Risk of comorbidity in patients with multiple sclerosis: a nationwide cohort study in Sweden
ECTRIMS Online Library. Piehl F. 09/13/19; 279535; 272
Fredrik Piehl
Fredrik Piehl
Contributions
Abstract

Abstract: 272

Type: Scientific Session

Abstract Category: Clinical aspects of MS - Epidemiology

F. Piehl1, A. Castelo-Branco2, F. Chiesa2, S. Conte2, M. Rosenlund2, S. Lee3, N. Minton3, S. Niemcryk3, A. Lindholm3, S. Montgomery4,5,6

1Department of Neurology, Karolinska University Hospital, 2Real-World Insights, IQVIA Nordics, Solna, Sweden, 3Celgene Corporation, Summit, NJ, United States, 4Clinical Epidemiology and Biostatistics, Örebro University Hospital and Örebro University, Örebro, 5Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden, 6Department of Epidemiology and Public Health, University College London, London, United Kingdom

Introduction: Substantial progress in the treatment of multiple sclerosis (MS) has been made since the 1990s. However, the presence of comorbidity and the impact of treatment are less defined. Here we determined rates of comorbidity before and after MS diagnosis as compared with a matched MS-free population.
Methods: A national incident MS cohort diagnosed in 2008-2016 was identified in the Swedish National Patient Register with data further linked to the national Prescribed Drug Register and Cause of Death Register. In addition, a sub-cohort of MS patients was identified in the electronic medical records (EMR) of the Karolinska University Hospital. MS patients were matched with and compared to 10 MS-free individuals by age, sex, and region of residence. Incidence rates (IR) per 10,000 person-years and incidence rate ratios (IRR) of comorbidities were calculated after MS diagnosis.
Results: In total, 6,602 MS patients were identified in the national cohort and were compared with 61,828 MS-free controls (female, 69%; median age, 40 years), while a sub-cohort from one hospital of 1,289 patients had a MS diagnosis recorded in EMR and was compared with 11,721 individuals without MS (female, 68%; median age, 37 years).
The national MS cohort had higher proportions before MS diagnosis compared with MS-free controls of autoimmune disease (1.3% vs 0.7%), bladder dysfunction (1.2% vs 0.2%), retinal disorders (2.4% vs 1.2%) and epilepsy (1.5% vs 0.8%). Similar patterns were observed for the single-hospital cohort, except for epilepsy. Bipolar disorder was more common among single-hospital MS patients (1.6% vs 0.7%).
After MS diagnosis, patients in the national cohort had higher IR compared with MS-free controls of autoimmune disease (IRR 3.60; 95% confidence interval [CI], 2.88-4.51), bladder dysfunction (IRR 47.44; 95% CI, 36.81-61.14) and epilepsy (IRR 2.36; 95% CI, 1.75-3.17). Similar patterns were observed in the single-hospital cohort. Toxic liver disease was higher (IRR 3.51; 95% CI 1.37-8.98) in the MS cohort in the national cohort only, while bipolar disorder was higher only in the single-hospital cohort (IRR 1.88; 95% CI 1.10-3.22).
Conclusions: Before a diagnosis of MS, patients already displayed an increased rate of comorbidity compared with MS-free controls. After diagnosis, patients with MS continued to display increased risk of several comorbidities, some of which may be explained by surveillance bias due to more frequent contact with healthcare.
Disclosure:
FP reports research grants from Biogen, Genzyme, Merck KGaA, and Novartis, and fees for serving as Chair of DMC in clinical trials with Parexel. ACB reports that she was paid as a consultant to Celgene Corporation through her employment at IQVIA. FC has nothing to disclose. SC has nothing to disclose. MR reports employment at IQVIA during study conduct, a CRO that received funding from Celgene Corporation for this work. SL is an employee of Celgene Corporation. NM is an employee of Celgene Corporation. SN is an employee of Celgene Corporation. AL is an employee of Celgene Corporation. SM reports research funding from Roche, Novartis, and AstraZeneca; a speaker's fee from Teva; and member of an advisory board for IQVIA.

This study was funded by Celgene Corporation.

Abstract: 272

Type: Scientific Session

Abstract Category: Clinical aspects of MS - Epidemiology

F. Piehl1, A. Castelo-Branco2, F. Chiesa2, S. Conte2, M. Rosenlund2, S. Lee3, N. Minton3, S. Niemcryk3, A. Lindholm3, S. Montgomery4,5,6

1Department of Neurology, Karolinska University Hospital, 2Real-World Insights, IQVIA Nordics, Solna, Sweden, 3Celgene Corporation, Summit, NJ, United States, 4Clinical Epidemiology and Biostatistics, Örebro University Hospital and Örebro University, Örebro, 5Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden, 6Department of Epidemiology and Public Health, University College London, London, United Kingdom

Introduction: Substantial progress in the treatment of multiple sclerosis (MS) has been made since the 1990s. However, the presence of comorbidity and the impact of treatment are less defined. Here we determined rates of comorbidity before and after MS diagnosis as compared with a matched MS-free population.
Methods: A national incident MS cohort diagnosed in 2008-2016 was identified in the Swedish National Patient Register with data further linked to the national Prescribed Drug Register and Cause of Death Register. In addition, a sub-cohort of MS patients was identified in the electronic medical records (EMR) of the Karolinska University Hospital. MS patients were matched with and compared to 10 MS-free individuals by age, sex, and region of residence. Incidence rates (IR) per 10,000 person-years and incidence rate ratios (IRR) of comorbidities were calculated after MS diagnosis.
Results: In total, 6,602 MS patients were identified in the national cohort and were compared with 61,828 MS-free controls (female, 69%; median age, 40 years), while a sub-cohort from one hospital of 1,289 patients had a MS diagnosis recorded in EMR and was compared with 11,721 individuals without MS (female, 68%; median age, 37 years).
The national MS cohort had higher proportions before MS diagnosis compared with MS-free controls of autoimmune disease (1.3% vs 0.7%), bladder dysfunction (1.2% vs 0.2%), retinal disorders (2.4% vs 1.2%) and epilepsy (1.5% vs 0.8%). Similar patterns were observed for the single-hospital cohort, except for epilepsy. Bipolar disorder was more common among single-hospital MS patients (1.6% vs 0.7%).
After MS diagnosis, patients in the national cohort had higher IR compared with MS-free controls of autoimmune disease (IRR 3.60; 95% confidence interval [CI], 2.88-4.51), bladder dysfunction (IRR 47.44; 95% CI, 36.81-61.14) and epilepsy (IRR 2.36; 95% CI, 1.75-3.17). Similar patterns were observed in the single-hospital cohort. Toxic liver disease was higher (IRR 3.51; 95% CI 1.37-8.98) in the MS cohort in the national cohort only, while bipolar disorder was higher only in the single-hospital cohort (IRR 1.88; 95% CI 1.10-3.22).
Conclusions: Before a diagnosis of MS, patients already displayed an increased rate of comorbidity compared with MS-free controls. After diagnosis, patients with MS continued to display increased risk of several comorbidities, some of which may be explained by surveillance bias due to more frequent contact with healthcare.
Disclosure:
FP reports research grants from Biogen, Genzyme, Merck KGaA, and Novartis, and fees for serving as Chair of DMC in clinical trials with Parexel. ACB reports that she was paid as a consultant to Celgene Corporation through her employment at IQVIA. FC has nothing to disclose. SC has nothing to disclose. MR reports employment at IQVIA during study conduct, a CRO that received funding from Celgene Corporation for this work. SL is an employee of Celgene Corporation. NM is an employee of Celgene Corporation. SN is an employee of Celgene Corporation. AL is an employee of Celgene Corporation. SM reports research funding from Roche, Novartis, and AstraZeneca; a speaker's fee from Teva; and member of an advisory board for IQVIA.

This study was funded by Celgene Corporation.

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