Beta-interferon and mortality in multiple sclerosis: a population-based international study
ECTRIMS Online Library. Kingwell E. 10/27/17; 202576; 218
Dr. Elaine Kingwell
Dr. Elaine Kingwell
Contributions
Abstract

Abstract: 218

Type: Oral

Abstract Category: Therapy - disease modifying - 28 Long-term treatment monitoring

Background: Whether beta-interferon (IFNB) prolongs survival for people with MS is unclear. We investigated the association between IFNB treatment and all-cause mortality in the 'real world' clinical setting.
Methods: We accessed prospectively collected data on relapsing-remitting (RRMS) onset patients including sex, birth date, Expanded Disability Status Scale (EDSS) scores and disease modifying treatments (DMTs), from British Columbia, Canada and Rennes, France. Data were linked to population-based administrative databases capturing death dates in both countries and, in Canada, drug prescriptions filled, universal health care registration, hospital admissions and physician visits. Patients were DMT-naïve at study entry, and followed from the earliest of first MS clinic visit, 18th birthday or 01/Jan/96 to the earliest of death, emigration or 31/Dec/13. Using a nested case control design, up to 20 MS controls were randomly selected by incidence density sampling and matched to MS cases (patients who died during follow-up) by sex, age+/-5 years, calendar year and EDSS at study entry. The association between all-cause mortality and IFNB exposure (>6 mths) was estimated by conditional logistic regression, expressed as odds ratios (OR), and adjusted for glatiramer acetate (>6 mths exposure), any exposure to another DMT, age, and comorbidity burden. Analyses were stratified by sex and country. The association with cumulative exposure to IFNB (up to 3 yrs or >3 yrs) was explored.
Results: The cohort included 7009 RRMS patients (75% women) with a median age at study entry of 42 yrs. During follow-up (median 12.3 yrs), 30% were exposed to IFNB, 11% to glatiramer acetate, and 12% to other DMTs including MS-specific immunosuppressants. Up to 20 controls were successfully matched to each of 649 cases (mean age at death 60 yrs). The odds of exposure to IFNB was 32% lower among cases than controls (OR:0.68;95%CI:0.52-0.89). Stratification by sex or country did not change interpretation of findings. Compared to no/minimal exposure, a longer cumulative time on IFNB (>3 yrs) was associated with increased survival (OR:0.44;95%CI:0.30-0.66), whereas < 3 yrs was not (OR:1.00;95%CI:0.73-1.39).
Conclusions: IFNB was associated with a lower risk of all-cause mortality among MS patients treated in clinical practice over an observation period of up to 18 years. Findings were consistent across two geographically distinct regions including North America (Canada) and Europe (France).
Disclosure:
Dr Kingwell was funded through research grants from the National MS Society (PI: Tremlett; RG#:5064-A-5) and the French ARSEP Foundation for this work.
Dr Leray received research support for this study from the French ARSEP Foundation. Outside of the submitted work, other sources of funding in the past year included the French National Security Agency of Medicines and Health Products, the EDMUS Foundation, and donation from Roche SAS. Dr Leray reports personal fees as speaker or consultant from Novartis and Sanofi Genzyme, and travel grants from Novartis and Roche SAS.
Mr Zhu was funded through research grants from the National MS Society (PI: Tremlett; RG#:5064-A-5) and the French ARSEP Foundation for this work.
Dr Petkau holds research funding from the Natural Sciences and Engineering Research Council of Canada (NSERC), and over the past year has received consulting fees or fees for service on Data Safety Monitoring Boards from the Canadian Study Group on CCSVI, Novartis, and Teva Pharmaceuticals Europe.
Dr. Edan reports personal fees from Sanofi, and personal fees and grants from Bayer, Merck Serono, Teva Pharma, Biogenidec, and Novartis, all outside the submitted work.
Dr Oger has received support from the Christopher Foundation and the University of British Columbia. He has received fees for service from the Medical Services Commission of British Columbia and consulting fees from Novartis, Bayer, Biogen-Idec, Genentech, Serono and Teva.
Dr Tremlett is the Canada Research Chair for Neuroepidemiology and Multiple Sclerosis and received research support for this study from the National Multiple Sclerosis Society (RG#:5064-A-5); other sources of funding in the last year included from: the Canadian Institutes of Health Research, the Multiple Sclerosis Society of Canada and the Multiple Sclerosis Scientific Research Foundation.

Abstract: 218

Type: Oral

Abstract Category: Therapy - disease modifying - 28 Long-term treatment monitoring

Background: Whether beta-interferon (IFNB) prolongs survival for people with MS is unclear. We investigated the association between IFNB treatment and all-cause mortality in the 'real world' clinical setting.
Methods: We accessed prospectively collected data on relapsing-remitting (RRMS) onset patients including sex, birth date, Expanded Disability Status Scale (EDSS) scores and disease modifying treatments (DMTs), from British Columbia, Canada and Rennes, France. Data were linked to population-based administrative databases capturing death dates in both countries and, in Canada, drug prescriptions filled, universal health care registration, hospital admissions and physician visits. Patients were DMT-naïve at study entry, and followed from the earliest of first MS clinic visit, 18th birthday or 01/Jan/96 to the earliest of death, emigration or 31/Dec/13. Using a nested case control design, up to 20 MS controls were randomly selected by incidence density sampling and matched to MS cases (patients who died during follow-up) by sex, age+/-5 years, calendar year and EDSS at study entry. The association between all-cause mortality and IFNB exposure (>6 mths) was estimated by conditional logistic regression, expressed as odds ratios (OR), and adjusted for glatiramer acetate (>6 mths exposure), any exposure to another DMT, age, and comorbidity burden. Analyses were stratified by sex and country. The association with cumulative exposure to IFNB (up to 3 yrs or >3 yrs) was explored.
Results: The cohort included 7009 RRMS patients (75% women) with a median age at study entry of 42 yrs. During follow-up (median 12.3 yrs), 30% were exposed to IFNB, 11% to glatiramer acetate, and 12% to other DMTs including MS-specific immunosuppressants. Up to 20 controls were successfully matched to each of 649 cases (mean age at death 60 yrs). The odds of exposure to IFNB was 32% lower among cases than controls (OR:0.68;95%CI:0.52-0.89). Stratification by sex or country did not change interpretation of findings. Compared to no/minimal exposure, a longer cumulative time on IFNB (>3 yrs) was associated with increased survival (OR:0.44;95%CI:0.30-0.66), whereas < 3 yrs was not (OR:1.00;95%CI:0.73-1.39).
Conclusions: IFNB was associated with a lower risk of all-cause mortality among MS patients treated in clinical practice over an observation period of up to 18 years. Findings were consistent across two geographically distinct regions including North America (Canada) and Europe (France).
Disclosure:
Dr Kingwell was funded through research grants from the National MS Society (PI: Tremlett; RG#:5064-A-5) and the French ARSEP Foundation for this work.
Dr Leray received research support for this study from the French ARSEP Foundation. Outside of the submitted work, other sources of funding in the past year included the French National Security Agency of Medicines and Health Products, the EDMUS Foundation, and donation from Roche SAS. Dr Leray reports personal fees as speaker or consultant from Novartis and Sanofi Genzyme, and travel grants from Novartis and Roche SAS.
Mr Zhu was funded through research grants from the National MS Society (PI: Tremlett; RG#:5064-A-5) and the French ARSEP Foundation for this work.
Dr Petkau holds research funding from the Natural Sciences and Engineering Research Council of Canada (NSERC), and over the past year has received consulting fees or fees for service on Data Safety Monitoring Boards from the Canadian Study Group on CCSVI, Novartis, and Teva Pharmaceuticals Europe.
Dr. Edan reports personal fees from Sanofi, and personal fees and grants from Bayer, Merck Serono, Teva Pharma, Biogenidec, and Novartis, all outside the submitted work.
Dr Oger has received support from the Christopher Foundation and the University of British Columbia. He has received fees for service from the Medical Services Commission of British Columbia and consulting fees from Novartis, Bayer, Biogen-Idec, Genentech, Serono and Teva.
Dr Tremlett is the Canada Research Chair for Neuroepidemiology and Multiple Sclerosis and received research support for this study from the National Multiple Sclerosis Society (RG#:5064-A-5); other sources of funding in the last year included from: the Canadian Institutes of Health Research, the Multiple Sclerosis Society of Canada and the Multiple Sclerosis Scientific Research Foundation.

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