scholarly journals Comparative effectiveness of dimethyl fumarate in Multiple Sclerosis

2021 ◽  
Author(s):  
Pauline Bosco-Lévy ◽  
Marc Debouverie ◽  
Bruno Brochet ◽  
Francis Guillemin ◽  
Céline Louapre ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Negative Binomial ◽  
Real Life ◽  
Negative Binomial Regression ◽  
Dimethyl Fumarate ◽  
Population Based ◽  
Disability Progression ◽  
Logistic Regression Models ◽  
Significant Difference ◽  
Using Data

Objectives: To assess the effectiveness of dimethyl fumarate (DMF) on annual rate of relapse (ARR) and disability progression in multiple sclerosis (MS) compared to injectable immunomodulators (IMM), teriflunomide (TERI) and fingolimob (FTY), in real life setting. Methods: A population-based cohort study was conducted using data of the French nationwide claims database, SNDS. All patients initiating IMM, TERI, FTY or DMF between July 1, 2015 and December 12, 2017, with 4.5 years of database history and 1 to 3.5 years of follow-up were included in this study. DMF patients were 1:1 matched to IMM, TERI or FTY using a high dimensional Propensity Score. Negative binomial regression and a logistic regression models were used to estimate the relative risk (RR ± [95% CI]) of ARR and the Odds Ratio (OR ± [95% CI]) of disability progression, respectively. Results: Overall, 9 304 subjects were identified: 29.0% initiated DMF, 33.2% TERI, 5.6% FTY and 32.2% an IMM. The matched cohorts consisted of 1779 DMF- IMM, patients, 1679 DMF-TERI patients, and 376 DMF-FTY patients. DMF significantly reduced ARR compared to IMM (RR 0.72 [0.61 - 0.86]) and TERI (0.81 [0.68 - 0.96]) and did not show any significant difference when compared with FTY The risk of the progression of MS specific disability was not significantly different for any matched cohorts. Interpretation: DMF is associated with lower risk of relapse for patients with RRMS than other first-line RRMS agents (TERI and IIM).

scholarly journals Comparative effectiveness of dimethyl fumarate in Multiple Sclerosis

2021 ◽  
Author(s):  
Pauline Bosco-Levy ◽  
Marc Debouverie ◽  
Bruno Brochet ◽  
Céline Louapre ◽  
Elisabeth Maillard ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Negative Binomial ◽  
Real Life ◽  
Logistic Models ◽  
Negative Binomial Regression ◽  
Dimethyl Fumarate ◽  
Population Based ◽  
Disability Progression ◽  
Real Life Setting ◽  
Using Data

Abstract Objectives: To assess the effectiveness of dimethyl fumarate (DMF) on annual rate of relapse (ARR) and disability progression in multiple sclerosis (MS) compared to injectable immunomodulators (IMM), teriflunomide (TERI) and fingolimob (FTY), in real life setting. Methods: A population-based cohort study was conducted using data of the French nationwide claims database, SNDS. All patients initiating IMM, TERI, FTY or DMF between July 1, 2015 and December 12, 2017, with 4.5 years of database history and 1 to 3.5 years of follow-up were included in this study. DMF patients were 1:1 matched to IMM, TERI or FTY using a high dimensional Propensity Score. Negative binomial regression and a regression logistic models were used to estimate the relative risk (RR ± [95% CI]) of ARR and the Odds Ratio (OR ± [95% CI]) of disability progression, respectively. Results: Overall, 9 304 subjects were identified: 29.0% initiated DMF, 33.2% TERI, 5.6% FTY and 32.2% an IMM. The matched cohorts consisted of 1779 DMF- IMM, patients, 1679 DMF-TERI patients, and 376 DMF-FTY patients. DMF significantly reduced ARR compared to IMM (RR 0.72 [0.61 - 0.86]) and TERI (0.81 [0.68 - 0.96]). The risk of the progression of MS specific disability was not significantly different for any matched cohorts.Interpretation: DMF is associated with lower risk of relapse for patients with RRMS than other first-line RRMS agents (TERI and IIM).

scholarly journals Natalizumab, Fingolimod and Dimethyl Fumarate Use and Pregnancy-Related Relapse and Disability in Women With Multiple Sclerosis

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012084
Author(s):  
Wei Zhen Yeh ◽  
Putu Ayu Widyastuti ◽  
Anneke Van der Walt ◽  
Jim Stankovich ◽  
Eva Havrdova ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cox Regression ◽  
Dimethyl Fumarate ◽  
Disability Progression ◽  
Third Trimester ◽  
Early Postpartum ◽  
Pregnancy And Postpartum ◽  
Relapsing Remitting ◽  
Effective Option ◽  
Using Data

Objective:To investigate pregnancy-related disease activity in a contemporary multiple sclerosis (MS) cohort.Methods:Using data from the MSBase Registry, we included pregnancies conceived after 31 Dec 2010 from women with relapsing-remitting MS or clinically isolated syndrome. Predictors of intrapartum relapse, and postpartum relapse and disability progression were determined by clustered logistic regression or Cox regression analyses.Results:We included 1998 pregnancies from 1619 women with MS. Preconception annualized relapse rate (ARR) was 0.29 (95% CI 0.27-0.32), fell to 0.19 (0.14-0.24) in third trimester, and increased to 0.59 (0.51-0.67) in early postpartum. Among women who used fingolimod or natalizumab, ARR before pregnancy was 0.37 (0.28-0.49) and 0.29 (0.22-0.37), respectively, and increased during pregnancy. Intrapartum ARR decreased with preconception dimethyl fumarate use. ARR spiked after delivery across all DMT groups. Natalizumab continuation into pregnancy reduced the odds of relapse during pregnancy (OR 0.76 per month [0.60-0.95], p=0.017). DMT re-initiation with natalizumab protected against postpartum relapse (HR 0.11 [0.04-0.32], p<0.0001). Breastfeeding women were less likely to relapse (HR 0.61 [0.41-0.91], p=0.016). 5.6% of pregnancies were followed by confirmed disability progression, predicted by higher relapse activity in pregnancy and postpartum.Conclusion:Intrapartum and postpartum relapse probabilities increased among women with MS after natalizumab or fingolimod cessation. In women considered to be at high relapse risk, use of natalizumab before pregnancy and continued up to 34 weeks gestation, with early re-initiation after delivery is an effective option to minimize relapse risks. Strategies of DMT use have to be balanced against potential fetal/neonatal complications.

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

2021 ◽  
pp. 135245852110634
Author(s):  
Huah Shin Ng ◽  
Feng Zhu ◽  
Elaine Kingwell ◽  
Yinshan Zhao ◽  
Shenzhen Yao ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
First Generation ◽  
Service Use ◽  
Second Generation ◽  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Population Based ◽  
Disease Modifying Drugs ◽  
Physician Visits ◽  
Disease Modifying

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.

scholarly journals Ownership Variation in Violated Regulations and National Care Standards: Evidence From Social Care Providers

2021 ◽  
pp. 089976402110014
Author(s):  
Anders M. Bach-Mortensen ◽  
Ani Movsisyan
Keyword(s):  
Social Care ◽  
Negative Binomial ◽  
Third Sector ◽  
Care Providers ◽  
Data Set ◽  
Logistic Regression Models ◽  
For Profit ◽  
Care Services ◽  
Significant Difference ◽  
Research Gap

Social care services are increasingly provisioned in quasi-markets in which for-profit, public, and third sector providers compete for contracts. Existing research has investigated the implications of this development by analyzing ownership variation in latent outcomes such as quality, but little is known about whether ownership predicts variation in more concrete outcomes, such as violation types. To address this research gap, we coded publicly available inspection reports of social care providers regulated by the Care Inspectorate in Scotland and created a novel data set enabling analysis of ownership variation in violations of (a) regulations, and (b) national care standards over an entire inspection year ( n = 4,178). Using negative binomial and logistic regression models, we find that for-profit providers are more likely to violate non-enforceable outcomes (national care standards) relative to other ownership types. We did not identify a statistically significant difference between for-profit and third sector providers with regard to enforceable outcomes (regulations).

scholarly journals Identifying Temporal Aggregation Effect on Crash-Frequency Modeling

2021 ◽  
Vol 13 (11) ◽  
pp. 6214
Author(s):  
Bumjoon Bae ◽  
Changju Lee ◽  
Tae-Young Pak ◽  
Sunghoon Lee
Keyword(s):  
Traffic Safety ◽  
Negative Binomial ◽  
Random Effect ◽  
Temporal Correlation ◽  
Negative Binomial Regression ◽  
Spatiotemporal Analysis ◽  
Parameter Estimates ◽  
Crash Frequency ◽  
Crash Frequency Modeling ◽  
Using Data

Aggregation of spatiotemporal data can encounter potential information loss or distort attributes via individual observation, which would influence modeling results and lead to an erroneous inference, named the ecological fallacy. Therefore, deciding spatial and temporal resolution is a fundamental consideration in a spatiotemporal analysis. The modifiable temporal unit problem (MTUP) occurs when using data that is temporally aggregated. While consideration of the spatial dimension has been increasingly studied, the counterpart, a temporal unit, is rarely considered, particularly in the traffic safety modeling field. The purpose of this research is to identify the MTUP effect in crash-frequency modeling using data with various temporal scales. A sensitivity analysis framework is adopted with four negative binomial regression models and four random effect negative binomial models having yearly, quarterly, monthly, and weekly temporal units. As the different temporal unit was applied, the result of the model estimation also changed in terms of the mean and significance of the parameter estimates. Increasing temporal correlation due to using the small temporal unit can be handled with the random effect models.

scholarly journals A comparative study of teriflunomide and dimethyl fumarate within the Swedish MS Registry

2021 ◽  
pp. 135245852110196
Author(s):  
Jan Hillert ◽  
Jon A Tsai ◽  
Mona Nouhi ◽  
Anna Glaser ◽  
Tim Spelman
Keyword(s):  
Multiple Sclerosis ◽  
Real World ◽  
Clinical Effectiveness ◽  
Dimethyl Fumarate ◽  
Population Based ◽  
Life Outcomes ◽  
Treatment Persistence ◽  
Relapsing Remitting ◽  
Relapsing Remitting Multiple Sclerosis

Background: Teriflunomide and dimethyl fumarate (DMF) are first-line disease-modifying treatments for multiple sclerosis with similar labels that are used in comparable populations. Objectives: The objective of this study was to compare the effectiveness and persistence of teriflunomide and DMF in a Swedish real-world setting. Methods: All relapsing-remitting multiple sclerosis (RRMS) patients in the Swedish MS registry initiating teriflunomide or DMF were included in the analysis. The primary endpoint was treatment persistence. Propensity score matching was used to adjust comparisons for baseline confounders. Results: A total of 353 teriflunomide patients were successfully matched to 353 DMF. There was no difference in the rate of overall treatment discontinuation by treatment group across the entire observation period (hazard ratio (HR) = 1.12; 95% confidence interval (CI) = 0.91–1.39; p = 0.277; reference = teriflunomide). Annualised relapse rate (ARR) was comparable ( p = 0.237) between DMF (0.07; 95% CI = 0.05–0.10) and teriflunomide (0.09; 95% CI = 0.07–0.12). There was no difference in time to first on-treatment relapse (HR = 0.78; 95% CI = 0.50–1.21), disability progression (HR = 0.55; 95% CI = 0.27–1.12) or confirmed improvement (HR = 1.17; 95% CI = 0.57–2.36). Conclusion: This population-based real-world study reports similarities in treatment persistence, clinical effectiveness and quality of life outcomes between teriflunomide and dimethyl fumarate.

Support for cigarette filter waste policies among US adults

2021 ◽  
pp. tobaccocontrol-2020-056451
Author(s):  
Minal Patel ◽  
Alison F Cuccia ◽  
Shanell Folger ◽  
Adam F Benson ◽  
Donna Vallone ◽  
...  
Keyword(s):  
Smoking Status ◽  
Population Based ◽  
Tobacco Product ◽  
Cross Sectional ◽  
Cigarette Filter ◽  
Logistic Regression Models ◽  
Knowledge And Beliefs ◽  
Cigarette Butts ◽  
Using Data ◽  
The Impact

IntroductionLittle is known on whether cigarette filter-related knowledge or beliefs are associated with support for policies to reduce their environmental impact.MethodsA cross-sectional, population-based sample of US adults aged 18–64 years (n=2979) was used to evaluate filter-related knowledge and beliefs by smoking status using data collected between 24 October 2018 and 17 December 2018. Multivariate logistic regression models explored whether these knowledge and belief items were associated with support for two policies, a US$0.75 litter fee and a ban on sales of filtered cigarettes, controlling for demographic characteristics and smoking status.ResultsRegardless of smoking status, 71% did not know plastic was a cigarette filter component and 20% believed filters were biodegradable. Overall, 23% believed filters reduce health harms and 60% believed filters make it easier to smoke; 90% believed cigarette butts are harmful to the environment. Individuals believing cigarette butts harmed the environment were more likely to support a litter fee (adjusted OR (aOR)=2.33, 95% CI: 1.71 to 3.17). Individuals believing that filters are not biodegradable had higher odds of supporting a litter fee (OR=1.47, 95% CI: 1.15 to 1.88). Respondents believing that filters do not make cigarettes less harmful were more likely to support a litter fee (aOR=1.50, 95% CI: 1.20 to 1.88) and filter ban (aOR=2.03, 95% CI: 1.64 to 2.50). Belief that filters make it easier to smoke was associated with decreased support for a filter ban (aOR=0.69, 95% CI: 0.58 to 0.83).ConclusionsComprehensive efforts are needed to educate the public about the impact of cigarette filters in order to build support for effective tobacco product waste policy.

Managing Inflation

2016 ◽  
Vol 63 (1) ◽  
pp. 77-87 ◽  
Author(s):  
William H. Fisher ◽  
Stephanie W. Hartwell ◽  
Xiaogang Deng
Keyword(s):  
Count Data ◽  
Regression Models ◽  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Excess Zeros ◽  
Binomial Regression ◽  
Negative Binomial Models ◽  
Using Data ◽  
Over Dispersion ◽  
Binomial Models

Poisson and negative binomial regression procedures have proliferated, and now are available in virtually all statistical packages. Along with the regression procedures themselves are procedures for addressing issues related to the over-dispersion and excessive zeros commonly observed in count data. These approaches, zero-inflated Poisson and zero-inflated negative binomial models, use logit or probit models for the “excess” zeros and count regression models for the counted data. Although these models are often appropriate on statistical grounds, their interpretation may prove substantively difficult. This article explores this dilemma, using data from a study of individuals released from facilities maintained by the Massachusetts Department of Correction.

Clinical predictors of Dimethyl Fumarate response in multiple sclerosis: a real life multicentre study

2020 ◽  
Vol 38 ◽  
pp. 101871 ◽  
Author(s):  
R. Lanzillo ◽  
M. Moccia ◽  
R. Palladino ◽  
E. Signoriello ◽  
A. Carotenuto ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Multicentre Study ◽  
Real Life ◽  
Dimethyl Fumarate ◽  
Clinical Predictors

Safety Evaluation of Horizontal Alignment Design Consistency on Rural Two-Lane Highways

2019 ◽  
Vol 2673 (2) ◽  
pp. 628-636 ◽  
Author(s):  
Ian Hamilton ◽  
Scott Himes ◽  
R. J. Porter ◽  
Eric Donnell
Keyword(s):  
Negative Binomial ◽  
Safety Evaluation ◽  
Negative Binomial Regression ◽  
Expected Number ◽  
Horizontal Alignment ◽  
Highway Safety Manual ◽  
Horizontal Curves ◽  
Alternative Measures ◽  
Using Data ◽  
Design Consistency

Design consistency in the context of highway and street design refers to the conformance of highway geometry to driver expectancy. Existing design policies provide guidance related to horizontal alignment design consistency. While design consistency has safety implications and is intuitively linked to roadway departure crashes, the authors are only aware of a few studies that sought to link measures of design consistency to safety performance. This study explores relationships between alternative measures of horizontal alignment design consistency and the expected number of roadway departure crashes along horizontal curves on rural, two-lane, two-way roads. The authors analyzed 854 horizontal curves on rural two-lane highways in Indiana and Pennsylvania using data obtained from the SHRP 2 Roadway Information Database (RID) 2.0. Relationships between measures of design consistency and the expected number of roadway departure crashes were explored using a negative binomial regression modeling approach. The results indicate a relationship between the frequency of roadway departure crashes on a study curve and the radii of upstream and downstream curves. The ratio of the length of upstream and downstream tangents relative to a study curve radius was also statistically significant in Pennsylvania. Such findings are intuitive given the concept of design consistency and represent an advancement to existing predictive methods in the AASHTO Highway Safety Manual, which estimate the expected number of crashes on a segment as a function of the characteristics of only that segment.

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