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Impact of comorbidity and DMT use on disability status by DMT group in participants in the Pacific Northwest MS Registry
Author(s): ,
E. Baraban
Affiliations:
Providence Health and Services, Portland, OR
,
T. Stuchiner
Affiliations:
Providence Health and Services, Portland, OR
,
L. Lucas
Affiliations:
Providence Health and Services, Portland, OR
,
C. Chen
Affiliations:
Providence Health and Services, Portland, OR
,
L. Hashemi
Affiliations:
Sanofi, Cambridge, MA, United States
,
A. Ranno
Affiliations:
Sanofi, Cambridge, MA, United States
,
A. Smith
Affiliations:
Sanofi, Cambridge, MA, United States
S.L. Cohan
Affiliations:
Providence Health and Services, Portland, OR
ECTRIMS Online Library. Baraban E. Oct 12, 2018; 228890
Elizabeth Baraban
Elizabeth Baraban
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Abstract: P1049

Type: Poster Sessions

Abstract Category: Clinical aspects of MS - Comorbidity

Introduction: Comorbidities may have a negative impact on disability in MS patients. MS disease modifying therapy (DMT) may potentially moderate the effect of comorbidities. Little is known about the relationship between DMT use and comorbidities with regard to disability in people with MS.
Aims: To determine the impact of different DMTs and comorbidities on disability among participants in the Pacific Northwest Multiple Sclerosis Registry in the USA.
Methods: The study used self-reported data for participants who registered between 2011 and 2016. Those not receiving DMT were excluded. Comorbidities included diabetes, cancer, depression, smoking, cardiovascular, respiratory, thyroid, and gastrointestinal disease. DMTs were grouped by type: self-injectable (beta interferons and glatiramer acetate), oral therapy (teriflunomide, dimethyl fumarate, and fingolimod), and infusion (IV) therapy (alemtuzumab, rituximab, natalizumab, and ocrelizumab). Disability was measured using the Patient Determined Disease Steps (PDDS), and categorised as: normal or mild (0-1) or moderate or greater (2-8). Multiple logistic regression was used to analyse the impact of comorbidity and DMT type on disability, adjusting for participant characteristics. Interactions between DMT type and comorbidity with post-hoc comparisons were used to examine possible moderating effects of DMT type among patients with comorbidities.
Results: Of the 908 participants included in the analyses, 55.3% (n=502) were on self-injectable, 34.1% (n=310) were on oral, and 10.6% (n=96) were on IV therapy. Participants with diabetes (Adjusted Odds Ratio [AOR]=2.83, P=0.009), depression (AOR=2.10, P< 0.001), and respiratory disease (AOR=1.99, P=0.004) were significantly more likely to report moderate or greater disability. The interaction between DMT and diabetes (P=0.019) was also significant. However, post-hoc comparisons showed no significant differences in disability between DMT types for participants with diabetes.
Conclusion: Participants with diabetes, depression, or respiratory disease were most likely to report greater disability. For these participants, there was no evidence of moderating effects of certain DMT types. Increased cohort size of patients with comorbidities may reveal statistically significant DMT and comorbidity interactions. However, the impact of comorbidities may override the potential disability benefits of DMTs and should prompt clinicians to focus on the overall health of MS patients.
Disclosure: EB, TS, LL, and CC: Nothing to disclose. LH, AR and AS: Employees of Sanofi. SLC: Advisory boards or steering committees (Biogen, Mallinckrodt, Novartis, and Sanofi); research support and/or speaker honoraria (Acorda, Biogen, Genentech, IMS Health, Mallinckrodt, Novartis, Roche, and Sanofi). STUDY SUPPORT: Sanofi.

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