scholarly journals Comorbid disease drives short-term hospitalization outcomes in patients with multiple sclerosis

2020 ◽  
Vol 10 (3) ◽  
pp. 255-264 ◽  
Author(s):  
Adys Mendizabal ◽  
Dylan P. Thibault ◽  
James A. Crispo ◽  
Adina Paley ◽  
Allison W. Willis
Keyword(s):  
Multiple Sclerosis ◽  
Vascular Diseases ◽  
Patient Characteristics ◽  
Primary Study ◽  
Comorbid Disease ◽  
Collagen Vascular Diseases ◽  
Logistic Regression Models ◽  
Disease Modifying Therapy ◽  
Medicare Program ◽  
The Us

ObjectiveReadmission is used as a quality indicator and is the primary target outcome for disease-modifying therapy (DMT) for multiple sclerosis (MS). However, data on readmissions for patients with MS are limited.MethodsUsing the US Nationwide Readmissions Database, we performed a retrospective cohort study of adults hospitalized for MS in 2014. Primary study outcomes were within 30- and 90-day readmissions. Descriptive analyses compared patient, clinical, and hospital variables readmission status. Multivariable logistic regression models estimated the associations between these variables and readmission.ResultsOf 16,629 individuals meeting the study criteria, most were women (73.7%), aged 35–54 years (48.0%), and Medicare program participants (36.8%). In total, 49.7% of inpatients with MS had 1–2 comorbid medical conditions and 23.7% had 3 or more. Having 3 or more comorbidity conditions associated with increased adjusted odds of the 30-day readmission (adjusted odds ratio [AOR] 1.92, 1.34–2.74). Anemia (AOR 1.62, 1.22–2.14), rheumatoid arthritis/collagen vascular diseases (AOR 2.20, 1.45–3.33), congestive heart failure (AOR 2.43, 1.39–4.24), chronic pulmonary disease (AOR 1.35, 1.02–1.78), diabetes with complications (AOR 2.27, 1.45–3.56), hypertension (AOR 1.25, 1.03–1.53), obesity (AOR 1.35, 1.05–1.73), and renal failure (AOR 1.68, 1.06–2.67) were associated with the 30-day readmission. Medicare insurance and nonroutine discharge were also associated with readmission, whereas patient characteristics (sex, age, and socioeconomic status) were not. The most frequent (26.7%) reason for readmission was multiple sclerosis. Ninety-day analyses produced similar findings.ConclusionsComorbid diseases were associated with the readmission for persons with multiple sclerosis. Evaluations of the real-world effectiveness for DMTs in reducing hospitalizations in patients with MS may need to consider comorbid disease burden and management.

scholarly journals Development of Glatopa® (Glatiramer Acetate): The First FDA-Approved Generic Disease-Modifying Therapy for Relapsing Forms of Multiple Sclerosis

2017 ◽  
Vol 31 (5) ◽  
pp. 481-488 ◽  
Author(s):  
Christine Bell ◽  
James Anderson ◽  
Tanmoy Ganguly ◽  
James Prescott ◽  
Ishan Capila ◽  
...  
Keyword(s):  
United States ◽  
Multiple Sclerosis ◽  
Glatiramer Acetate ◽  
Treatment Options ◽  
Functional Characterization ◽  
The United States ◽  
Complex Nature ◽  
Disease Modifying Therapy ◽  
The Us ◽  
Disease Modifying

The multiple sclerosis (MS) treatment landscape in the United States has changed dramatically over the past decade. While many disease-modifying therapies (DMTs) have been approved by the US Food and Drug Administration (FDA) for the treatment of relapsing forms of MS, DMT costs continue to rise. The availability of generics and biosimilars in the MS-treatment landscape is unlikely to have a major impact on clinical benefit. However, their availability will provide alternative treatment options and potentially lower costs through competition, thus increasing the affordability of and access to these drugs. In April 2015, the first generic version of the complex drug glatiramer acetate (Glatopa® 20 mg/mL) injection was approved in the United States as a fully substitutable generic for all approved indications of the 20 mg/mL branded glatiramer acetate (Copaxone®) dosage form. Despite glatiramer acetate’s complex nature—being a chemically synthesized (ie, nonbiologic) mixture of peptides—the approval occurred without conducting any clinical trials. Rather, extensive structural and functional characterization was performed to demonstrate therapeutic equivalence to the innovator drug. The approval of Glatopa signifies an important milestone in the US MS-treatment landscape, with the hope that the introduction of generic DMTs and eventually biosimilar DMTs will lead to future improvements in the affordability and access of these much-needed treatments for MS.

scholarly journals Risk of relapse phenotype recurrence in multiple sclerosis

2014 ◽  
Vol 20 (11) ◽  
pp. 1511-1522 ◽  
Author(s):  
Tomas Kalincik ◽  
Katherine Buzzard ◽  
Vilija Jokubaitis ◽  
Maria Trojano ◽  
Pierre Duquette ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Regression Models ◽  
Progressive Disease ◽  
Advanced Disease ◽  
Principal Component ◽  
Patient Characteristics ◽  
Early Disease ◽  
Logistic Regression Models ◽  
History Of ◽  
Risk Of Relapse

Objectives: The aim was to analyse risk of relapse phenotype recurrence in multiple sclerosis and to characterise the effect of demographic and clinical features on this phenotype. Methods: Information about relapses was collected using MSBase, an international observational registry. Associations between relapse phenotypes and history of similar relapses or patient characteristics were tested with multivariable logistic regression models. Tendency of relapse phenotypes to recur sequentially was assessed with principal component analysis. Results: Among 14,969 eligible patients (89,949 patient-years), 49,279 phenotypically characterised relapses were recorded. Visual and brainstem relapses occurred more frequently in early disease and in younger patients. Sensory relapses were more frequent in early or non-progressive disease. Pyramidal, sphincter and cerebellar relapses were more common in older patients and in progressive disease. Women presented more often with sensory or visual symptoms. Men were more prone to pyramidal, brainstem and cerebellar relapses. Importantly, relapse phenotype was predicted by the phenotypes of previous relapses. (OR = 1.8–5, p = 10-14). Sensory, visual and brainstem relapses showed better recovery than other relapse phenotypes. Relapse severity increased and the ability to recover decreased with age or more advanced disease. Conclusion: Relapse phenotype was associated with demographic and clinical characteristics, with phenotypic recurrence significantly more common than expected by chance.

Characteristics influencing therapy switch behavior after suboptimal response to first-line treatment in patients with multiple sclerosis

2013 ◽  
Vol 20 (7) ◽  
pp. 830-836 ◽  
Author(s):  
Barbara Teter ◽  
Neetu Agashivala ◽  
Katelyn Kavak ◽  
Lynn Chouhfeh ◽  
Ron Hashmonay ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Patient Characteristics ◽  
Initial Therapy ◽  
Clinical Relapse ◽  
Clinical Events ◽  
Disease Modifying Therapy ◽  
Relapsing Remitting ◽  
Mri Changes ◽  
Relapsing Remitting Multiple Sclerosis ◽  
Therapy Switch

Background: Factors driving disease-modifying therapy (DMT) switch behavior are not well understood. Objective: The objective of this paper is to identify patient characteristics and clinical events predictive of therapy switching in patients with suboptimal response to DMT. Methods: This retrospective study analyzed patients with relapsing–remitting multiple sclerosis (MS) and a suboptimal response to initial therapy with either interferon β or glatiramer acetate. Suboptimal responders were defined as patients with ≥1 MS event (clinical relapse, worsening disability, or MRI worsening) while on DMT. Switchers were defined as those who changed DMT within six to 12 months after the MS event. Results: Of 606 suboptimal responders, 214 (35.3%) switched therapy. Switchers were younger at symptom onset ( p = 0.012), MS diagnosis ( p = 0.004), DMT initiation ( p < 0.001), and first MS event ( p = 0.011) compared with nonswitchers. Compared with one relapse alone, MRI worsening alone most strongly predicted switch behavior (odds ratio 6.3; 95% CI, 3.1–12.9; p < 0.001), followed by ≥2 relapses (2.8; 95% CI, 1.1–7.3; p = 0.040), EDSS plus MRI worsening (2.5; 95% CI, 1.1–5.9; p = 0.031) and EDSS worsening alone (2.2; 95% CI, 1.2–4.1; p = 0.009). Conclusions: Younger patients with disease activity, especially MRI changes, are more likely to have their therapy switched sooner than patients who are older at the time of MS diagnosis and DMT initiation.

Adherence to laboratory monitoring among people taking oral drugs for multiple sclerosis: A Canadian population-based study

2020 ◽  
pp. 135245852091050 ◽  
Author(s):  
Huah Shin Ng ◽  
Elaine Kingwell ◽  
Feng Zhu ◽  
Tingting Zhang ◽  
Ruth Ann Marrie ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Laboratory Testing ◽  
Laboratory Data ◽  
Patient Characteristics ◽  
Dimethyl Fumarate ◽  
Population Based ◽  
Oral Disease ◽  
Laboratory Monitoring ◽  
Disease Modifying Therapy ◽  
Canadian Population

Objective: To examine laboratory testing adherence by persons initiating an oral disease-modifying therapy (DMT) for multiple sclerosis (MS). Methods: Population-based health administrative and laboratory data were accessed in British Columbia, Canada, to identify everyone filling their first prescription for dimethyl fumarate (DMF), fingolimod or teriflunomide (2011–2015). The proportion of people adherent to each drug monograph’s recommended laboratory monitoring schedule, pre- and on-DMT, was estimated. The association between patient characteristics and adherence was examined using multivariable logistic regression. Results: A total of 1016 people were included (DMF 567, fingolimod 253 and teriflunomide 196). The proportions of people adherent to pre-DMT liver and lymphocyte tests ranged from 88% to 91% and 91% to 94%, respectively, while 77% adhered to pre-DMF urinalysis. Adherence to the first on-DMT liver test was 89% for DMF (within 6 months), 61% for fingolimod (within 3 months) and 40% for teriflunomide (within 1 month). Men were less likely than women to have pre-DMF urinalysis (adjusted odds ratio (aOR); 95% confidence interval (CI): 0.40–0.95) or on-DMF liver (aOR: 0.46; 95% CI: 0.23–0.95) or lymphocyte (aOR: 0.47; 95% CI: 0.22–0.98) tests. Conclusions: Adherence to recommended laboratory testing was high (>77%) before oral DMT initiation, but lower once on drug. There is a need to understand the long-term consequences of suboptimal laboratory monitoring and sex differences in the DMT-treated MS population.

scholarly journals The effect of cardiovascular diseases on the course of multiple sclerosis (review of literature)

2020 ◽  
Vol 26 (3) ◽  
pp. 31-42
Author(s):  
N. A. Neofidov ◽  
N. A. Totolyan ◽  
M. V. Shumilina ◽  
A. A. Skoromets ◽  
E. P. Evdoshenko
Keyword(s):  
Risk Factors ◽  
Multiple Sclerosis ◽  
Age Groups ◽  
Vascular Diseases ◽  
Progression Rate ◽  
Review Of Literature ◽  
Cardiovascular Pathology ◽  
Disease Modifying Therapy ◽  
Disease Modifying ◽  
Vascular Comorbidity

Comorbidity is one of the factors determining the course of multiple sclerosis. Cardiovascular pathology is one of the most common in the population as a whole, especially in age groups over 50. Several studies showed that arterial hypotension and dyslipidemia affected the course, progression rate, and neuroimaging characteristics of patients with multiple sclerosis. An important issue is the effect of disease modifying therapy on the course of concomitant diseases in patients with multiple sclerosis and the effect of concomitant diseases on the effectiveness and safety of disease modifying therapy. The question of the use of statins in multiple sclerosis remains controversial. This review presents data on vascular comorbidity in multiple sclerosis, including the prevalence of risk factors for cardiovascular pathology and concomitant vascular diseases in the population of patients with multiple sclerosis. Data on the effect of cardiovascular pathology on the course and treatment of multiple sclerosis were also analyzed.

scholarly journals Lipoatrophy in Patients with Multiple Sclerosis on Glatiramer Acetate

2004 ◽  
Vol 31 (1) ◽  
pp. 58-63 ◽  
Author(s):  
Catherine M. Edgar ◽  
Donald G. Brunet ◽  
Paul Fenton ◽  
E. Vee McBride ◽  
Peter Green
Keyword(s):  
Multiple Sclerosis ◽  
Adverse Reaction ◽  
Injection Site ◽  
Glatiramer Acetate ◽  
Chart Review ◽  
Psychological Impact ◽  
Patient Characteristics ◽  
Additional Patient ◽  
Disease Modifying Therapy ◽  
Relapsing Remitting Multiple Sclerosis

Background:Patients with relapsing remitting multiple sclerosis on the disease modifying therapy of glatiramer acetate may be experiencing an adverse reaction of lipoatrophy at the sites of their subcutaneous injections. The purpose of this study was to complete a full examination of the injection site areas for users of glatiramer acetate, and to examine the relationship between lipoatrophy and patient characteristics.Methods:Glatiramer acetate users were identified by means of chart review. Over six months, during regular clinic appointments, assessment included a full examination of injection site areas including visual inspection and manual palpation. Additional patient and clinical characteristics were obtained by means of chart review and patient questioning.Results:Seventy-six patients had been or were current users of glatiramer acetate. Of these, 34 (45%) had evidence of lipoatrophy in at least one injection site area. All were female, and five had severe, nine had moderate and 20 had mild lipoatrophy. In some cases, lipoatrophy occurred within months of therapy initiation. Case reviews are included for five of the 34 patients, along with photographs of the lipoatrophy, a magnetic resonance image and comments on skin biopsies.Conclusion:Prevalence of lipoatrophy was much higher than expected. Possible reasons for this adverse reaction are explored and suggested treatment recommendations are reviewed. Lipoatrophy can be very disfiguring and is thought to be permanent, and the psychological impact can be significant. It is, therefore, important that patients be aware of the possibility of lipoatrophy, be able to identify it and discontinue injecting in areas where it is identified.

Relationship Between Fibrinopeptide A and Fibrinogen/Fibrin Fragment E in Thromboembolism, DIC and Various Non-Thromboembolic Diseases

1987 ◽  
Vol 58 (02) ◽  
pp. 758-763 ◽  
Author(s):  
G Mombelli ◽  
R Monotti ◽  
A Haeberli ◽  
P W Straub
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Liver Cirrhosis ◽  
Healthy Subjects ◽  
Vascular Diseases ◽  
Fibrinopeptide A ◽  
Normal Range ◽  
Collagen Vascular Diseases ◽  
Intravascular Coagulation ◽  
Fibrin Formation

SummaryIncreased fibrinopeptide A (FPA) levels have been reported in various non-thrombotic disorders, including cancer, acute myocardial infarction, liver cirrhosis and collagen vascular diseases. To investigate the significance of these findings, the present study combined the radioimmunoassay of FPA with that of fibrinogen/fibrin degradation fragment E (FgE) in the aforementioned disorders and compared the results with those observed in healthy subjects as well as in patients with thromboembolism and overt disseminated intravascular coagulation (DIC). Mean FPA and FgE in malignancy were 6.3 and 305 ng/ml, in myocardial infarction 5.6 and 98 ng/ml, in liver cirrhosis 2.7 and 132 ng/ml and in collagen vascular diseases 5.6 and 142 ng/ml. All these values were significantly higher than in healthy controls (mean FPA 1.6 ng/ml, mean FgE 49 ng/ml) but significantly lower than in thromboembolism (mean FPA 10.7 ng/ml, mean FgE 639 ng/ ml) and DIC (mean FPA 22.0 ng/ml, mean FgE 1041 ng/ml). The overall correlation between FPA and FgE was highly significant. Elowever, different disorders showed peculiar patterns in FPA, FgE and fibrinogen levels. In malignancy, a definite increase of FPA, FgE and plasma fibrinogen levels was observed. This finding probably indicates a compensated state of (intra- or extravascular) fibrin formation and lysis. Acute myocardial infarction was characterized by a high FPA to FgE ratio, which is interpreted to reflect acute thrombin generation and fibrin formation. FPA in cirrhosis was only marginally elevated with most single values within the normal range, indicating that intravascular coagulation was infrequent and unimportant in quantitative terms.

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