Multiple sclerosis (MS) is a neurodegenerative disease accumulating disabilities over time. However, the mean age of individuals with MS is increasing, consequently elevating their risk of developing ...comorbidities. Comorbidities' impact on MS is widely debated. Yet very few countries possess population-based registries, which provide unique opportunities for individual-level data linkage. This study aims to assess acute and chronic comorbidities among elderly patients with MS, comparing them to matched controls. Additionally, this study seeks to investigate the influence of chronic comorbidities on all-cause mortality.
A nationwide register-based study using the Danish Multiple Sclerosis Registry to identify all living patients with MS older than 50 years at the reference date (January 1st, 2022). Patients were matched 1:10 with individuals from the general population. Comprehensive healthcare data within the Danish hospital system were obtained. Chronic comorbidities were classified according to the Charlson Comorbidity Index, while acute comorbidities were based on ICD-10 codes and an "acute" admission type. To investigate all-cause mortality, a Cox regression analysis was conducted.
The study encompassed a total of 8,688 individuals with MS, matched with 86,880 controls. The mean age was 63.5 years, with females constituting 68.3%. Individuals with MS exhibited a higher frequency of acute hospitalizations (OR: 2.1, 95% CI: 1.9-2.2), primarily due to various infectious diseases, along with longer median hospital stays (4 vs. 3 days,
< 0.001). When assessed using the Charlson Comorbidity Index, individuals with MS carried a significantly greater burden of chronic comorbidities (
< 0.001). The most prevalent chronic comorbidity among individuals with MS was "Uncomplicated Diabetes" (20.1%). Notably, while individuals with MS displayed an overall lower 5-year survival rate, this difference ceased to be statistically significant among those with a high Charlson Comorbidity Index score of ≥4 (
= 0.32).
This study highlights a heightened prevalence of both acute and chronic comorbidities among individuals with MS, with chronic comorbidities significantly increasing the risk of mortality. These findings underscore the critical importance of factoring in comorbidities when devising treatment strategies for individuals living with MS.
Multiple sclerosis (MS) leads to physical and cognitive disability, which in turn impacts the socioeconomic status of the individual. The altered socioeconomic trajectory combined with the critical ...role of aging in MS progression could potentially lead to pronounced differences between MS patients and the general population. Few nations have the ability to connect long-term clinical and socioeconomic data at the individual level, and Denmark's robust population-based registries offer unique insights. This study aimed to examine the socioeconomic aspects of elderly Danish MS patients in comparison to matched controls from the general population.
A nationwide population-based study in Denmark was conducted, comprising all living MS patients aged 50 years or older as of 1 January 2021. Patients were matched 1:10 based on sex, age, ethnicity, and residence with a 25% sample of the total Danish population. Demographic and clinical information was sourced from the Danish Multiple Sclerosis Registry, while socioeconomic data were derived from national population-based registries containing details on education, employment, social services, and household characteristics. Univariate comparisons between MS patients and matched controls were then carried out.
The study included 8,215 MS patients and 82,150 matched individuals, with a mean age of 63.4 years (SD: 8.9) and a 2:1 female-to-male ratio. For those aged 50-64 years, MS patients demonstrated lower educational attainment (high education: 28.3 vs. 34.4%,
< 0.001) and fewer received income from employment (46.0 vs. 78.9%,
< 0.001), and working individuals had a lower annual income (48,500 vs. 53,500€,
< 0.001) in comparison to the controls. Additionally, MS patients within this age group were more likely to receive publicly funded practical assistance (14.3 vs. 1.6%,
< 0.001) and personal care (10.5 vs. 0.8%,
< 0.001). Across the entire population, MS patients were more likely to live alone (38.7 vs. 33.8%,
< 0.001) and less likely to have one or more children (84.2 vs. 87.0%,
< 0.001).
MS presents significant socioeconomic challenges among the elderly population, such as unemployment, reduced income, and increased dependence on social care. These findings underscore the pervasive impact of MS on an individual's life course, extending beyond the clinical symptoms of cognitive and physical impairment.
•A period of uncertainty precedes the assignation of secondary progressive MS.•The median uncertainty period among Danish patients was 2.12 years.•Two objective classifiers were tested in a Danish ...longitudinal setting.•The objective classifiers show potential to help shorten the uncertainty period.•Limitations questions the future of the objective classifiers in their current form.
The clinical transition from relapsing-remitting multiple sclerosis (RRMS) to secondary progressive MS (SPMS) is often related to a period of diagnostic uncertainty delaying diagnosis. With emerging treatment options for SPMS how to identify RRMS patients at risk of SPMS and when to assign a SPMS diagnosis has become a matter of growing clinical concern. This study aimed to determine the period of diagnostic uncertainty among Danish MS patients. Secondly, this study examined the performance of two objective classifiers in a longitudinal setting regarding their ability to shorten the period of diagnostic uncertainty.
By using the Danish Multiple Sclerosis Registry, we identified all patients linked to Rigshospitalet with clinically assigned SPMS from 2010 to 2021. We reviewed all patient records and identified the first mentioned sign of progression (FMP). The time between the dates of FMP and clinically assigned SPMS was defined as the period of diagnostic uncertainty. Secondly, we applied two objective classifiers (the Karolinska Decision tree and the MSBase criteria) to generate suggested transition dates and compared them to the ones obtain from the patient records. Detailed descriptions of the population were made at all mentioned timepoints.
In total 138 patients were included. We found a median period of diagnostic uncertainty of 2.12 years. The objective classifiers generated a median suggested transition date 3.44 and 4.48 years earlier than the date of clinically assigned SPMS, but they only provided an earlier SPMS transition date in 50.72% and 55.80% of cases.
Our findings emphasize the uncertainty related to the transition from RRMS to SPMS illustrating the need of an improved diagnostic approach. Objective classifiers might have the potential to help reduce the period of diagnostic uncertainty in the future, but in their current form they do not perform satisfactorily enough to solve all difficulties related to detecting SPMS-transition.
Fingolimod is a frequently used disease-modifying therapy in relapsing-remitting multiple sclerosis. However, case reports and small observational studies indicate a highly increased risk of disease ...reactivation after discontinuation. We aimed to investigate the risk of radiological disease reactivation in patients discontinuing fingolimod. We performed a nationwide cohort study in Denmark, including patients who discontinued fingolimod between January 2014 and January 2023. Eligibility was a diagnosis with relapsing-remitting multiple sclerosis and two MRIs performed respectively within 1 year before and after discontinuing fingolimod. The included patients were compared with those discontinuing dimethyl fumarate with the same eligibility criteria in an unadjusted and matched propensity score analysis. Matching was done on age, sex, Expanded Disability Status Scale, MRI data, cause for treatment discontinuation, treatment duration and relapse rate. The main outcome was the presence of new T
lesions on the first MRI after treatment discontinuation. To identify high-risk patients among those discontinuing fingolimod, we made a predictive model assessing risk factors for obtaining new T
lesions. Of 1324 patients discontinuing fingolimod in the study period, 752 were eligible for inclusion mean age (standard deviation), years, 41 (10); 552 females (73%); median Expanded Disability Status Scale (Q1-Q3), 2.5 (2.0-3.5); mean disease duration (standard deviation), years, 12 (8). Of 2044 patients discontinuing dimethyl fumarate in the study period, 957 were eligible for inclusion, presenting similar baseline characteristics. Among patients discontinuing fingolimod, 127 (17%) had 1-2 new T
lesions, and 124 (17%) had ≥3 new T
lesions compared with 114 (12%) and 45 (5%), respectively, for those discontinuing dimethyl fumarate, corresponding to odds ratios (95% confidence interval) of 1.8 (1.3-2.3) and 4.4 (3.1-6.3). The predictive model, including 509 of the 752 patients discontinuing fingolimod, showed a highly increased risk of new T
lesions among those with disease activity during fingolimod treatment and among females under 40 years. This nationwide study suggests that discontinuing fingolimod in some cases carries a risk of developing new T
lesions, emphasizing the importance of clinical awareness. If feasible, clinicians should prioritize the prompt initiation of new disease-modifying therapies, particularly among young females.
Abstract Fingolimod is a frequently used disease-modifying therapy in relapsing–remitting multiple sclerosis. However, case reports and small observational studies indicate a highly increased risk of ...disease reactivation after discontinuation. We aimed to investigate the risk of radiological disease reactivation in patients discontinuing fingolimod. We performed a nationwide cohort study in Denmark, including patients who discontinued fingolimod between January 2014 and January 2023. Eligibility was a diagnosis with relapsing–remitting multiple sclerosis and two MRIs performed respectively within 1 year before and after discontinuing fingolimod. The included patients were compared with those discontinuing dimethyl fumarate with the same eligibility criteria in an unadjusted and matched propensity score analysis. Matching was done on age, sex, Expanded Disability Status Scale, MRI data, cause for treatment discontinuation, treatment duration and relapse rate. The main outcome was the presence of new T2 lesions on the first MRI after treatment discontinuation. To identify high-risk patients among those discontinuing fingolimod, we made a predictive model assessing risk factors for obtaining new T2 lesions. Of 1324 patients discontinuing fingolimod in the study period, 752 were eligible for inclusion mean age (standard deviation), years, 41 (10); 552 females (73%); median Expanded Disability Status Scale (Q1–Q3), 2.5 (2.0–3.5); mean disease duration (standard deviation), years, 12 (8). Of 2044 patients discontinuing dimethyl fumarate in the study period, 957 were eligible for inclusion, presenting similar baseline characteristics. Among patients discontinuing fingolimod, 127 (17%) had 1–2 new T2 lesions, and 124 (17%) had ≥3 new T2 lesions compared with 114 (12%) and 45 (5%), respectively, for those discontinuing dimethyl fumarate, corresponding to odds ratios (95% confidence interval) of 1.8 (1.3–2.3) and 4.4 (3.1–6.3). The predictive model, including 509 of the 752 patients discontinuing fingolimod, showed a highly increased risk of new T2 lesions among those with disease activity during fingolimod treatment and among females under 40 years. This nationwide study suggests that discontinuing fingolimod in some cases carries a risk of developing new T2 lesions, emphasizing the importance of clinical awareness. If feasible, clinicians should prioritize the prompt initiation of new disease-modifying therapies, particularly among young females.
BackgroundClinicians frequently rely on relapse counts, T2 MRI lesion load (T2L) and Expanded Disability Status Scale (EDSS) scores to guide treatment decisions for individuals diagnosed with ...multiple sclerosis (MS). This study evaluates how these factors, along with age and sex, influence prognosis during treatment with teriflunomide (TFL).MethodsWe conducted a nationwide cohort study using data from the Danish Multiple Sclerosis Registry.Eligible participants had relapsing-remitting MS or clinically isolated syndrome and initiated TFL as their first treatment between 2013 and 2019. The effect of age, pretreatment relapses, T2L and EDSS scores on the risk of disease activity on TFL were stratified by sex.ResultsIn total, 784 individuals were included (57.4% females). A high number of pretreatment relapses (≥2) was associated with an increased risk of disease activity in females only (OR and (95% CI): 1.76 (1.11 to 2.81)). Age group 50+ was associated with a lower risk of disease activity in both sexes (OR females=0.28 (0.14 to 0.56); OR males=0.22 (0.09 to 0.55)), while age 35–49 showed a different impact in males and females (OR females=0.79 (0.50 to 1.23); OR males=0.42 (0.24 to 0.72)). EDSS scores and T2L did not show any consistent associations.ConclusionA high number of pretreatment relapses was only associated with an increased risk of disease activity in females, while age had a differential impact on the risk of disease activity according to sex. Clinicians may consider age, sex and relapses when deciding on TFL treatment.
Using Patient Reported Outcomes (PRO) in meetings between patients and healthcare professionals (HCPs) can strengthen patient involvement and improve quality of care. The purpose of this study was to ...investigate how PRO-data becomes meaningful to use for both people with Multiple Sclerosis (PwMS) and HCPs.
The study consisted of 1) a systematic literature study, where existing PRO questionnaires within the MS area and whether patients have been involved in the development of them were mapped, 2) an interview study, where PwMS’ perspective on PRO was investigated, 3) a workshop where HCPs perspective on PRO was investigated.
There is an increased need to involve PwMS in developing PRO if PRO should be relevant for PwMS. For PRO questionnaires to be meaningful for both PwMS and HCPs, it should be possible to individualize the use of PRO as the disease, and symptom profile of MS can vary greatly. It should also be considered whether all patients benefit from PRO. To hold what is relevant for PwMS to discuss with HCPs, PRO questionnaires should include neurological symptoms, cognitive impairments, mental health and well-being, self-care, and social challenges related to MS. However, it is important to be aware that the HCP should have the competencies to handle these areas of MS. This is so that the HCPs can give evident advice about symptoms and treatment, but also, for the patient to receive the best possible treatment and guidance. Furthermore, it must not be time-consuming for the HCPs to use nor for the patients to complete PROs. However, whether the Danish healthcare system is prepared to incorporate an initiative as PRO, reflecting both patients’ and HCPs’ wishes and needs, can be discussed.
Brug af Patientrapporterede Oplysninger (PRO) i mødet mellem patient og sundhedsprofessionel kan styrke patientinddragelsen og højne behandlingskvaliteten. Formålet med dette studie er at undersøge, hvordan PRO bliver relevant og meningsfuldt at anvende for både personer med multipel sclerose (MS) og sundhedsprofessionelle.
Undersøgelsen bestod af 1) et systematisk litteraturstudie, hvor eksisterende PRO-spørgeskemaer indenfor MS-området, og hvorvidt der har været inddraget patienter i udviklingen af dem, blev kortlagt2) en interviewundersøgelse, hvor personer med MS’ perspektiv på PRO blev undersøgt, 3) en workshop hvor sundhedsprofessionelles perspektiv på PRO blev undersøgt.
Der er et øget behov for at inddrage personer med MS i udviklingen af PRO, hvis PRO skal være relevant for personer med MS samt fremme personcentrering i MS-behandlingen. For at PRO-spørgeskemaer bliver meningsfulde for både personer med MS og sundhedsprofessionelle at anvende, skal PRO kunne tilpasses den enkelte patient, da sygdomsforløbet og symptomprofilen for personer med MS kan variere meget. Imidlertid bør det overvejes om alle patienter har gavn af PRO. For at favne, hvad der for personer med MS er relevant at drøfte med en sundhedsprofessionel, bør PRO-spørgeskemaer omfatte neurologiske symptomer, kognitive funktionsnedsættelser, mental sundhed og velvære, egenomsorg og sociale udfordringer relateret til MS. Dog bør dette afstemmes ift. den sundhedsprofessionelles kompetencer, både for at den sundhedsprofessionelle oplever at kunne give evidente råd om symptomer og behandling, men også for at patienten modtager den bedst mulige behandling og vejledning. Desuden må PRO ikke være tidskrævende, hverken for de sundhedsprofessionelle at anvende eller for patienterne at udfylde. Imidlertid kan det diskuteres, hvorvidt det danske sundhedsvæsen rustet og organiseret til at inkorporerer et tiltag som PRO, som reflekterer både patienter og sundhedsprofessionelles ønsker og behov.
Etablering af fælles fodslag Steenberg, Josephine Lyngh; Hørmann Thomsen, Trine; Lynning, Marie ...
Tidsskrift for Forskning i Sygdom og Samfund,
12/2023, Letnik:
21, Številka:
39
Journal Article
Recenzirano
Brug af Patientrapporterede Oplysninger (PRO) i mødet mellem patient og sundhedsprofessionel kan styrke patientinddragelsen og højne behandlingskvaliteten. Formålet med dette studie er at undersøge, ...hvordan PRO bliver relevant og meningsfuldt at anvende for både personer med multipel sclerose (MS) og sundhedsprofessionelle.
Undersøgelsen bestod af 1) et systematisk litteraturstudie, hvor eksisterende PRO-spørgeskemaer indenfor MS-området, og hvorvidt der har været inddraget patienter i udviklingen af dem, blev kortlagt2) en interviewundersøgelse, hvor personer med MS’ perspektiv på PRO blev undersøgt, 3) en workshop hvor sundhedsprofessionelles perspektiv på PRO blev undersøgt.
Der er et øget behov for at inddrage personer med MS i udviklingen af PRO, hvis PRO skal være relevant for personer med MS samt fremme personcentrering i MS-behandlingen. For at PRO-spørgeskemaer bliver meningsfulde for både personer med MS og sundhedsprofessionelle at anvende, skal PRO kunne tilpasses den enkelte patient, da sygdomsforløbet og symptomprofilen for personer med MS kan variere meget. Imidlertid bør det overvejes om alle patienter har gavn af PRO. For at favne, hvad der for personer med MS er relevant at drøfte med en sundhedsprofessionel, bør PRO-spørgeskemaer omfatte neurologiske symptomer, kognitive funktionsnedsættelser, mental sundhed og velvære, egenomsorg og sociale udfordringer relateret til MS. Dog bør dette afstemmes ift. den sundhedsprofessionelles kompetencer, både for at den sundhedsprofessionelle oplever at kunne give evidente råd om symptomer og behandling, men også for at patienten modtager den bedst mulige behandling og vejledning. Desuden må PRO ikke være tidskrævende, hverken for de sundhedsprofessionelle at anvende eller for patienterne at udfylde. Imidlertid kan det diskuteres, hvorvidt det danske sundhedsvæsen rustet og organiseret til at inkorporerer et tiltag som PRO, som reflekterer både patienter og sundhedsprofessionelles ønsker og behov.
