95% CI 0.6-2.2). Conclusion During the follow-up period, there was a substantial increase in mortality among the patients with MS, compared with the general population. There was no increase in mortality among the incidence cohort, when followed for up to 18.5 years following diagnosis.
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Affiliation(s)
- Olöf Eliasdottir
- Olöf Eliasdottir, Department of Neurology,
Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Ólafur Kjartansson
- Department of Radiology, Landspítali-The
National University Hospital of Iceland, Reykjavik, Iceland
| | - Elias Olafsson
- Faculty of Medicine, University of Iceland,
Reykjavik, Iceland
- Department of Neurology, Landspítali-The
National University Hospital of Iceland, Reykjavik, Iceland
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12
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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: 2] [Impact Index Per Article: 2.0] [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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13
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Leadbetter R, MacAskill M, Myall DJ, Taylor BV, Joshi P, Mason DF. Multiple sclerosis mortality in New Zealand: a nationwide prospective study. J Neurol Neurosurg Psychiatry 2023:jnnp-2022-330582. [PMID: 36882223 DOI: 10.1136/jnnp-2022-330582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 02/07/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Mortality data from Europe and North America show a shorter life expectancy for people with multiple sclerosis (MS). It is not known if a similar mortality risk exists in the southern hemisphere. We analysed the mortality outcomes of a comprehensive New Zealand (NZ) MS cohort, 15 years postrecruitment. METHODS All participants of the nationwide 2006 NZ MS prevalence study were included and mortality outcomes were compared with life table data from the NZ population using classic survival analyses, standardised mortality ratios (SMRs) and excess death rates (EDRs). RESULTS Of 2909 MS participants, 844 (29%) were deceased at the end of the 15-year study period. Median survival age for the MS cohort was 79.4 years (78.5, 80.3), compared with 86.6 years (85.5, 87.7) for the age-matched and sex-matched NZ population. The overall SMR was 1.9 (1.8, 2.1)). Symptom onset between 21 and 30 years corresponded to an SMR of 2.8 and a median survival age 9.8 years lower than the NZ population. Progressive-onset disease was associated with a survival gap of 9 years compared with 5.7 years for relapsing onset. The EDR for those diagnosed in 1997-2006 was 3.2 (2.6, 3.9) compared with 7.8 (5.8, 10.3) for those diagnosed between 1967 and 1976. CONCLUSIONS New Zealanders with MS have a median survival age 7.2 years lower than the general population and twice the mortality risk. The survival gap was greater for progressive-onset disease and for those with an early age of onset.
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Affiliation(s)
- Ruth Leadbetter
- Department of Neurology, Wellington Regional Hospital, Wellington, New Zealand .,New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Michael MacAskill
- New Zealand Brain Research Institute, Christchurch, New Zealand.,Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Daniell J Myall
- New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Bruce V Taylor
- Menzies Research Institute, University of Tasmania, Hobart, Tasmania, Australia
| | - Purwa Joshi
- Department of Neurology, Wellington Regional Hospital, Wellington, New Zealand
| | | | - Deborah F Mason
- New Zealand Brain Research Institute, Christchurch, New Zealand.,Department of Medicine, University of Otago, Christchurch, New Zealand.,Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
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14
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Sokratous D, Charalambous CC, Papanicolaou EZ, Michailidou K, Konstantinou N. Investigation of in-phase bilateral exercise effects on corticospinal plasticity in relapsing remitting multiple sclerosis: A registered report single-case concurrent multiple baseline design across five subjects. PLoS One 2023; 18:e0272114. [PMID: 36862693 PMCID: PMC9980831 DOI: 10.1371/journal.pone.0272114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 01/24/2023] [Indexed: 03/03/2023] Open
Abstract
Relapsing-remitting Multiple Sclerosis is the most common demyelinating neurodegenerative disease and is characterized by periods of relapses and generation of various motor symptoms. These symptoms are associated with the corticospinal tract integrity, which is quantified by means of corticospinal plasticity which can be probed via transcranial magnetic stimulation and assessed with corticospinal excitability measures. Several factors, such as exercise and interlimb coordination, can influence corticospinal plasticity. Previous work in healthy and in chronic stroke survivors showed that the greatest improvement in corticospinal plasticity occurred during in-phase bilateral exercises of the upper limbs. During in-phase bilateral movement, both upper limbs are moving simultaneously, activating the same muscle groups and triggering the same brain region respectively. Altered corticospinal plasticity due to bilateral cortical lesions is common in MS, yet, the impact of these type of exercises in this cohort is unclear. The aim of this concurrent multiple baseline design study is to investigate the effects of in-phase bilateral exercises on corticospinal plasticity and on clinical measures using transcranial magnetic stimulation and standardized clinical assessment in five people with relapsing-remitting MS. The intervention protocol will last for 12 consecutive weeks (30-60 minutes /session x 3 sessions/week) and include in-phase bilateral movements of the upper limbs, adapted to different sports activities and to functional training. To define functional relation between the intervention and the results on corticospinal plasticity (central motor conduction time, resting motor threshold, motor evoked potential amplitude and latency) and on clinical measures (balance, gait, bilateral hand dexterity and strength, cognitive function), we will perform a visual analysis and if there is a potential sizeable effect, we will perform statistical analysis. A possible effect from our study, will introduce a proof-of-concept for this type of exercise that will be effective during disease progression. Trial registration: ClinicalTrials.gov NCT05367947.
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Affiliation(s)
- Dimitris Sokratous
- Faculty of Health Sciences, Department of Rehabilitation Sciences, Cyprus University of Technology, Limassol, Cyprus
- Physiotherapy Unit, Neurology Clinics, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
- * E-mail:
| | - Charalambos C. Charalambous
- Department of Basic and Clinical Sciences, Medical School, University of Nicosia, Nicosia, Cyprus
- Centre for Neuroscience and Integrative Brain Research (CENIBRE), University of Nicosia Medical School, Nicosia, Cyprus
| | | | - Kyriaki Michailidou
- Biostatistics Unit, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Nikos Konstantinou
- Faculty of Health Sciences, Department of Rehabilitation Sciences, Cyprus University of Technology, Limassol, Cyprus
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15
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Rodríguez-Sánchez B, Daugbjerg S, Peña-Longobardo LM, Oliva-Moreno J, Aranda-Reneo I, Cicchetti A, López-Bastida J. Does the inclusion of societal costs change the economic evaluations recommendations? A systematic review for multiple sclerosis disease. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023; 24:247-277. [PMID: 35596098 PMCID: PMC9985586 DOI: 10.1007/s10198-022-01471-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 04/19/2022] [Indexed: 05/14/2023]
Abstract
BACKGROUND Multiple sclerosis imposes a heavy burden on the person who suffers from it and on the relatives, due to the caregiving load involved. The objective was to analyse whether the inclusion of social costs in economic evaluations of multiple sclerosis-related interventions changed results and/or conclusions. METHODS A systematic review was launched using Medline and the Cost-Effectiveness Analysis Registry of Tufts University (2000-2019). Included studies should: (1) be an original study published in a scientific journal, (2) be an economic evaluation of any multiple sclerosis-related intervention, (3) include productivity losses and/or informal care costs (social costs), (4) be written in English, (5) use quality-adjusted life years as outcome, and (6) separate the results according to the perspective applied. RESULTS Twenty-nine articles were selected, resulting in 67 economic evaluation estimations. Social costs were included in 47% of the studies. Productivity losses were assessed in 90% of the estimations (the human capital approach was the most frequently used method), whereas informal care costs were included in nearly two-thirds of the estimations (applying the opportunity and the replacement-cost methods equally). The inclusion of social costs modified the figures for incremental costs in 15 estimations, leading to a change in the conclusions in 10 estimations, 6 of them changing from not recommended from the healthcare perspective to implemented from the societal perspective. The inclusion of social costs also altered the results from cost-effective to dominant in five additional estimations. CONCLUSIONS The inclusion of social costs affected the results/conclusions in multiple sclerosis-related interventions, helping to identify the most appropriate interventions for reducing its economic burden from a broader perspective.
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Affiliation(s)
- B Rodríguez-Sánchez
- Department of Applied Economics, Public Economics and Political Economy, University Complutense of Madrid, Pl. Menéndez Pelayo 4, 28040, Madrid, Spain
| | - S Daugbjerg
- Graduate School of Health Economics and Management (Alta Scuola Di Economia E Management Dei Sistemi Sanitari), Universitá Cattolica del Sacro Cuore, Rome, Italy
| | - L M Peña-Longobardo
- Economic Analysis and Finance Department, Faculty of Law and Social Sciences, University of Castilla-La Mancha, 45071, Toledo, Spain
| | - J Oliva-Moreno
- Economic Analysis and Finance Department, Faculty of Law and Social Sciences, University of Castilla-La Mancha, 45071, Toledo, Spain
| | - I Aranda-Reneo
- Economic Analysis and Finance Department, Faculty of Social Sciences, University of Castilla-La Mancha, Avda. Real Fábrica de Seda s/n, 45600, Talavera de la Reina, Toledo, Spain.
| | - A Cicchetti
- Graduate School of Health Economics and Management (Alta Scuola Di Economia E Management Dei Sistemi Sanitari), Universitá Cattolica del Sacro Cuore, Rome, Italy
| | - J López-Bastida
- Faculty of Health Sciences, Universidad Castilla-La Mancha, 45600, Talavera de la Reina, Toledo, Spain
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16
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Knapp R, Hardtstock F, Wilke T, Maywald U, Chognot C, Craveiro L, Rouzic EML. Comparing the risk of serious infections in patients with and without MS: A German claims data analysis. Mult Scler Relat Disord 2023; 72:104583. [PMID: 36905817 DOI: 10.1016/j.msard.2023.104583] [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: 12/05/2022] [Revised: 02/07/2023] [Accepted: 02/16/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Research suggests that serious infections (SIs), comorbidities, and advanced disability represent key drivers of early death in people with Multiple Sclerosis (pwMS). Nevertheless, further research is warranted to better characterize and quantify the risk of SI among pwMS compared to the general population. METHODS Our study consisted of a retrospective analysis of claims data provided by a German statutory health insurance fund, AOK PLUS, covering 3.4 million individuals in Saxony and Thuringia from 01/01/2015-31/12/2019. A propensity score (PS) matching method was used to compare the incidence of SIs among people with and without MS. PwMS were required to have ≥1 inpatient or ≥2 confirmed outpatient diagnoses of MS (ICD-10 G35) from a neurologist from 01/01/2016-31/12/2018, while people from the general population could not have any inpatient/outpatient codes for MS during the entire study period. The index date was defined as the first observed MS diagnosis or, in the case of the non-MS cohort, a randomly assigned date within the inclusion period. For both cohorts a PS was assigned, corresponding with their probabilistic likelihood of having MS based on observable factors including patient characteristics, comorbidities, medication use and other variables. People with and without MS were matched using a 1:1 nearest neighbor strategy. An exhaustive list of ICD-10 codes was created in association with 11 main SI categories. SIs were those recorded as the main diagnosis during an inpatient stay. ICD-10 codes from the 11 main categories were sorted into smaller classification units, used to distinguish between infections. A 60-day threshold for measuring new cases was defined to account for the potential risk of re-infection. Patients were observed until the end of the study period (31/12/2019) or death. Cumulative incidence, incidence rates (IRs) and IR ratios (IRRs) were reported during follow-up and at 1-, 2- and 3-years post-index. RESULTS A total of 4250 and 2,098,626 patients were included in the unmatched cohorts of people with and without MS. Ultimately, one match was identified for all 4,250 pwMS, corresponding with a final population of 8,500 patients. On average, patients were 52.0/52.2 years in the matched MS/non-MS cohorts; the gender breakdown was 72% female. Overall, IRs of SIs per 100 patient years (PY) were higher in pwMS than in those without MS (1 year: 7.6 vs. 4.3; 2 years: 7.1 vs. 3.8; 3 years: 6.9 vs. 3.9). During follow-up, the most common infection types in pwMS were of a bacterial/parasitic origin (2.3 per 100 PY), followed by respiratory (2.0) and genitourinary (1.9) infections. Respiratory infections were most common in patients without MS (1.5 per 100 PY). Differences in the IRs of SIs were statistically significant (p<0.01) at each measurement window, with IRRs ranging from 1.7-1.9. PwMS had a higher risk of hospitalized genitourinary infections (IRR: 3.3-3.8) and bacterial/parasitic infections (2.0-2.3). CONCLUSIONS The incidence of SIs is much higher in pwMS, than comparators from the general population in Germany. Differences in hospitalized infection rates were largely driven by higher levels of bacterial/parasitic and genitourinary infections in the MS population.
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Affiliation(s)
- Rachel Knapp
- Cytel Inc., Potsdamer Straße 58, 10785, Berlin, Germany.
| | | | - Thomas Wilke
- IPAM e.V., Alter Holzhafen 19, 23966, Wismar, Germany.
| | - Ulf Maywald
- AOK PLUS, Sternplatz 7, 01067, Dresden, Germany
| | - Cathy Chognot
- F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124, 4070, Basel, Switzerland
| | - Licinio Craveiro
- F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124, 4070, Basel, Switzerland
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Moghtaderi A, Shahidi-Pourakbari M, Izadi S, Khosravi A, Hashemzehi Z. Ongoing increase in incidence and prevalence of multiple sclerosis in south-eastern Iran: A three decade study. Mult Scler Relat Disord 2023; 71:104557. [PMID: 36857854 DOI: 10.1016/j.msard.2023.104557] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 01/09/2023] [Accepted: 02/09/2023] [Indexed: 02/19/2023]
Abstract
BACKGROUND Prevalence of multiple sclerosis has been increased during the last decades throughout the world. Epidemiological studies could improve our understanding relating to its intrinsic and extrinsic causes. OBJECTIVES The current study has been conducted to determine the epidemiological features of MS in south-eastern Iran which is a semi-tropical area with different ethnicities. METHODS This longitudinal descriptive study was carried out in south-eastern Iran, based on information of MS patients registered at Zahedan University of Medical Sciences database from 1990 to 2020. RESULTS A total of 1045 cases were enrolled into the study. The age-standardized prevalence ratio of MS increased to 42.2/100,000 population by 2020. These figures showed increasing trends both in females and males and reached to 61.5 and 22.6 per 100,000 population, respectively by the year 2020. Likewise, the total incidence rate grew to its maximum amount of 4.5 in 2015. Female incidence also revealed an upward trend and peaked in 2016 to 6.4 while male incidence rate reached at its highest level of 1.8 in 2009. CONCLUSION MS prevalence ratios and incidence rates in south-eastern Iran have been increasing steadily, especially in women during the last three decades. The south-eastern part of Iran should be considered a high-risk region.
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Affiliation(s)
- Ali Moghtaderi
- Department of Neurology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran.
| | | | - Shahrokh Izadi
- Department of Epidemiology and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Khosravi
- Department of Neurology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Zabihollah Hashemzehi
- Department of Neurology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
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Multiple sclerosis diagnostic delay and its associated factors in Upper Egyptian patients. Sci Rep 2023; 13:2249. [PMID: 36754987 PMCID: PMC9908930 DOI: 10.1038/s41598-023-28864-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/25/2023] [Indexed: 02/10/2023] Open
Abstract
The earlier the diagnosis of multiple sclerosis (MS), the sooner disease-modifying treatments can be initiated. However, significant delays still occur in developing countries. We aimed to identify factors leading to delayed diagnosis of MS in Upper Egypt. One hundred forty-two patients with remitting relapsing MS (RRMS) were recruited from 3 MS units in Upper Egypt. Detailed demographic and clinical data were collected. Neurological examination and assessment of the Disability Status Scale (EDSS) were performed. The mean age was 33.52 ± 8.96 years with 72.5% of patients were females. The mean time from symptom onset to diagnosis was 18.63 ± 27.87 months and the median was 3 months. Seventy-two patients (50.7%) achieved diagnosis within three months after the first presenting symptom (early diagnosis), while seventy patients (49.3%) had more than three months delay in diagnosis (delayed diagnosis). Patients with a delayed diagnosis frequently presented in the period before 2019 and had a significantly higher rate of initial non-motor presentation, initial non-neurological consultations, prior misdiagnoses, and a higher relapse rate. Another possible factor was delayed MRI acquisition following the initial presentation in sixty-six (46.5%) patients. Multivariable logistic regression analysis demonstrated that earlier presentation, initial non-neurological consultation, and prior misdiagnosis were independent predictors of diagnostic delay. Despite advances in MS management in Egypt, initial non-neurological consultation and previous misdiagnoses are significant factors responsible for delayed diagnosis in Upper Egypt.
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Misnaza-Castrillón SP, Martínez-Angarita JC, Martínez-Gómez VM. [Geographic distribution of mortality due to multiple sclerosis in Colombia, 2010-2015]. Rev Salud Publica (Bogota) 2023; 21:444-451. [PMID: 36753268 DOI: 10.15446/rsap.v21n4.76176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 05/30/2019] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To characterize the geographical distribution of extended mortality due to multiple sclerosis in Colombia between 2010 and 2015. MATERIALS AND METHODS Descriptive study to analyze the geographical distribution of mortality rates from the death certificates between 2010 and 2015. State and municipal mortality rates were calculated and adjusted by age and sex. RESULTS 56.8% of deaths occurred in women and 28.7% in people aged 50 to 59 years. In 2010, the national mortality rate was 0.28 per 100,000 people, and the highest was recorded in Casanare (0.59 per 100,000). In 2011, the rate was 0.24, and Buenaventura recorded the highest (0.51). In 2012, the rate was 0.27, and la Guajira recorded the highest (0.34). In 2013, the rate was 0.27, and the highest was in Arauca (0.83). In 2014, the rate was 0.32, and the highest was occurred in Putumayo (1.14). In 2015 the rate was 0.23 and Santa Marta recorded the highest (0.58). By municipalities, Sativanorte, Arcabuco (Boyacá), San Miguel, la Paz (Santander) and la Merced (Caldas) recorded the highest rates. CONCLUSION The pattern of mortality due to multiple sclerosis is similar in the study period. The highest burden of mortality was recorded in women and in municipalities of Santander and Boyacá.
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Affiliation(s)
- Sandra P Misnaza-Castrillón
- SM: OD. Esp. Gerencia de la Salud Pública. M. Sc. Administración en Salud. Instituto Nacional de Salud. Bogotá, Colombia.
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Wilson S, Calocer F, Rollot F, Fauvernier M, Remontet L, Tron L, Vukusic S, Le Page E, Debouverie M, Ciron J, Ruet A, De Sèze J, Zephir H, Moreau T, Lebrun-Frénay C, Laplaud DA, Clavelou P, Labauge P, Berger E, Pelletier J, Heinzlef O, Thouvenot E, Camdessanché JP, Leray E, Dejardin O, Defer G. Effects of socioeconomic status on excess mortality in patients with multiple sclerosis in France: A retrospective observational cohort study. Lancet Reg Health Eur 2023; 24:100542. [PMID: 36426377 PMCID: PMC9678948 DOI: 10.1016/j.lanepe.2022.100542] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/21/2022] [Accepted: 10/25/2022] [Indexed: 11/19/2022] Open
Abstract
Background The effects of socio-economic status on mortality in patients with multiple sclerosis is not well known. The objective was to examine mortality due to multiple sclerosis according to socio-economic status. Methods A retrospective observational cohort design was used with recruitment from 18 French multiple sclerosis expert centers participating in the Observatoire Français de la Sclérose en Plaques. All patients lived in metropolitan France and had a definite or probable diagnosis of multiple sclerosis according to either Poser or McDonald criteria with an onset of disease between 1960 and 2015. Initial phenotype was either relapsing-onset or primary progressive onset. Vital status was updated on January 1st 2016. Socio-economic status was measured by an ecological index, the European Deprivation Index and was attributed to each patient according to their home address. Excess death rates were studied according to socio-economic status using additive excess hazard models with multidimensional penalised splines. The initial hypothesis was a potential socio-economic gradient in excess mortality. Findings A total of 34,169 multiple sclerosis patients were included (88% relapsing onset (n = 30,083), 12% progressive onset (n = 4086)), female/male sex ratio 2.7 for relapsing-onset and 1.3 for progressive-onset). Mean age at disease onset was 31.6 (SD = 9.8) for relapsing-onset and 42.7 (SD = 10.8) for progressive-onset. At the end of follow-up, 1849 patients had died (4.4% for relapsing-onset (n = 1311) and 13.2% for progressive-onset (n = 538)). A socio-economic gradient was found for relapsing-onset patients; more deprived patients had a greater excess death rate. At thirty years of disease duration and a year of onset of symptoms of 1980, survival probability difference (or deprivation gap) between less deprived relapsing-onset patients (EDI = −6) and more deprived relapsing-onset patients (EDI = 12) was 16.6% (95% confidence interval (CI) [10.3%–22.9%]) for men and 12.3% (95%CI [7.6%–17.0%]) for women. No clear socio-economic mortality gradient was found in progressive-onset patients. Interpretation Socio-economic status was associated with mortality due to multiple sclerosis in relapsing-onset patients. Improvements in overall care of more socio-economically deprived patients with multiple sclerosis could help reduce these socio-economic inequalities in multiple sclerosis-related mortality. Funding This study was funded by the ARSEP foundation “Fondation pour l'aide à la recherche sur la Sclérose en Plaques” (Grant Reference Number 1122). Data collection has been supported by a grant provided by the French State and handled by the “Agence Nationale de la Recherche,” within the framework of the “Investments for the Future” programme, under the reference ANR-10-COHO-002, Observatoire Français de la Sclérose en Plaques (OFSEP).
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Affiliation(s)
- Sarah Wilson
- UNICAEN, CHU de Caen, INSERM U1086 ANTICIPE, Pôle de Recherche, Normandy University, Caen 14000, France
- Corresponding author. INSERM UMR 1086 “ANTICIPE”, University of Caen Normandy, Comprehensive Cancer Center Francois Baclesse, Avenue du General Harris, 14076 Caen Cedex 5, France.
| | - Floriane Calocer
- Department of Neurology, UNICAEN, Normandy University, MS Expert Center, CHU de Caen Normandy, Caen 14000, France
| | - Fabien Rollot
- Université de Lyon, Université Claude Bernard Lyon 1, Lyon 69000, France
- Hospices Civils de Lyon, Hôpital Neurologique, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-Inflammation, Bron 69500, France
- Observatoire Français de la Sclérose en Plaques, Centre de Recherche en Neurosciences de Lyon, INSERM 1028 et CNRS UMR 5292, Lyon 69000, France
- EUGENE DEVIC EDMUS Foundation Against Multiple Sclerosis, State-Approved Foundation, Bron, France
| | - Mathieu Fauvernier
- Service de Biostatistique–Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon 69000, France
- Université Lyon 1, CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Lyon 69000, France
| | - Laurent Remontet
- Service de Biostatistique–Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon 69000, France
- Université Lyon 1, CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Lyon 69000, France
| | - Laure Tron
- UNICAEN, CHU de Caen, INSERM U1086 ANTICIPE, Pôle de Recherche, Normandy University, Caen 14000, France
| | - Sandra Vukusic
- Université de Lyon, Université Claude Bernard Lyon 1, Lyon 69000, France
- Hospices Civils de Lyon, Hôpital Neurologique, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-Inflammation, Bron 69500, France
- Observatoire Français de la Sclérose en Plaques, Centre de Recherche en Neurosciences de Lyon, INSERM 1028 et CNRS UMR 5292, Lyon 69000, France
- EUGENE DEVIC EDMUS Foundation Against Multiple Sclerosis, State-Approved Foundation, Bron, France
| | | | - Marc Debouverie
- Department of Neurology, Nancy University Hospital, Nancy, France
- Université de Lorraine, APEMAC, Nancy F-54000, France
| | - Jonathan Ciron
- Department of Neurology, CHU de Toulouse, CRC-SEP, Toulouse Cedex 9 F-31059, France
- Université Toulouse III, Infinity, INSERM UMR1291 - CNRS UMR5051, Toulouse Cedex 3 F-31024, France
| | - Aurélie Ruet
- Univ. Bordeaux, Bordeaux F-33000, France
- INSERM U1215, Neurocentre Magendie, Bordeaux F-33000, France
- Department of Neurology, CHU de Bordeaux, CIC Bordeaux CIC1401, Bordeaux F-33000, France
| | - Jérôme De Sèze
- Department of Neurology and Clinical Investigation Center, CHU de Strasbourg, CIC 1434, INSERM 1434, Strasbourg F-67000, France
| | - Hélène Zephir
- CHU Lille, CRCSEP Lille, Univ Lille, U1172, Lille F-59000, France
| | - Thibault Moreau
- Department of Neurology, CHU de Dijon, EA4184, Dijon F-21000, France
| | - Christine Lebrun-Frénay
- Neurology, UR2CA, Centre Hospitalier Universitaire Pasteur2, Université Nice Côte d’Azur, Nice, France
| | - David-Axel Laplaud
- Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, CIC INSERM 1413, Service de Neurologie, Nantes F-44000, France
| | - Pierre Clavelou
- Department of Neurology, CHU Clermont-Ferrand, Clermont-Ferrand F-63000, France
- Université Clermont Auvergne, Inserm, Neuro-Dol, Clermont-Ferrand F-63000, France
| | - Pierre Labauge
- MS Unit, CHU de Montpellier, Montpellier Cedex 5 F-34295, France
- University of Montpellier (MUSE), Montpellier F-34000, France
| | - Eric Berger
- CHU de Besançon, Service de Neurologie 25 030, Besançon, France
| | - Jean Pelletier
- Aix Marseille Univ, APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, Marseille 13005, France
| | - Olivier Heinzlef
- Departement of Neurology, Hôpital de Poissy, Poissy F-78300, France
| | - Eric Thouvenot
- Department of Neurology, Nimes University Hospital, Nimes Cedex 9 F-30029, France
- Institut de Génomique Fonctionnelle, UMR5203, INSERM 1191, Univ. Montpellier, Montpellier Cedex 5 F-34094, France
| | | | - Emmanuelle Leray
- Univ Rennes, EHESP, CNRS, Inserm, Arènes - UMR 6051, RSMS (Recherche sur les Services et Management en Santé) - U 1309, Rennes F-35000, France
| | - Olivier Dejardin
- UNICAEN, CHU de Caen, INSERM U1086 ANTICIPE, Pôle de Recherche, Normandy University, Caen 14000, France
| | - Gilles Defer
- Department of Neurology, UNICAEN, Normandy University, MS Expert Center, CHU de Caen Normandy, Caen 14000, France
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Modulation of the Microglial Nogo-A/NgR Signaling Pathway as a Therapeutic Target for Multiple Sclerosis. Cells 2022; 11:cells11233768. [PMID: 36497029 PMCID: PMC9737582 DOI: 10.3390/cells11233768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/23/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022] Open
Abstract
Current therapeutics targeting chronic phases of multiple sclerosis (MS) are considerably limited in reversing the neural damage resulting from repeated inflammation and demyelination insults in the multi-focal lesions. This inflammation is propagated by the activation of microglia, the endogenous immune cell aiding in the central nervous system homeostasis. Activated microglia may transition into polarized phenotypes; namely, the classically activated proinflammatory phenotype (previously categorized as M1) and the alternatively activated anti-inflammatory phenotype (previously, M2). These transitional microglial phenotypes are dynamic states, existing as a continuum. Shifting microglial polarization to an anti-inflammatory status may be a potential therapeutic strategy that can be harnessed to limit neuroinflammation and further neurodegeneration in MS. Our research has observed that the obstruction of signaling by inhibitory myelin proteins such as myelin-associated inhibitory factor, Nogo-A, with its receptor (NgR), can regulate microglial cell function and activity in pre-clinical animal studies. Our review explores the microglial role and polarization in MS pathology. Additionally, the potential therapeutics of targeting Nogo-A/NgR cellular mechanisms on microglia migration, polarization and phagocytosis for neurorepair in MS and other demyelination diseases will be discussed.
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22
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Zhang X, Huai Y, Wei Z, Yang W, Xie Q, Yi L. Non-invasive brain stimulation therapy on neurological symptoms in patients with multiple sclerosis: A network meta analysis. Front Neurol 2022; 13:1007702. [PMID: 36457862 PMCID: PMC9705977 DOI: 10.3389/fneur.2022.1007702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 10/31/2022] [Indexed: 02/22/2024] Open
Abstract
OBJECTIVE The aim of the study was to evaluate non-invasive brain stimulation (NIBS) [including transcranial magnetic stimulation (TMS) and transcranial electrical stimulation (tES)] on neurological symptoms in patients with multiple sclerosis (PwMS). METHOD We searched PubMed, Embase, Cochrane Library, Web of Science and Ovid MEDLINE until February 2022. And we evaluated the included studies for methodological quality by the Cochrane bias risk assessment tool and assessed the studies' certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. We performed network meta analysis (NMA) by using Stata 15 and ranked the results of the NMA by using the surface under the cumulative ranking curve (SUCRA) ranking chart. RESULT Twenty seven clinical trials were finally included (N = 596, 66.4% women). For the immediate effects, rTMS over M1 yielded the most optimal scheme for fatigue reduction among all the interventions compared to the sham stimulation groups [MD = -0.85, 95% CI (-1.57, -0.14)] (SUCRA = 82.6%). iTBS over M1 yielded the most signifcant reduced pain level than the sham groups did [MD = -1.26, 95% CI (-2.40, -0.11)] (SUCRA = 98.4%). tDCS over F3 was the best protocol of NIBS to improve quality of life (QOL) [MD = 1.41, 95% CI = (0.45,2.36)] (SUCRA = 76.7%), and iTBS over M1 may significantly reduce spasticity compared to sham stimulation [MD = -1.20, 95% CI = (-1.99, -0.41)] (SUCRA = 90.3%). Furthermore, rTMS, tRNS, and tDCS on certain areas may improve PwMS accuracy, response time, manual dexterity, pain relief and QOL, but does not show statistically significant differences. The evidence assessed using GRADE is very low. CONCLUSION Based on the NMA and SUCRA ranking, we can conclude that symptoms including fatigue, pain, spasticity, and QOL can be improved by following NIBS protocol after treatment. Nonetheless, most of the included studies lack a good methodology, and more high-quality randomized clinical trials are needed.
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Affiliation(s)
- Xiaoyun Zhang
- Rehabilitation Department, Shenzhen Longhua District Central Hospital, Shenzhen, Guangdong, China
- Shenzhen Longhua District Rehabilitation Medical Equipment Development and Transformation Joint Key Laboratory, Shenzhen, Guangdong, China
| | - Yaping Huai
- Rehabilitation Department, Shenzhen Longhua District Central Hospital, Shenzhen, Guangdong, China
- Shenzhen Longhua District Rehabilitation Medical Equipment Development and Transformation Joint Key Laboratory, Shenzhen, Guangdong, China
| | - Zhiqiang Wei
- Neurology Department, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Weiwei Yang
- Rehabilitation Department, Shenzhen Longhua District Central Hospital, Shenzhen, Guangdong, China
| | - Qizhi Xie
- Neurology Department, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Li Yi
- Neurology Department, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
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Araújo VO, Marcelino PFS, Rabelo SR, Junior FASDL, Teixeira VGG, Eisele RR, Eisele AR, de Carvalho JPSF, Filho LBDA, de Medeiros SDP, Oliveira LF, Claudino dos Santos JC, Júnior EM. Tumefactive demyelination after covid-19 successfully treated with betainterferon 1A. Radiol Case Rep 2022; 17:4123-4127. [PMID: 36068807 PMCID: PMC9438400 DOI: 10.1016/j.radcr.2022.06.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/21/2022] [Accepted: 06/25/2022] [Indexed: 11/28/2022] Open
Abstract
The Marburg variant of MS is a rare variant that leads to a severe clinical course, with a high rate of mortality or severe residual deficits and unclear pathophysiology. A 20-year-old female patient, presented at the hospital emergency with left inferior limb paresis and visual blurring. The neurologic exam showed complete and proportionate left hemiparesis with pyramidal signs and clonus, loss of proprioception and vibration in lower limbs, tactile, and painful hypoesthesia on the left side. This report describes a rare case of Marburg variant associated with COVID-19 infection.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Julio Cesar Claudino dos Santos
- Christus University Center, Unichristus, Fortaleza, Ceará, Brazil
- Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
- Corresponding author.
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Willumsen JS, Grytten N, Aarseth J, Myklebust TÅ, Myhr KM, Midgard R. Mortality and cause of death in multiple sclerosis in western Norway 1950-2021: a registry-based linkage study. J Neurol Neurosurg Psychiatry 2022; 93:jnnp-2022-329169. [PMID: 36096665 PMCID: PMC9606487 DOI: 10.1136/jnnp-2022-329169] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 08/08/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Persons with multiple sclerosis (pwMS) have higher risk of mortality compared with the general population. Longitudinal studies are important for understanding the evolution of survival in pwMS. OBJECTIVE Examine changes in mortality among pwMS during the past seven decades. METHODS We followed pwMS from Hordaland and Møre and Romsdal in Western Norway, with disease onset from before 1950, identified from population-based epidemiological surveys and the Norwegian MS Registry and Biobank, until 1 January 2021. Data were linked to the Norwegian Cause of Death Registry to obtain underlying cause of death. We examined all-cause, and cause-specific mortality using standardised mortality ratios (SMR) and excess death rates (EDR). We calculated life expectancies and assessed survival stratified by sex, age and disease phenotype at onset. We compared hazard ratios (HRs) for mortality, in pwMS diagnosed before and after the era of disease-modifying treatment (DMT). RESULTS Of 3624 pwMS, 964 (55.5% women) had died, predominantly of multiple sclerosis (49.0%). Median life expectancy for pwMS was 74.3 years (95% CI 73.3 to 75.3), compared with 83.1 years for the general population (p<0.001). From disease onset, pwMS survived 14.6 years shorter than the general population (p<0.001). Overall, SMR was 2.3 (95% CI 2.13 to 2.42) and EDR was 6.8 (95% CI 6.42 to 7.09) for pwMS. Treatment-eligible pwMS diagnosed in the DMT era had the lowest risk of mortality, HR 0.49 (95% CI 0.34 to 0.70,p<0.001). CONCLUSION Excess mortality among pwMS declined during the past seven decades, possibly due to improved diagnostics, better symptomatic treatment and access to DMTs.
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Affiliation(s)
- Johannes Sverre Willumsen
- Department of Neurology, Møre og Romsdal Hospital Trust, Molde, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Nina Grytten
- Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland Universitetssjukehus, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Neuro-SysMed, Department of Neurology, Haukeland Universitetssjukehus, Bergen, Norway
| | - Jan Aarseth
- Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland Universitetssjukehus, Bergen, Norway
- Neuro-SysMed, Department of Neurology, Haukeland Universitetssjukehus, Bergen, Norway
- Norwegian MS Registry and Biobank, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Tor Åge Myklebust
- Department of Research and Innovation, Møre og Romsdal Hospital Trust, Ålesund, Norway
| | - Kjell-Morten Myhr
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Neuro-SysMed, Department of Neurology, Haukeland Universitetssjukehus, Bergen, Norway
| | - Rune Midgard
- Department of Neurology, Møre og Romsdal Hospital Trust, Molde, Norway
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Ng HS, Zhu F, Kingwell E, Yao S, Ekuma O, Evans C, Fisk JD, Marrie RA, Zhao Y, Tremlett H. Disease-Modifying Drugs for Multiple Sclerosis and Association With Survival. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2022; 9:9/5/e200005. [PMID: 35701187 PMCID: PMC9210547 DOI: 10.1212/nxi.0000000000200005] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/22/2022] [Indexed: 05/31/2023]
Abstract
BACKGROUND AND OBJECTIVES We examined the association between the disease-modifying drugs (DMDs) for multiple sclerosis (MS) and survival in a multiregion population-based study. METHODS We accessed multiple administrative health databases from 4 Canadian provinces. Persons with MS were identified and followed from the most recent of the first MS or demyelinating event or January 1, 1996 (index date), until death, emigration, or December 31, 2017. Association between the first-generation and second-generation DMDs and all-cause mortality was examined using stratified Cox proportional hazard models, reported as adjusted hazard ratios (aHRs). Timing of DMD initiation was explored, with findings reported at 2, 5, or 10 years postindex date, representing very early, early, or late initiation. RESULTS We identified 35,894 persons with MS; 72% were female. The mean age at index date was 44.5 years (SD = 13.6). The total person-years of follow-up while DMD-exposed was 89,180, and total person-years while unexposed was 342,217. Compared with no exposure, exposure to any DMD or to any first-generation DMD was associated with a 26% lower hazard of mortality (both aHRs 0.74; 95% CI 0.56-0.98), while any second-generation DMD exposure was associated with a 33% lower hazard (aHR 0.67; 95% CI 0.46-0.98). Earlier DMD initiation (beta-interferon or glatiramer acetate vs no exposure) was associated with a significant mortality effect (p < 0.05), while later initiation was not (95% CIs included 1). However, the survival advantage with earlier initiation diminished over time, no longer reaching statistical significance at 15 years postindex date. DISCUSSION Our study demonstrates an association between the DMDs for MS and improved survival in the real-world setting.
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Longinetti E, Bower H, McKay KA, Englund S, Burman J, Fink K, Fogdell-Hahn A, Gunnarsson M, Hillert J, Langer-Gould A, Lycke J, Nilsson P, Salzer J, Svenningsson A, Mellergård J, Olsson T, Piehl F, Frisell T. COVID-19 clinical outcomes and DMT of MS patients and population-based controls. Ann Clin Transl Neurol 2022; 9:1449-1458. [PMID: 35993445 PMCID: PMC9463950 DOI: 10.1002/acn3.51646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 07/20/2022] [Indexed: 11/10/2022] Open
Abstract
Objective To estimate risks for all‐cause mortality and for severe COVID‐19 in multiple sclerosis patients and across relapsing–remitting multiple sclerosis patients exposed to disease‐modifying therapies. Methods We conducted a Swedish nationwide population‐based multi‐register linkage cohort study and followed all multiple sclerosis patients (n = 17,692 in March 2020), individually age‐, sex‐, and region‐matched to five population‐based controls (n = 86,176 in March 2020) during March 2020–June 2021. We compared annual all‐cause mortality within and across cohorts, and assessed incidence rates and relative risks for hospitalization, intensive care admission, and death due to COVID‐19 in relation to disease‐modifying therapy use, using Cox regression. Results Absolute all‐cause mortality among multiple sclerosis patients was higher from March to December 2020 than in previous years, but relative risks versus the population‐based controls were similar to preceding years. Incidence rates of hospitalization, intensive care admission, and death due to COVID‐19 remained in line with those for all‐cause hospitalization, intensive care admission, and mortality. Among relapsing–remitting patients on rituximab, trends for differences in risk of hospitalization due to COVID‐19 remained in the demographics‐, socioeconomic status‐, comorbidity‐, and multiple sclerosis severity‐adjusted model. Interpretation Risks of severe COVID‐19‐related outcomes were increased among multiple sclerosis patients as a whole compared to population controls, but risk increases were also seen for non‐COVID‐19 hospitalization, intensive care admission, and mortality, and did not significantly differ during the pandemic compared to pre‐pandemic years. The risk conveyed by disease‐modifying therapies was smaller than previously assumed, likely as a consequence of the possibility to better control for confounders.
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Affiliation(s)
- Elisa Longinetti
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Hannah Bower
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Kyla A McKay
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Simon Englund
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Joachim Burman
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Katharina Fink
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Anna Fogdell-Hahn
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Annette Langer-Gould
- Clinical and Translational Neuroscience, Southern California Permanente Medical Group, Kaiser Permanente, Los Angeles, USA
| | - Jan Lycke
- Department of Clinical Neuroscience, University of Gothenburg, Gothenburg, Sweden
| | - Petra Nilsson
- Department of Clinical Sciences, Division of Neurology, Lund University, Lund, Sweden
| | - Jonatan Salzer
- Department of Clinical Sciences, Neurosciences, Umeå University, Umeå, Sweden
| | - Anders Svenningsson
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Johan Mellergård
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Tomas Olsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Piehl
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Frisell
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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Broche-Pérez Y, Jiménez-Morales RM, Monasterio-Ramos LO, Vázquez-Gómez LA, Fernández-Fleites Z. Fear of Relapse Scale: Spanish version and psychometric characteristics in a sample of patients with Relapsing-Remitting multiple sclerosis. Neurologia 2022:S2173-5808(22)00080-3. [PMID: 35907628 DOI: 10.1016/j.nrleng.2022.06.003] [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: 12/08/2021] [Accepted: 06/28/2022] [Indexed: 10/16/2022] Open
Abstract
INTRODUCTION Relapses are a hallmark of multiple sclerosis, being a characteristic feature of relapsing-remitting multiple sclerosis (RRMS). The occurrence of a relapse constitutes a source of significant discomfort that impacts all domains of daily life of patients with multiple sclerosis (PwMS). In this study we first explored the psychometric properties of the Spanish version of the Fear of Relapse Scale (FoR) in a sample of patients with RRMS. Besides, we explored the relationship between the Fear of Relapse Scale with fatigue and cognitive perceived deficits in our PwMS sample. METHODS An online cross-sectional survey was conducted on 173 MS patients from 12 Spanish-speaking countries (Argentina, Mexico, Uruguay, Dominican Republic, Spain, Cuba, Colombia, Guatemala, Chile, Paraguay, Peru, and El Salvador). Confirmatory factor analysis (CFA) was performed to assess the factor structure of the scale. Multiple linear regression was used to evaluate the effects of health self-perception, fatigue, and perceived cognitive deficits over fear of relapse. RESULTS The three-factor model in the CFA yielded a good model fit (χ2/df = 2.25, P < .001, RMSEA = .078, CFI = .91). McDonalds' Omega of the FoR (Spanish version) was .91. There was a statistically significant inverse correlation between FoR and health self-perception, and a positive correlation between FoR, fatigue, and perceived cognitive deficits. Finally, level of fatigue was a predictor of fear of relapse. CONCLUSIONS The Spanish version of the Fear of Relapse Scale is a valid and reliable instrument to explore the experience of fear of relapse in patients with RRMS.
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Affiliation(s)
- Y Broche-Pérez
- Psychology Department, Universidad Central "Marta Abreu" de Las Villas, Santa Clara, Cuba; CognitiON (Cuban Inicative on Cognitive Health), Santa Clara, Cuba.
| | | | | | - L A Vázquez-Gómez
- Department of Neurology, Hospital Provincial Universitario Arnaldo Milián Castro, Santa Clara, Cuba
| | - Z Fernández-Fleites
- Psychology Department, Universidad Central "Marta Abreu" de Las Villas, Santa Clara, Cuba; CognitiON (Cuban Inicative on Cognitive Health), Santa Clara, Cuba
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Titcomb TJ, Bao W, Du Y, Liu B, Snetselaar LG, Wahls TL. Association of multiple sclerosis with risk of mortality among a nationally representative sample of adults in the United States. Mult Scler J Exp Transl Clin 2022; 8:20552173221104009. [PMID: 35665135 PMCID: PMC9158421 DOI: 10.1177/20552173221104009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/12/2022] [Indexed: 11/16/2022] Open
Abstract
Background Multiple sclerosis (MS) has been associated with increased mortality ratios, but few studies have investigated the independent association of MS with mortality. Objective To examine the prospective association of MS with risk of mortality in a nationally representative sample of U.S. adults. Methods This prospective study included 23,053 adults aged 45–79 years who participated in the National Health Interview Survey in 2002 and 2008. Physician-diagnosed MS was reported by participants during household interviews. These participants were linked to death records from survey date through December 31, 2015. Results Among the 23,053 participants included in this study, 120 reported a physician’s diagnosis of MS, with a higher prevalence in females (0.85%) than in males (0.31%). During on average 9.4 years (maximum 13.8 years) of observation, 4208 deaths occurred. After adjustment for age, sex, race/ethnicity, socioeconomic factors, lifestyle factors, and BMI, participants with MS had an 80% higher risk of mortality (HR 1.80; 95% CI, 1.11–2.92), compared with those without MS. The association remained significant (HR 1.75; 95% CI, 1.07–2.87) after further adjustment for baseline diabetes, cardiovascular disease, chronic lung disease, and cancer. Conclusion In this nationally representative sample of U.S. adults, MS was associated with an increased risk of mortality.
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Affiliation(s)
- Tyler J. Titcomb
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Wei Bao
- Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Yang Du
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Buyun Liu
- Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Linda G. Snetselaar
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Terry L. Wahls
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
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Siyah Mansoory M, Chehreh A, Khoshgard K, Rashidi I, Ebrahiminia A. Effective Connectivity within the Papez Circuit in the Multiple Sclerosis Patients: A Comparative Study Using Resting-State fMRI. J Biomed Phys Eng 2022; 12:149-160. [PMID: 35433517 PMCID: PMC8995756 DOI: 10.31661/jbpe.v0i0.2003-1090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 05/06/2020] [Indexed: 06/14/2023]
Abstract
Background Multiple sclerosis (MS) disease causes structural and functional damage to brain. Structural imaging of the MS-induced damage cannot adequately describe the functional impairment of the brain in MS patients. Therefore, it seems that advanced functional imaging analysis such as functional magnetic resonance imaging (fMRI) data is needed for better management of this disease. Objective The aim of present study was to evaluate the effective connectivity within the Papez circuit in MS patients using resting-state fMRI. Material and Methods In this cross-sectional analytical study, 22 healthy individuals and 24 patients with MS underwent resting-state fMRI. After pre-processing of the obtained data, the time series of Cingulate gyrus (CG), Para hippocampus gyrus (PHG), anterior thalamic nuclei (ATN), Mammillary body (MB), and Hippocampus (HPC) were extracted as the main Papez circuit components. The obtained time series were statistically analyzed as an input of the dynamic causal model in order to evaluate the effective connectivity in the Papez circuit. Results The power of effective connectivity between each pair of tested nodes in Papez circuit was significantly lower in MS patients than healthy subjects. Also, the effective connectivity level of MS patients in direction of HPC→ATN was higher in men than women. In addition, effective self-connection in CG→CG and MB→MB regions in healthy subjects were higher in women than them in men. Conclusion The present study reveals significant difference in effective connectivity of the Papez nodes in MS patients than control group, which can be exploited to diagnosis and predict or evaluate the treatment response of these patients.
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Affiliation(s)
- Meysam Siyah Mansoory
- PhD, Department of Biomedical Engineering, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ava Chehreh
- MSc Student, Student Research Committee, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Karim Khoshgard
- PhD, Department of Medical Physics, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Iraj Rashidi
- PhD, Department of Anatomy, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ali Ebrahiminia
- PhD, Department of Biochemistry & Biophysics, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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Ostolaza Ibáñez A, Corroza Laviñeta J, Ayuso Blanco T. Immunosenescence: the role of age in multiple sclerosis. NEUROLOGÍA (ENGLISH EDITION) 2022; 38:284-290. [PMID: 35260362 DOI: 10.1016/j.nrleng.2020.05.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/11/2020] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION The number of elderly people with multiple sclerosis (MS) has increased in line with population ageing. As the immune system presents profound changes over an individual's lifetime, it is important to understand the differences between these patients and younger patients. DEVELOPMENT Immunosenescence, defined as age-related alterations naturally occurring in the immune system, particularly influences tolerance, response, and adverse effects of disease-modifying treatments for MS. Thymic involution is the most noteworthy characteristic of this phenomenon. This process leads to a reduction in the number of virgin T cells. Other effects include an inverted CD4+/CD8+ cell ratio, severe alterations in NK cell functioning, and reduced tissue repair capacity in the brain. CONCLUSIONS The number of older people with MS is increasing due to population ageing, advances in disease-modifying treatments, and improved health and social care of these patients. Ageing of the immune system increases the risk of infections, tumours, and autoimmune diseases in elderly individuals. Furthermore, neurodegeneration is accelerated in patients with MS due to the nervous system's loss of remyelination capacity. Understanding of the changes affecting the immune system in the elderly population is essential to improving the care provided to this ever-growing patient group.
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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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Determinants of COVID-19-related lethality in multiple sclerosis: a meta-regression of observational studies. J Neurol 2022; 269:2275-2285. [PMID: 34984514 PMCID: PMC8726522 DOI: 10.1007/s00415-021-10951-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 12/18/2022]
Abstract
Objective To identify risk factors for an increased lethality of COVID-19 in patients with multiple sclerosis (MS). Methods We searched scientific databases to identify cohort studies with the number of deaths in patients with MS. We fitted inverse-variance weighted meta-regressions with random-effects models to identify potential moderators (determinants) of COVID-19-related lethality (outcome). Results After an independent screening, 18 articles satisfied the eligibility criteria; all data were collected before anti-SARS-COV-2 vaccination was available. Out of 5,634 patients, 111 died, yielding a pooled death rate of 1.97% (95% confidence intervals 1.61–2.33). There was a substantial heterogeneity between the included studies (Q17 = 66.9, p < 0.001; I2 = 77.5%), but no relevant publication bias (p = 0.085). Higher lethality was observed in studies including older patients (β = 0.80, p = 0.025) and in studies with higher proportions of patients with comorbidity (β = 0.17, p = 0.046), progressive disease course (β = 0.15, p = 0.027), and current treatment with anti-CD20 agents (β = 0.18, p < 0.001). Otherwise, higher proportions of patients treated with interferon beta (β = – 0.16, p < 0.001) and teriflunomide (β = – 0.11, p = 0.035) were associated with lower lethality. These estimates did not change even in both multivariable meta-regressions including adjustment variables and leave-one-out sensitivity analyses. Conclusion Except for age and comorbidities, risk factors in common with the general population, we identified MS-specific determinants influencing the lethality of COVID-19. Our findings suggest the implementation of a risk mitigation plan for patients with progressive MS and for those treated with anti-CD20 agents. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-021-10951-6.
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Myelin imaging measures as predictors of cognitive impairment in MS patients: A hybrid PET-MRI study. Mult Scler Relat Disord 2022; 57:103331. [PMID: 35158445 DOI: 10.1016/j.msard.2021.103331] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/01/2021] [Accepted: 10/11/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Cognitive impairment is one of the concerns of Multiple Sclerosis (MS) and has been related to myelin loss. Different neuroimaging methods have been used to quantify myelin and relate it to cognitive dysfunctions, among them Magnetization Transfer Ratio (MTR), Diffusion Tensor Imaging (DTI), and, more recently, Positron Emission Tomography (PET) with 11C-PIB. OBJECTIVE To investigate different myelin imaging modalities as predictors of cognitive dysfunction. METHODS Fifty-one MS patients and 24 healthy controls underwent clinical and neuropsychological assessment and MTR, DTI (Axial Diffusion-AD and Fractional Anisotropy-FA maps), and 11C-PIB PET images in a PET/MR hybrid system. RESULTS MTR and DTI(FA) differed in patients with or without cognitive impairment. There was an association of DTI(FA) and DTI(AD) with cognition and psychomotor speed for progressive MS, and of 11C-PIB uptake and MTR for relapsing-remitting MS. MTR in the Thalamus (β= -0.51, p = 0.021) and Corpus Callosum (β= -0.24, p = 0.033) were predictive of cognitive impairment. DTI-FA in the Caudate (β= -26.93, p = 0.006) presented abnormal predictive result. CONCLUSION Lower myelin content by 11C-PIB uptake was associated with worse cognitive status. MTR was predictive of cognitive impairment in MS.
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Cavaco S, Ferreira I, Moreira I, Santos E, Samões R, Sousa AP, Pinheiro J, Teixeira-Pinto A, Martins da Silva A. Cognitive dysfunction and mortality in multiple sclerosis: Long-term retrospective review. Mult Scler 2021; 28:1382-1391. [PMID: 34965761 DOI: 10.1177/13524585211066598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cognitive dysfunction as a predictor of clinical progression and mortality in multiple sclerosis (MS) is still a matter of debate. OBJECTIVE The aim of this study was to explore the long-term outcome associated with neuropsychological performance in a cohort of patients with MS. METHODS A series of 408 MS patients had previously undergone a comprehensive neuropsychological assessment and a contemporaneous neurological evaluation (T1). A retrospective review of the clinical records was conducted 102-192 months after T1. Demographic and clinical data regarding the last clinical appointment with EDSS measurement (T2) were collected and the date of the last clinical contact or death (TS) was recorded. RESULTS This review revealed that cognitive dysfunction (T1) was associated with higher odds of transitioning from relapsing-remitting course to a progressive disease course (adjusted odds ratio (OR) = 2.29, p = 0.043) and higher hazard of death in the total sample (adjusted hazard ratio (HR) = 3.07, p = 0.006) and the progressive disease course subgroup (adjusted HR = 3.68, p = 0.007), even when adjusting for other covariates. DISCUSSION The study results demonstrate that cognitive dysfunction in MS is predictive of poorer prognosis and mortality.
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Affiliation(s)
- Sara Cavaco
- Neurology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal/Neuropsychology Unit, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Inês Ferreira
- Neurology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal/Neuropsychology Unit, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Inês Moreira
- Neurology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal/Neuropsychology Unit, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Ernestina Santos
- Neurology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Raquel Samões
- Neurology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Ana Paula Sousa
- Neurophysiology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Joaquim Pinheiro
- Neurology Department, Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, Portugal
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Głąbska D, Kołota A, Lachowicz K, Skolmowska D, Stachoń M, Guzek D. Vitamin D Supplementation and Mental Health in Multiple Sclerosis Patients: A Systematic Review. Nutrients 2021; 13:nu13124207. [PMID: 34959758 PMCID: PMC8705844 DOI: 10.3390/nu13124207] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 11/20/2021] [Accepted: 11/22/2021] [Indexed: 12/19/2022] Open
Abstract
Vitamin D has a promising role in multiple sclerosis (MS) management, and it has been found to be beneficial for patients' mental health, which is reduced in MS patients. The aim of the present study was to conduct a systematic review of the literature to assess the influence of vitamin D supplementation on mental health in MS patients. The systematic review was registered in the PROSPERO database (CRD42020155779) and it was conducted on the basis of the PRISMA guidelines. The search procedure was conducted using PubMed and Web of Science databases and it included studies published up until September 2021. Six studies were included in the systematic review. The risk of bias was analyzed using the Newcastle-Ottawa Scale (NOS). Within the included studies, there were two studies randomized against placebo and four other prospective studies. The studies presented vitamin D interventions randomized against placebo or not randomized, while supplementation was applied for various durations-from 4 weeks to 12 months, or the studies compared patients who applied vitamin D supplementation and those who did not apply it and verified the effect of the supplementation after a number of years. The mental health outcomes that were assessed included quality of life, depression/depressive symptoms, and fatigue as an additional element. The majority of studies supported the positive influence of vitamin D on the mental health of MS patients, including the study characterized as having the highest quality (randomized against placebo with the highest NOS score). All the studies that assessed the quality of life indicated the positive influence of vitamin D while the studies that did not find a positive influence of vitamin D were conducted for depression/depressive symptoms. In spite of the fact that only a small number of studies have been conducted so far, and only two studies were randomized against a placebo, some conclusions may be formulated. The systematic review allowed us to conclude that there may be a positive effect of vitamin D supplementation in MS patients, which was stated in all of the studies analyzing quality of life, as well as in one study analyzing depressive symptoms. Considering that vitamin D deficiency is common in MS patients, and the potential positive influence of supplementation on the quality of life, supplementation should be applied at least in doses that cover the recommended intake.
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Affiliation(s)
- Dominika Głąbska
- Department of Dietetics, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (WULS-SGGW), 159C Nowoursynowska Street, 02-776 Warsaw, Poland; (A.K.); (K.L.); (D.S.); (M.S.)
- Correspondence: ; Tel.: +48-22-593-71-26
| | - Aleksandra Kołota
- Department of Dietetics, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (WULS-SGGW), 159C Nowoursynowska Street, 02-776 Warsaw, Poland; (A.K.); (K.L.); (D.S.); (M.S.)
| | - Katarzyna Lachowicz
- Department of Dietetics, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (WULS-SGGW), 159C Nowoursynowska Street, 02-776 Warsaw, Poland; (A.K.); (K.L.); (D.S.); (M.S.)
| | - Dominika Skolmowska
- Department of Dietetics, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (WULS-SGGW), 159C Nowoursynowska Street, 02-776 Warsaw, Poland; (A.K.); (K.L.); (D.S.); (M.S.)
| | - Małgorzata Stachoń
- Department of Dietetics, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (WULS-SGGW), 159C Nowoursynowska Street, 02-776 Warsaw, Poland; (A.K.); (K.L.); (D.S.); (M.S.)
| | - Dominika Guzek
- Department of Food Market and Consumer Research, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (WULS-SGGW), 159C Nowoursynowska Street, 02-776 Warsaw, Poland;
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Deng R, Wu Y, Xu L, Liu K, Huang X, Zhang X. Clinical risk factors and prognostic model for idiopathic inflammatory demyelinating diseases after haploidentical hematopoietic stem cell transplantation in patients with hematological malignancies. Am J Hematol 2021; 96:1407-1419. [PMID: 34350623 DOI: 10.1002/ajh.26312] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/16/2021] [Accepted: 08/02/2021] [Indexed: 01/09/2023]
Abstract
Idiopathic inflammatory demyelinating diseases (IIDDs) of the central nervous system (CNS) are rare but serious neurological complications of haploidentical hematopoietic stem cell transplantation (haplo-HSCT). However, the risk factors and a method to predict the prognosis of post-transplantation CNS IIDDs are not available. This retrospective study first reviewed data from 4532 patients who received haplo-HSCT during 2008-2019 in our center, and 184 patients (4.1%) with IIDDs after haplo-HSCT were identified. Grades II to IV acute graft-versus-host disease (aGVHD) (p < 0.001) and chronic GVHD (cGVHD) (p = 0.009) were identified as risk factors for developing IIDDs after haplo-HSCT. We then divided the 184 IIDD patients into a derivation cohort and validation cohort due to transplantation time to develop and validate a model for predicting the prognosis of IIDDs. In the multivariate analysis of the derivation cohort, four candidate predictors were entered into the final prognostic model: cytomegalovirus (CMV) infection, Epstein-Barr virus (EBV) infection, IgG synthesis (IgG-syn) and spinal cord lesions. The prognostic model had an area under the receiver operating characteristic curve of 0.864 (95% CI: 0.803-0.925) in the internal validation cohort and 0.871 (95% CI: 0.806-0.931) in the external validation cohort. The calibration plots showed a high agreement between the predicted and observed outcomes. Decision curve analysis indicated that IIDD patients could benefit from the clinical application of the prognostic model. The identification of IIDD patients after allo-HSCT who have a poor prognosis might allow timely treatment and improve patient survival and outcomes.
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Affiliation(s)
- Rui‐Xin Deng
- Peking University People's Hospital Peking University Institute of Hematology Beijing China
- Collaborative Innovation Center of Hematology Peking University Beijing China
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation Beijing China
- National Clinical Research Center for Hematologic Disease Beijing China
| | - Ye‐Jun Wu
- Peking University People's Hospital Peking University Institute of Hematology Beijing China
- Collaborative Innovation Center of Hematology Peking University Beijing China
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation Beijing China
- National Clinical Research Center for Hematologic Disease Beijing China
| | - Lan‐Ping Xu
- Peking University People's Hospital Peking University Institute of Hematology Beijing China
- Collaborative Innovation Center of Hematology Peking University Beijing China
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation Beijing China
- National Clinical Research Center for Hematologic Disease Beijing China
| | - Kai‐Yan Liu
- Peking University People's Hospital Peking University Institute of Hematology Beijing China
- Collaborative Innovation Center of Hematology Peking University Beijing China
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation Beijing China
- National Clinical Research Center for Hematologic Disease Beijing China
| | - Xiao‐Jun Huang
- Peking University People's Hospital Peking University Institute of Hematology Beijing China
- Collaborative Innovation Center of Hematology Peking University Beijing China
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation Beijing China
- National Clinical Research Center for Hematologic Disease Beijing China
| | - Xiao‐Hui Zhang
- Peking University People's Hospital Peking University Institute of Hematology Beijing China
- Collaborative Innovation Center of Hematology Peking University Beijing China
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation Beijing China
- National Clinical Research Center for Hematologic Disease Beijing China
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Dadsetan F, Shahrbabaki PM, Mirzai M, Nouhi E. Palliative care needs of patients with multiple sclerosis in southeast Iran. BMC Palliat Care 2021; 20:169. [PMID: 34706707 PMCID: PMC8554857 DOI: 10.1186/s12904-021-00867-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 10/19/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Due to the chronic nature of multiple sclerosis, palliative care can play a significant role in improving the quality of life and well-being of the affected patients. An essential step for developing appropriate palliative care for these patients is to determine the types of palliative care necessary, from different points of view. Therefore, this study was conducted to compare the palliative care needs from the nurses' and patients' points of view in southeast Iran in 2017. METHOD This descriptive-analytical cross-sectional study was conducted on 154 nurses working in neurology wards of teaching hospitals associated with Kerman University of Medical Sciences and 132 patients with multiple sclerosis who were referred to these hospitals in southeast Iran. The data were collected using a questionnaire for assessing the palliative care needs of patients with multiple sclerosis. Pearson correlation coefficient, independent t-test, ANOVA, chi-square, and the Mann-Whitney and Kruskal-Wallis tests were used to examine the data. RESULTS Both nurses and patients mentioned the palliative needs of patients with multiple sclerosis in terms of physical, social, spiritual, psychological, and economic dimensions, respectively, but the results showed that there was a significant difference between the two groups in all dimensions of palliative needs (P < 0.0001). CONCLUSION Given the differences in how patients and nurses prioritize palliative care needs, it is essential to consider the different dimensions of palliative needs of patients with multiple sclerosis.
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Affiliation(s)
- Fatemeh Dadsetan
- M.s Medical Surgical Nursing, Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Parvin Mangolian Shahrbabaki
- Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran.,Razi Faculty of Nursing and Midwifery, Department of Critical Care Nursing, Kerman University of Medical Sciences, Kerman, Iran
| | - Moghadameh Mirzai
- Health Modeling Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Esmat Nouhi
- Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran. .,Razi Faculty of Nursing and Midwifery, Department of Medical Surgical Nursing, Kerman University of Medical Sciences, Kerman, Iran.
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Prosperini L, Tortorella C, Haggiag S, Ruggieri S, Galgani S, Gasperini C. Increased risk of death from COVID-19 in multiple sclerosis: a pooled analysis of observational studies. J Neurol 2021; 269:1114-1120. [PMID: 34533590 PMCID: PMC8446478 DOI: 10.1007/s00415-021-10803-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 12/04/2022]
Abstract
Objective To estimate whether the risk of death from COVID-19 in patients with multiple sclerosis (MS) exceeds that of the general population. Methods We conducted a pooled analysis of cohort studies on COVID-19 in patients with MS published until July 31, 2021. We calculated the pooled crude death rate (CDR) and estimated the indirectly-adjusted age-standardized lethality ratio (SLR) to assess the risk of death from COVID-19 in patients with MS as compared to general population. Results Out of 520 articles, 18 fulfilled criteria for pooled analysis, with a total of 5634 patients (28.6% males, mean age 41.8 years). Of them, 111 died, yielding a CDR of 1.97% (95% confidence intervals [CIs] 1.61–2.33). The estimated SLR was 1.24 (95% CIs 1.01–1.48) after indirect age-standardization using case-fatality rates obtained from the detailed surveillance data available at the World Health Organization (WHO) website. A leave-one-out sensitivity analysis and the analysis of temporal trends of SLR from March 2020 to July 2021 provided consistent findings. Conclusions Our pooled analysis suggests a 24%-increased risk of death from COVID-19 in patients with MS. These findings must be interpreted with caution, mainly because of the difficulties in COVID-19 case detection (especially in the first pandemic wave) and heterogeneity of the analyzed cohorts. Confirmation in larger population-based studies is warranted.
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Affiliation(s)
- Luca Prosperini
- Department of Neurology, S. Camillo-Forlanini Hospital, C.ne Gianicolense 87, 00152, Rome, Italy.
| | - Carla Tortorella
- Department of Neurology, S. Camillo-Forlanini Hospital, C.ne Gianicolense 87, 00152, Rome, Italy
| | - Shalom Haggiag
- Department of Neurology, S. Camillo-Forlanini Hospital, C.ne Gianicolense 87, 00152, Rome, Italy
| | - Serena Ruggieri
- Department of Human Neurosciences, Sapienza University, Viale dell'Università 30, 00185, Rome, Italy.,Neuroimmunology Unit, Santa Lucia Foundation, Via del Fosso di Fiorano 64/65, 00143, Rome, Italy
| | - Simonetta Galgani
- Department of Neurology, S. Camillo-Forlanini Hospital, C.ne Gianicolense 87, 00152, Rome, Italy
| | - Claudio Gasperini
- Department of Neurology, S. Camillo-Forlanini Hospital, C.ne Gianicolense 87, 00152, Rome, Italy
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Patti F, Penaherrera JN, Zieger L, Wicklein EM. Clinical characteristics of middle-aged and older patients with MS treated with interferon beta-1b: post-hoc analysis of a 2-year, prospective, international, observational study. BMC Neurol 2021; 21:324. [PMID: 34425763 PMCID: PMC8381478 DOI: 10.1186/s12883-021-02347-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/28/2021] [Indexed: 12/18/2022] Open
Abstract
Background Despite trends towards the increased age of patients living with multiple sclerosis (MS), little is known about the response of older adults with MS to disease-modifying therapies (DMTs). Thus, a post-hoc analysis was undertaken using data from a 2-year, international, non-interventional, prospective cohort study (NCT00787657; BEACON: BEtaferon prospective study on Adherence, COping and Nurse support) of patients above the age of 40 years with MS and starting interferon beta-1b (IFNB-1b) treatment within 6 months before study entry. Methods Middle-aged and older patients with MS were divided into two sub-groups: 41–50 years and > 50 years. Treatment with IFNB-1b started within 6 months before study entry. Patients were followed-up for a 2-year observation period. Assessments included disease history and course, annualised relapse rate (ARR), Expanded Disability Scale Score (EDSS), treatment adherence, Hospital Anxiety and Depression Scale (HADS), and adverse events (AE). Results At baseline, the intention-to-treat (ITT) population (n = 481) aged 41–50 years (n = 327) and > 50 years (n = 154), had mean (standard deviation [SD]) ages of 45.1 (2.8) and 56.2 (4.2) years, maximum age of 72 years, and duration of MS since onset of symptoms of 3.9 (5.2) and 5.9 (7.1) years, respectively. At baseline, the proportion of patients with relapsing–remitting MS (RRMS) was 96.3 and 94.9 %, and secondary progressive MS (SPMS) was 3.7 and 5.1 %, in the 41–50 and > 50 years sub-groups, respectively. The ARR in the 2 years before study start was 0.93 (0.48) and 0.86 (0.54) for the 41–50 and > 50 years groups, respectively, and decreased since study start to 0.20 (1.09) and 0.07 (0.37), respectively. The percentage of patients with anxiety and depression, as measured by HADS, were stable over the study period. Polypharmacy (five or more medications) was seen in 32.3 and 41.2 % of patients aged 41–50 and > 50 years. No unexpected AEs were reported. Conclusions This study provides observational data on patients between 40 and 72 years of age, suggesting that IFNB-1b can be an effective and well-tolerated treatment option in MS patients of advanced age. Trial registration ClinicalTrials.gov, NCT00787657.
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Affiliation(s)
- Francesco Patti
- Department of Medical and Surgical and Advanced Technologies, GF Ingrassia, Neuroscience Section, University of Catania, Catania, Italy.
| | | | - Lorissa Zieger
- Parexel Inc (at the time of this analysis), Berlin, Germany.,Current address: Freelance Biostatistician, Berlin, Germany
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40
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De Panfilis L, Veronese S, Bruzzone M, Cascioli M, Gajofatto A, Grasso MG, Kruger P, Lugaresi A, Manson L, Montepietra S, Patti F, Pucci E, Solaro C, Giordano A, Solari A. Study protocol on advance care planning in multiple sclerosis (ConCure-SM): intervention construction and multicentre feasibility trial. BMJ Open 2021; 11:e052012. [PMID: 34389580 PMCID: PMC8365819 DOI: 10.1136/bmjopen-2021-052012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 08/02/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Multiple sclerosis (MS) is the most common cause of progressive neurological disability in young adults. The use of advance care planning (ACP) for people with progressive MS (pwPMS) remains limited. The ConCure-SM project aims to assess the effectiveness of a structured ACP intervention for pwPMS. The intervention consists of a training programme on ACP for healthcare professionals caring for pwPMS, and a booklet to be used during the ACP conversation. Herein, we describe the first two project phases. METHODS In phase 1 we translated and adapted, to the Italian legislation and MS context, the ACP booklet of the National ACP Programme for New Zealand. Acceptability, comprehensibility and usefulness of the booklet were assessed via 13 personal cognitive interviews with pwPMS and significant others (SOs), and one health professional focus group. Based on these findings, we will revise the booklet. In phase 2 we will conduct a single-arm pilot/feasibility trial with nested qualitative study. Participants will be 40 pwPMS, their SOs, health professionals from six MS and rehabilitation centres in Italy. In the 6 months following the ACP conversation, we will assess completion of an advance care plan document (primary outcome), as well as safety of the intervention. Secondary outcomes will be a range of measures to capture the full process of ACP; patient-carer congruence in treatment preferences; quality of patient-clinician communication and caregiver burden. A qualitative process evaluation will help understand the factors likely to influence future implementation and scalability of the intervention. ETHICS AND DISSEMINATION The project is coleaded by a neurologist and a bioethicist. Phase 1 has received ethical approvals from each participating centre, while phase 2 will be submitted to the centres in May 2021. Findings from both phases will be disseminated widely through peer-reviewed publications, conferences and workshops. TRIAL REGISTRATION NUMBER ISRCTN48527663; Pre-results.
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Affiliation(s)
| | | | | | - Marta Cascioli
- Hospice "La Torre sul Colle", USL Umbria 2, Spoleto (PG), Italy
| | - Alberto Gajofatto
- Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
- Unit of Neurology, Borgo Roma Hospital, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | | | - Paola Kruger
- EUPATI Fellow (European Patients Academy for Therapeutic Innovation) Italy, Roma, Italy
| | - Alessandra Lugaresi
- UOSI Riabilitazione Sclerosi Multipla, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Leigh Manson
- New Zealand Health Quality and Safety Commission, Nelson, New Zealand
| | - Sara Montepietra
- Multiple Sclerosis Center, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesco Patti
- Multiple Sclerosis Center, University Hospital Policlinico Vittorio Emanuele, Catania, Italy
| | | | - Claudio Solaro
- Department of Rehabilitation, M.L. Novarese Hospital, Moncrivello (VC), Italy
| | - Andrea Giordano
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Alessandra Solari
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
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Ye F, Wu X, Wang T, Liang J, Li J, Dai Y, Lan K, Sheng W. Identification of immune-associated gene signature and immune cell infiltration related to overall survival in progressive multiple sclerosis. Mult Scler Relat Disord 2021; 55:103188. [PMID: 34371273 DOI: 10.1016/j.msard.2021.103188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/25/2021] [Accepted: 08/01/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Delayed diagnosis and noneffective treatment contribute to the shorter life expectancy in patients with progressive multiple sclerosis (PMS). Studies demonstrate the key role of autoimmunity in PMS, but the prognostic value of immune-associated factors remains unknown. Thus, this study aimed to develop an immune-associated gene (IAG) signature related to overall survival (OS) and conduct an immune cell infiltration analysis using PMS data. METHODS The differentially expressed IAGs were identified based on gene expression profiles (from the Gene Expression Omnibus database) and IAGs (from the ImmPort database). Univariate and least absolute shrinkage and selection operator (LASSO)-penalized Cox regression analyses were used to develop the IAG signature related to OS. Kaplan-Meier analyses were conducted, and receiver operating characteristic (ROC) curves were generated to assess the performance. Additionally, the differential distribution of immune cells was identified by Wilcoxon rank-sum tests and correlations with IAGs were analyzed using Spearman correlation analyses. Moreover, univariate and multivariate Cox regression analyses were used to identify the independent prognostic factors to develop a prognostic nomogram. RESULTS The training group, consisting of 57 PMS lesions and 52 control tissues, was obtained through batch normalization to remove the inter-batch difference. A total of 206 differentially expressed IAGs were identified, and 38 of them were associated with OS. Thereafter, a 4-IAG signature was constructed to calculate the risk score and thus classify PMS patients into high- and low-risk groups according to mean risk score. Patients in the high-risk group had a lower survival time than those in the low-risk group. The Kaplan-Meier plots and ROC curves demonstrated a good performance in both the training and internal validation groups. Additionally, five differentially abundant immune cell types were identified and their relationships with IAGs were analyzed. Finally, risk score, cortical region, and naive B cells were identified as independent prognostic factors, and a nomogram incorporating these factors was developed to predict the OS in PMS. CONCLUSION The novel IAG signature may be a reliable tool for assisting neurologists in predicting the OS for PMS patients in clinical settings. These findings may facilitate personalized treatment and provide insights into the complex mechanism of PMS.
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Affiliation(s)
- Fei Ye
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoxin Wu
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Tianzhu Wang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jie Liang
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jiaoxing Li
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yuanyuan Dai
- Department of Neurology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Kai Lan
- Department of Anesthesiology, Troops 32268 Hospital, Dali, China
| | - Wenli Sheng
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
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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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Wnuk M, Maluchnik M, Perwieniec J, Podwojcic K, Szelag M, Walkiewicz D, Zakrzewski M, Kulakowska A, Brola W, Rejdak K, Slowik A. Multiple sclerosis incidence and prevalence in Poland: Data from administrative health claims. Mult Scler Relat Disord 2021; 55:103162. [PMID: 34332458 DOI: 10.1016/j.msard.2021.103162] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/28/2021] [Accepted: 07/19/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The detailed data concerning multiple sclerosis (MS) epidemiology in Poland are based on studies from few and less populated provinces. Therefore, we evaluated MS incidence and prevalence in Poland using electronic administrative health claims (AHCs) from the National Health Fund. METHODS We retrospectively analyzed the AHC financial database collected from 2009 to 2019, encompassing all patients using public health resources. Three different algorithms for identification of MS cases were used: based on studies performed in German population (type 1), tested in the United States (type 2), and one created for the purpose of this study (type 3) that required at least 3 AHCs since 2009 with G35 ICD-10 diagnosis in outpatient specialist care, during hospitalization, and/or at rehabilitation service in any combination within maximally 3 years between the first and the last AHC, and provided that at least one AHC was either in neurological outpatient care or during hospitalization at a neurological ward or prescription of disease-modifying therapy. The American algorithm (type 2) required 3 AHCs within the analyzed year, while the German algorithm (type 1) required only one AHC in the analyzed year. RESULTS According to the type 3 algorithm, age-adjusted MS incidence and prevalence in 2019 was 6.6 and 131.2 / 100,000 inhabitants, respectively. From 2014 to 2019, the significant trend in increasing prevalence and decreasing incidence of MS was observed (p<0.001). Median age of prevalent MS patients was 50 years (interquartile range, IQR 39-61) whereas median age of incident MS cases was 37 years (IQR 28-48). Female-to-male ratio in MS patients was 2.4. According to the type 1 algorithm, age-adjusted MS incidence and prevalence in 2019 was 11.6 and 244.9 / 100,000 inhabitants, respectively. Use of the type 2 algorithm resulted in estimated age-adjusted MS incidence and prevalence values in 2019 of 6.2 and 120.1 / 100,000 inhabitants, respectively. CONCLUSIONS Multiple sclerosis incidence and prevalence in Poland are higher than previously reported and similar to the numbers shown for central European countries.
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Affiliation(s)
- Marcin Wnuk
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland; Department of Neurology, University Hospital in Krakow, Krakow, Poland.
| | - Michal Maluchnik
- Ministry of Health, Warsaw, Poland; Medical University of Gdansk, Gdansk, Poland
| | | | - Krzysztof Podwojcic
- Ministry of Health, Warsaw, Poland; Institute of Labour and Social Studies, Warsaw, Poland
| | | | | | | | - Alina Kulakowska
- Department of Neurology, Medical University of Bialystok, Bialystok, Poland
| | - Waldemar Brola
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Konrad Rejdak
- Department of Neurology, Medical University of Lublin, Lublin, Poland
| | - Agnieszka Slowik
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland; Department of Neurology, University Hospital in Krakow, Krakow, Poland
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Kremer IEH, Hiligsmann M, Carlson J, Zimmermann M, Jongen PJ, Evers SMAA, Petersohn S, Pouwels XGLV, Bansback N. Exploring the Cost Effectiveness of Shared Decision Making for Choosing between Disease-Modifying Drugs for Relapsing-Remitting Multiple Sclerosis in the Netherlands: A State Transition Model. Med Decis Making 2021; 40:1003-1019. [PMID: 33174513 PMCID: PMC7672783 DOI: 10.1177/0272989x20961091] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background Up to 31% of patients with relapsing-remitting multiple sclerosis (RRMS) discontinue treatment with disease-modifying drug (DMD) within the first year, and of the patients who do continue, about 40% are nonadherent. Shared decision making may decrease nonadherence and discontinuation rates, but evidence in the context of RRMS is limited. Shared decision making may, however, come at additional costs. This study aimed to explore the potential cost-effectiveness of shared decision making for RRMS in comparison with usual care, from a (limited) societal perspective over a lifetime. Methods An exploratory economic evaluation was conducted by adapting a previously developed state transition model that evaluates the cost-effectiveness of a range of DMDs for RRMS in comparison with the best supportive care. Three potential effects of shared decision making were explored: 1) a change in the initial DMD chosen, 2) a decrease in the patient’s discontinuation in using the DMD, and 3) an increase in adherence to the DMD. One-way and probabilistic sensitivity analyses of a scenario that combined the 3 effects were conducted. Results Each effect separately and the 3 effects combined resulted in higher quality-adjusted life years (QALYs) and costs due to the increased utilization of DMD. A decrease in discontinuation of DMDs influenced the incremental cost-effectiveness ratio (ICER) most. The combined scenario resulted in an ICER of €17,875 per QALY gained. The ICER was sensitive to changes in several parameters. Conclusion This study suggests that shared decision making for DMDs could potentially be cost-effective, especially if shared decision making would help to decrease treatment discontinuation. Our results, however, may depend on the assumed effects on treatment choice, persistence, and adherence, which are actually largely unknown.
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Affiliation(s)
- Ingrid E H Kremer
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Limburg, The Netherlands.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Mickael Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Limburg, The Netherlands
| | - Josh Carlson
- Department of Pharmacy, University of Washington, Seattle, WA, USA
| | | | - Peter J Jongen
- MS4 Research Institute, Nijmegen, The Netherlands.,Department of Community and Occupational Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Silvia M A A Evers
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Limburg, The Netherlands.,Centre for Economic Evaluations, Trimbos Institute, Utrecht, The Netherlands
| | - Svenja Petersohn
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, Limburg, The Netherlands.,Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Xavier G L V Pouwels
- Department of Health Technology & Services Research, Faculty of Behavioral, Management & Social Sciences, University of Twente, Enschede, The Netherlands
| | - Nick Bansback
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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Lisiecka D, Kearns A, Bourke F, Lawson I, Muir C. A qualitative meta-synthesis of evidence (meta-ethnography) exploring the personal experiences of gastrostomy tube in neurodegenerative diseases: a case of motor neurone disease. Disabil Rehabil 2021; 44:4949-4965. [PMID: 34033736 DOI: 10.1080/09638288.2021.1922518] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
PURPOSE The lived experiences of a gastrostomy tube (GT) in adults with neurodegenerative diseases (NDDs) are not well understood. The aim of this qualitative meta-synthesis was to review and synthesise the available evidence to inform clinical practice and identify research gaps. METHODS Meta-ethnographic synthesis of qualitative studies was conducted with systematic searching of eight databases from inception to March 2021. Qualitative studies reporting personal experiences of GTs in adults with NDDs were identified. New theories were developed during translation of concepts from each study and combined as a "line-of-argument" synthesis. Patient and public involvement was incorporated as two of the authors are living with an NDD and a GT. RESULTS AND CONCLUSIONS Of 2863 unique records identified, only nine fulfilled the review criteria. All studies recruited participants with motor neurone disease (MND); no other NDDs were represented. Two main themes emerged: decision making and living with GT. Decision making was the predominant theme and data regarding living with GT were sparse. There is limited research on the lived experience of a GT in adults with NDDs. The lived experience of GT in MND is complex and individualised. Future research is indicated to inform clinical practice.Implications for rehabilitationEvidence related to the lived experiences of gastrostomy tube (GT) in neurodegenerative diseases (NDDs) is lacking especially in relation to the time after GT insertion.Decision making in relation to GT is a complex and individualised psychological process for some people, while others perceive no decisional conflict.Support from healthcare professionals is crucial during the decision-making time and should not cease after GT insertion.Support from healthcare professionals can help resolve any clinical complications and also incorporate GT into everyday routines.Healthcare professionals should be aware that their views on the benefits and problems related to GT may differ to those of individuals with a NDD.
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Affiliation(s)
- Dominika Lisiecka
- Department of Nursing and Healthcare Sciences, School of Health and Social Sciences, Munster Technological University, Kerry Campus, Tralee, Ireland
| | - Aine Kearns
- Department of Speech & Language Therapy, School of Allied Health, University of Limerick, Limerick, Ireland
| | - Fiona Bourke
- Department of Speech & Language Therapy, School of Allied Health, University of Limerick, Limerick, Ireland
| | - Ian Lawson
- North Yorkshire Disability Forum, Whitby, UK
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Rollot F, Fauvernier M, Uhry Z, Vukusic S, Bossard N, Remontet L, Leray E. Effects of Age and Disease Duration on Excess Mortality in Patients With Multiple Sclerosis From a French Nationwide Cohort. Neurology 2021; 97:e403-e413. [PMID: 34011577 DOI: 10.1212/wnl.0000000000012224] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 04/20/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To determine the effects of current age and disease duration on excess mortality in multiple sclerosis (MS), we describe the dynamics of excess death rates over these 2 time scales and study the effect of age at MS clinical onset on these dynamics, separately in each initial phenotype. METHODS We used data from 18 French MS expert centers participating in the Observatoire Français de la Sclérose en Plaques. Patients with MS living in metropolitan France and having a clinical onset between 1960 and 2014 were included. Vital status was updated on January 1, 2016. For each MS phenotype separately (relapsing onset [RMS] or primary progressive [PPMS]), we used an innovative statistical method to model the logarithm of excess death rates by a multidimensional penalized spline of age and disease duration. RESULTS Among 37,524 patients (71% women, mean age at MS onset ± SD 33.0 ± 10.6 years), 2,883 (7.7%) deaths were observed and 7.8% of patients were lost to follow-up. For patients with RMS, there was no excess mortality during the first 10 years after disease onset; afterwards, whatever the age at onset, excess death rates increased with current age. From current age 70, the excess death rate values converged and became identical whatever the age at disease onset, which means that disease duration had no more effect. Excess death rates were higher in men, with an excess hazard ratio of 1.46 (95% confidence interval 1.25-1.70). In contrast, in patients with PPMS, excess death rates rapidly increased from disease onset, and were associated with age at onset, but not with sex. CONCLUSIONS In RMS, current age has a stronger effect on MS mortality than disease duration, while their respective effects are not clear in PPMS.
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Affiliation(s)
- Fabien Rollot
- From the Université de Lyon (F.R., S.V.), Université Claude Bernard Lyon 1; Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation (F.R., S.V.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; Observatoire Français de la Sclérose en Plaques (F.R., S.V.), Centre de Recherche en Neurosciences de Lyon, INSERM 1028 and CNRS UMR 5292, Lyon; Eugene Devic EDMUS Foundation Against Multiple Sclerosis (F.R., S.V.), Bron; Service de Biostatistique-Bioinformatique (M.F., Z.U., N.B., L.R.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Evolutive UMR 5558 (M.F., N.B., L.R.), Université Lyon 1 and CNRS, Villeurbanne; Direction des Maladies Nontransmissibles et des Traumatismes (Z.U.), Santé Publique France, Saint-Maurice; REPERES-EA 7449 (E.L.), Univ Rennes/EHESP; and CIC-P 1414 (E.L.), CHU Rennes, France.
| | - Mathieu Fauvernier
- From the Université de Lyon (F.R., S.V.), Université Claude Bernard Lyon 1; Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation (F.R., S.V.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; Observatoire Français de la Sclérose en Plaques (F.R., S.V.), Centre de Recherche en Neurosciences de Lyon, INSERM 1028 and CNRS UMR 5292, Lyon; Eugene Devic EDMUS Foundation Against Multiple Sclerosis (F.R., S.V.), Bron; Service de Biostatistique-Bioinformatique (M.F., Z.U., N.B., L.R.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Evolutive UMR 5558 (M.F., N.B., L.R.), Université Lyon 1 and CNRS, Villeurbanne; Direction des Maladies Nontransmissibles et des Traumatismes (Z.U.), Santé Publique France, Saint-Maurice; REPERES-EA 7449 (E.L.), Univ Rennes/EHESP; and CIC-P 1414 (E.L.), CHU Rennes, France
| | - Zoe Uhry
- From the Université de Lyon (F.R., S.V.), Université Claude Bernard Lyon 1; Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation (F.R., S.V.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; Observatoire Français de la Sclérose en Plaques (F.R., S.V.), Centre de Recherche en Neurosciences de Lyon, INSERM 1028 and CNRS UMR 5292, Lyon; Eugene Devic EDMUS Foundation Against Multiple Sclerosis (F.R., S.V.), Bron; Service de Biostatistique-Bioinformatique (M.F., Z.U., N.B., L.R.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Evolutive UMR 5558 (M.F., N.B., L.R.), Université Lyon 1 and CNRS, Villeurbanne; Direction des Maladies Nontransmissibles et des Traumatismes (Z.U.), Santé Publique France, Saint-Maurice; REPERES-EA 7449 (E.L.), Univ Rennes/EHESP; and CIC-P 1414 (E.L.), CHU Rennes, France
| | - Sandra Vukusic
- From the Université de Lyon (F.R., S.V.), Université Claude Bernard Lyon 1; Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation (F.R., S.V.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; Observatoire Français de la Sclérose en Plaques (F.R., S.V.), Centre de Recherche en Neurosciences de Lyon, INSERM 1028 and CNRS UMR 5292, Lyon; Eugene Devic EDMUS Foundation Against Multiple Sclerosis (F.R., S.V.), Bron; Service de Biostatistique-Bioinformatique (M.F., Z.U., N.B., L.R.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Evolutive UMR 5558 (M.F., N.B., L.R.), Université Lyon 1 and CNRS, Villeurbanne; Direction des Maladies Nontransmissibles et des Traumatismes (Z.U.), Santé Publique France, Saint-Maurice; REPERES-EA 7449 (E.L.), Univ Rennes/EHESP; and CIC-P 1414 (E.L.), CHU Rennes, France
| | - Nadine Bossard
- From the Université de Lyon (F.R., S.V.), Université Claude Bernard Lyon 1; Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation (F.R., S.V.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; Observatoire Français de la Sclérose en Plaques (F.R., S.V.), Centre de Recherche en Neurosciences de Lyon, INSERM 1028 and CNRS UMR 5292, Lyon; Eugene Devic EDMUS Foundation Against Multiple Sclerosis (F.R., S.V.), Bron; Service de Biostatistique-Bioinformatique (M.F., Z.U., N.B., L.R.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Evolutive UMR 5558 (M.F., N.B., L.R.), Université Lyon 1 and CNRS, Villeurbanne; Direction des Maladies Nontransmissibles et des Traumatismes (Z.U.), Santé Publique France, Saint-Maurice; REPERES-EA 7449 (E.L.), Univ Rennes/EHESP; and CIC-P 1414 (E.L.), CHU Rennes, France
| | - Laurent Remontet
- From the Université de Lyon (F.R., S.V.), Université Claude Bernard Lyon 1; Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation (F.R., S.V.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; Observatoire Français de la Sclérose en Plaques (F.R., S.V.), Centre de Recherche en Neurosciences de Lyon, INSERM 1028 and CNRS UMR 5292, Lyon; Eugene Devic EDMUS Foundation Against Multiple Sclerosis (F.R., S.V.), Bron; Service de Biostatistique-Bioinformatique (M.F., Z.U., N.B., L.R.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Evolutive UMR 5558 (M.F., N.B., L.R.), Université Lyon 1 and CNRS, Villeurbanne; Direction des Maladies Nontransmissibles et des Traumatismes (Z.U.), Santé Publique France, Saint-Maurice; REPERES-EA 7449 (E.L.), Univ Rennes/EHESP; and CIC-P 1414 (E.L.), CHU Rennes, France
| | - Emmanuelle Leray
- From the Université de Lyon (F.R., S.V.), Université Claude Bernard Lyon 1; Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation (F.R., S.V.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; Observatoire Français de la Sclérose en Plaques (F.R., S.V.), Centre de Recherche en Neurosciences de Lyon, INSERM 1028 and CNRS UMR 5292, Lyon; Eugene Devic EDMUS Foundation Against Multiple Sclerosis (F.R., S.V.), Bron; Service de Biostatistique-Bioinformatique (M.F., Z.U., N.B., L.R.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Evolutive UMR 5558 (M.F., N.B., L.R.), Université Lyon 1 and CNRS, Villeurbanne; Direction des Maladies Nontransmissibles et des Traumatismes (Z.U.), Santé Publique France, Saint-Maurice; REPERES-EA 7449 (E.L.), Univ Rennes/EHESP; and CIC-P 1414 (E.L.), CHU Rennes, France
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Grieb P, Świątkiewicz M, Kamińska A, Jünemann A, Rejdak R, Rejdak K. Citicoline: A Candidate for Adjunct Treatment of Multiple Sclerosis. Pharmaceuticals (Basel) 2021; 14:ph14040326. [PMID: 33918331 PMCID: PMC8066453 DOI: 10.3390/ph14040326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/24/2021] [Accepted: 03/29/2021] [Indexed: 12/13/2022] Open
Abstract
In remitting–relapsing multiple sclerosis (RR-MS), relapses are driven by autoreactive immune cells that enter the brain and spinal cord and damage myelin sheaths of axons in white and grey matter, whereas during remissions myelin is repaired by activated oligodendroglial cells. Disease-modifying therapies (DMTs) may either retard/attenuate myelin damage or promote/enhance/speed up myelin repair. Almost all currently approved DMTs inhibit myelin damage and are considerably toxic. Enhancement of myelin repair is considered an unmet medical need of MS patients. Citicoline, known for many years as a nootropic and neuroprotective drug and recently pronounced food supplement, has been found to be significantly efficacious in two complementary rodent models of MS, experimental autoimmune encephalomyelitis (EAE) and cuprizone-induced myelin toxicity. Moreover, citicoline treatment improves visual evoked potentials (VEPs) in glaucoma patients, which is relevant because VEP monitoring is frequently used as an indicator of remyelination in MS. Although over-the-counter availability of citicoline may impede its formal translation to the clinic of MS, evaluation of its efficacy for supporting remyelination in this disease is strongly indicated.
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Affiliation(s)
- Paweł Grieb
- Department of Experimental Pharmacology, Mossakowski Medical Research Institute, Polish Academy of Sciences, 02-106 Warsaw, Poland;
| | - Maciej Świątkiewicz
- Department of Experimental Pharmacology, Mossakowski Medical Research Institute, Polish Academy of Sciences, 02-106 Warsaw, Poland;
- Correspondence:
| | - Agnieszka Kamińska
- Faculty of Medical Sciences, Collegium Medicum, Cardinal Stefan Wyszynski University, 01-938 Warsaw, Poland;
| | - Anselm Jünemann
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-079 Lublin, Poland; (A.J.); (R.R.)
| | - Robert Rejdak
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-079 Lublin, Poland; (A.J.); (R.R.)
| | - Konrad Rejdak
- Department of Neurology, Medical University of Lublin, 20-954 Lublin, Poland;
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Goodin DS, Khankhanian P, Gourraud PA, Vince N. The nature of genetic and environmental susceptibility to multiple sclerosis. PLoS One 2021; 16:e0246157. [PMID: 33750973 PMCID: PMC7984655 DOI: 10.1371/journal.pone.0246157] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 01/15/2021] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To understand the nature of genetic and environmental susceptibility to multiple sclerosis (MS) and, by extension, susceptibility to other complex genetic diseases. BACKGROUND Certain basic epidemiological parameters of MS (e.g., population-prevalence of MS, recurrence-risks for MS in siblings and twins, proportion of women among MS patients, and the time-dependent changes in the sex-ratio) are well-established. In addition, more than 233 genetic-loci have now been identified as being unequivocally MS-associated, including 32 loci within the major histocompatibility complex (MHC), and one locus on the X chromosome. Despite this recent explosion in genetic associations, however, the association of MS with the HLA-DRB1*15:01~HLA-DQB1*06:02~a1 (H+) haplotype has been known for decades. DESIGN/METHODS We define the "genetically-susceptible" subset (G) to include everyone with any non-zero life-time chance of developing MS. Individuals who have no chance of developing MS, regardless of their environmental experiences, belong to the mutually exclusive "non-susceptible" subset (G-). Using these well-established epidemiological parameters, we analyze, mathematically, the implications that these observations have regarding the genetic-susceptibility to MS. In addition, we use the sex-ratio change (observed over a 35-year interval in Canada), to derive the relationship between MS-probability and an increasing likelihood of a sufficient environmental exposure. RESULTS We demonstrate that genetic-susceptibitly is confined to less than 7.3% of populations throughout Europe and North America. Consequently, more than 92.7% of individuals in these populations have no chance whatsoever of developing MS, regardless of their environmental experiences. Even among carriers of the HLA-DRB1*15:01~HLA-DQB1*06:02~a1 haplotype, far fewer than 32% can possibly be members the (G) subset. Also, despite the current preponderance of women among MS patients, women are less likely to be in the susceptible (G) subset and have a higher environmental threshold for developing MS compared to men. Nevertheless, the penetrance of MS in susceptible women is considerably greater than it is in men. Moreover, the response-curves for MS-probability in susceptible individuals increases with an increasing likelihood of a sufficient environmental exposure, especially among women. However, these environmental response-curves plateau at under 50% for women and at a significantly lower level for men. CONCLUSIONS The pathogenesis of MS requires both a genetic predisposition and a suitable environmental exposure. Nevertheless, genetic-susceptibility is rare in the population (< 7.3%) and requires specific combinations of non-additive genetic risk-factors. For example, only a minority of carriers of the HLA-DRB1*15:01~HLA-DQB1*06:02~a1 haplotype are even in the (G) subset and, thus, genetic-susceptibility to MS in these carriers must result from the combined effect this haplotype together with the effects of certain other (as yet, unidentified) genetic factors. By itself, this haplotype poses no MS-risk. By contrast, a sufficient environmental exposure (however many events are involved, whenever these events need to act, and whatever these events might be) is common, currently occurring in, at least, 76% of susceptible individuals. In addition, the fact that environmental response-curves plateau well below 50% (especially in men), indicates that disease pathogenesis is partly stochastic. By extension, other diseases, for which monozygotic-twin recurrence-risks greatly exceed the disease-prevalence (e.g., rheumatoid arthritis, diabetes, and celiac disease), must have a similar genetic basis.
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Affiliation(s)
- Douglas S. Goodin
- Department of Neurology, University of California, San Francisco, San Francisco, CA, United States of America
| | - Pouya Khankhanian
- Center for Neuro-Engineering and Therapeutics, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Pierre-Antoine Gourraud
- Department of Neurology, University of California, San Francisco, San Francisco, CA, United States of America
- Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes, France
- Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France
| | - Nicolas Vince
- Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes, France
- Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France
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Abstract
Multiple sclerosis (MS) is an autoimmune inflammatory disorder that affects more than 900,000 Americans. Patient presentations vary widely; therefore, symptom recognition and an understanding of diagnostic criteria are critical in providing timely patient referrals. This article describes recognition and diagnosis of MS using the updated 2017 criteria, and offers an overview of epidemiology, prognosis, and treatment strategies.
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50
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Rosato R, Pagano E, Giordano A, Farinotti M, Ponzio M, Veronese S, Confalonieri P, Grasso MG, Patti F, Solari A. Living with severe multiple sclerosis: Cost-effectiveness of a palliative care intervention and cost of illness study. Mult Scler Relat Disord 2021; 49:102756. [PMID: 33486403 DOI: 10.1016/j.msard.2021.102756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/26/2020] [Accepted: 01/12/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Little is known about the economic consequences of living with severe multiple sclerosis (SMS). AIMS To assess the cost-effectiveness of a home-based palliative approach (HPA) for people with SMS (pwSMS). To assess direct healthcare costs in this population. METHODS PwSMS from three Italian centers received (2:1 ratio) HPA or usual care over six months. Direct healthcare costs were collected on a monthly basis. Incremental cost-effectiveness was gauged from a national healthcare system (NHS) and a personal perspective, considering the Palliative Outcome Scale-Symptoms-MS (POS-S-MS) and the EuroQol five-dimension descriptive system quality-adjusted life years (EQ-5D-3L QALYs), both completed at baseline, after three and six months. RESULTS Of 78 randomized pwSMS, 76 (50 HPA, 26 usual care) were analyzed. Mean QALYs were close to zero, and the mean group difference was -0.006 (95% CI -0.057 to 0.044). The mean baseline-adjusted cost difference was € -394 (95% confidence interval, CI -3,532 to 2,743). POS-S-MS cost-effectiveness showed a slight mean reduction of symptom burden (-1.9; 95% CI -1.1 to 5.0) with unchanged costs. Mean direct costs due to MS were € 23,195/year, almost equally distributed between NHS (€ 13,108) and pwSMS (€ 10,087). Personal care, medications and home rehabilitation accounted for 80% of total expenditures. Most personal care costs were covered by pwSMS, and these costs were 3/4 of pwSMS out-of-pocket. CONCLUSIONS The slight reduction of symptom burden produced by the HPA was not associated with an increase in costs. NHS and pwSMS almost equally sustained these costs. TRIAL REGISTRATION Current Controlled Trials ISRCTN73082124.
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Affiliation(s)
- Rosalba Rosato
- Department of Psychology, University of Turin, Turin, Italy; Unit of Clinical Epidemiology, "Città della Salute e della Scienza" Hospital, Turin, Italy and CPO Piemonte, Turin, Italy.
| | - Eva Pagano
- Unit of Clinical Epidemiology, "Città della Salute e della Scienza" Hospital, Turin, Italy and CPO Piemonte, Turin, Italy
| | - Andrea Giordano
- Department of Psychology, University of Turin, Turin, Italy; Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy.
| | - Mariangela Farinotti
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy.
| | - Michela Ponzio
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Via Operai 40, 16149 Genoa, Italy.
| | | | - Paolo Confalonieri
- Multiple Sclerosis Center, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy.
| | - Maria Grazia Grasso
- Multiple Sclerosis Unit, IRCCS S. Lucia Foundation, Via Ardeatina 306, 00179 Rome, Italy.
| | - Francesco Patti
- Multiple Sclerosis Center, Neurology Clinic, University Hospital Policlinico Vittorio Emanuele, Via S. Sofia 78, 95123 Catania, Italy.
| | - Alessandra Solari
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy.
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