Characteristics of a population-based multiple sclerosis cohort treated with disease-modifying drugs in a universal healthcare setting

Ng, Huah Shin; Zhu, Feng; Kingwell, Elaine; Zhao, Yinshan; Yao, Shenzhen; Ekuma, Okechukwu; Svenson, Lawrence W.; Evans, Charity; Fisk, John D.; Marrie, Ruth Ann; Tremlett, Helen

doi:10.1080/14737175.2021.1847085

Cited by 11 publications

(27 citation statements)

References 52 publications

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“…Cohort characteristics, including by DMD exposure, are published in detail. 2 Approximately 30% of our study population were exposed to a DMD during follow-up, and this estimate falls within the ranges reported in other population-based observational studies over a comparable time period. 2 The total person-years of follow-up while exposed to any DMD was 63,290 (10,418 individuals); any first-generation DMD was 54,605 (9204 individuals) and any second-generation DMD was 8685 (3668 individuals).…”

Section: Resultssupporting

confidence: 86%

“…A recent study showed that nearly 20% of people with MS had some comorbidity and approximately one in six were aged ⩾50 years when first receiving a DMD. 2 However, such individuals are typically excluded from clinical trials. 2 Understanding the benefits of the DMDs in the broader MS populations treated in the “real-world” setting is needed for therapeutic-related decision-making.…”

Section: Introductionmentioning

confidence: 99%

“… 2 However, such individuals are typically excluded from clinical trials. 2 Understanding the benefits of the DMDs in the broader MS populations treated in the “real-world” setting is needed for therapeutic-related decision-making. Health service use, particularly hospitalizations, represents a major burden for society, patients, and families.…”

Section: Introductionmentioning

confidence: 99%

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Disease-modifying drugs for multiple sclerosis and subsequent health service use

Zhu

Kingwell

et al. 2021

Mult Scler

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Objective: We assessed the relationship between the multiple sclerosis (MS) disease-modifying drugs (DMDs) and healthcare use. Methods: Persons with MS (aged ⩾18 years) were identified using linked population-based health administrative data in four Canadian provinces and were followed from the most recent of their first MS/demyelinating event or 1 January 1996 until the earliest of death, emigration, or study end (31 December 2017 or 31 March 2018). Prescription records captured DMD exposure, examined as any DMD, then by generation (first-generation (the injectables) or second-generation (orals/infusions)) and individual DMD. The associations with subsequent all-cause hospitalizations and physician visits were examined using proportional means model and negative binomial regression. Results: Of 35,894 MS cases (72% female), mean follow-up was 12.0 years, with person-years of DMD exposure for any, or any first- or second-generation DMD being 63,290, 54,605 and 8685, respectively. Any DMD or any first-generation DMD exposure (versus non-exposure) was associated with a 24% lower hazard of hospitalization (adjusted hazard ratio, aHR: 0.76; 95% confidence intervals (CIs): 0.71–0.82), rising to 29% for the second-generation DMDs (aHR: 0.71; 95% CI: 0.58–0.88). This ranged from 18% for teriflunomide (aHR: 0.82; 95% CI: 0.67–1.00) to 44% for fingolimod (aHR: 0.56; 95% CI: 0.36–0.87). In contrast, DMD exposure was generally not associated with substantial differences in physician visits. Conclusion: Findings provide real-world evidence of a beneficial relationship between DMD exposure and hospitalizations.

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Section: Resultssupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Disease-modifying drugs for multiple sclerosis and subsequent health service use

Zhu

Kingwell

et al. 2021

Mult Scler

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“…To address this, a large phase 4 randomized controlled DMD treatment discontinuation trial is currently underway in the Unites States which includes persons ≥55 years old, and its findings may add crucial knowledge to this emerging aspect of MS care (49). While, as expected, a smaller proportion of our older (versus younger) persons with MS were DMD exposed (22,32,50), we also observed that the proportions of persons continuing or discontinuing DMD were similar. Specifically, the proportions of persons who initiated their first DMD before age 55 years, and who continued or discontinued once aged ≥55 years were rather similar (n=706/1,302 versus n=596/1,302, respectively) (Supplementary Table 3).…”

Section: Complementary Descriptive Analysis -Dmd Use In the Older Age...supporting

confidence: 84%

“…We selected all persons with MS by using a validated algorithm with the cases defined as having at least 3 MS diagnostic codes (ICD-9/10 340/G35) in the hospital and/or physician data or an MS DMD record in the prescription data, as outlined previously (20)(21)(22). We assigned an index date to each person based on the most recent date of: the first MS or demyelinating event recorded in the hospital, physician or prescription data (Supplementary Tables 1, 2), or 01-January-1996 (the date when the provincial prescription data first became available), or the person's 18 th birthday.…”

Section: Study Populationmentioning

confidence: 99%

Disease-Modifying Drug Uptake and Health Service Use in the Ageing MS Population

Graf

Zhu

et al. 2022

Front. Immunol.

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BackgroundEvidence regarding the efficacy or effectiveness of the disease-modifying drugs (DMDs) in the older multiple sclerosis (MS) population is scarce. This has contributed to a lack of evidence-based treatment recommendations for the ageing MS population in practice guidelines. We examined the relationship between age (<55 and ≥55 years), DMD exposure and health service use in the MS population.MethodsWe conducted a population-based observational study using linked administrative health data from British Columbia, Canada. We selected all persons with MS and followed from the most recent of their first MS or demyelinating event, 18th birthday or 01-January-1996 (index date) until the earliest of emigration, death or 31-December-2017 (study end). We assessed DMD exposure status over time, initially as any versus no DMD, then by generation (first or second) and finally by each individual DMD. Age-specific analyses were conducted with all-cause hospitalizations and number of physician visits assessed using proportional means model and negative binomial regression with generalized estimating equations.ResultsWe included 19,360 persons with MS (72% were women); 10,741/19,360 (56%) had ever reached their 55th birthday. Person-years of follow-up whilst aged <55 was 132,283, and 93,594 whilst aged ≥55. Any DMD, versus no DMD in the <55-year-olds was associated with a 23% lower hazard of hospitalization (adjusted hazard ratio, aHR0.77; 95%CI 0.72-0.82), but not in the ≥55-year-olds (aHR0.95; 95%CI 0.87-1.04). Similar patterns were observed for the first and second generation DMDs. Exposure to any (versus no) DMD was not associated with rates of physician visits in either age group (<55 years: adjusted rate ratio, aRR1.02; 95%CI 1.00-1.04 and ≥55 years: aRR1.00; 95%CI 0.96-1.03), but variation in aRR was observed across the individual DMDs.ConclusionOur study showed beneficial effects of the DMDs used to treat MS on hospitalizations for those aged <55 at the time of exposure. In contrast, for individuals ≥55 years of age exposed to a DMD, the hazard of hospitalization was not significantly lowered. Our study contributes to the broader understanding of the potential benefits and risks of DMD use in the ageing MS population.

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Disease-modifying drugs, multiple sclerosis and infection-related healthcare use in British Columbia, Canada: a population-based study

Graf,

Ng,

Zhu

et al. 2024

The Lancet Regional Health - Americas

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Characteristics of a population-based multiple sclerosis cohort treated with disease-modifying drugs in a universal healthcare setting

Cited by 11 publications

References 52 publications

Disease-modifying drugs for multiple sclerosis and subsequent health service use

Disease-modifying drugs for multiple sclerosis and subsequent health service use

Disease-Modifying Drug Uptake and Health Service Use in the Ageing MS Population

Disease-modifying drugs, multiple sclerosis and infection-related healthcare use in British Columbia, Canada: a population-based study

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