Disease-modifying drugs, multiple sclerosis and infection-related healthcare use in British Columbia, Canada: a population-based studyResearch in context
Summary: Background: Much remains unknown surrounding the disease-modifying drugs (DMDs) used to treat multiple sclerosis and infection-related healthcare use in the ‘real-world’ setting. We examined if DMD exposure was associated with altered infection-related healthcare use. Methods: We assessed...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2024-01-01
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| Series: | The Lancet Regional Health. Americas |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2667193X23002417 |
| _version_ | 1797362516033011712 |
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| author | Jonas Graf Huah Shin Ng Feng Zhu Yinshan Zhao José MA. Wijnands Charity Evans John D. Fisk Ruth Ann Marrie Helen Tremlett |
| author_facet | Jonas Graf Huah Shin Ng Feng Zhu Yinshan Zhao José MA. Wijnands Charity Evans John D. Fisk Ruth Ann Marrie Helen Tremlett |
| author_sort | Jonas Graf |
| collection | DOAJ |
| description | Summary: Background: Much remains unknown surrounding the disease-modifying drugs (DMDs) used to treat multiple sclerosis and infection-related healthcare use in the ‘real-world’ setting. We examined if DMD exposure was associated with altered infection-related healthcare use. Methods: We assessed if DMD (versus no) exposure was associated with altered infection-related hospitalizations, physician claims, and prescriptions filled in British Columbia, Canada (1996–2017). Healthcare use was assessed using negative binomial and proportional means regression models, reported as sex-/age-/comorbidity-/calendar year-/socioeconomic-adjusted rate and hazard ratios [aRR, aHR], with 95% confidence intervals [CIs]). Findings: We identified 19,360 multiple sclerosis cases (13,940/19,360; 72.0% women; mean age at study start = 44.5 standard deviation, SD = 13.3; mean follow-up = 11.7 [SD = 7.3] years). Relative to unexposed periods, exposure to any DMD was associated with a lower infection-related rate of physician claims (aRR = 0.88; 95% CI:0.85–0.92) and hazard of hospitalization (aHR = 0.64; 95% CI:0.56–0.73), and a higher rate of infection-related prescriptions (aRR = 1.14; 95% CI:1.08–1.20). Exposure to any injectable or oral DMD was associated with a lower infection-related rate of physician claims (injectable aRR = 0.88; 95% CI:0.84–0.92, oral aRR = 0.83; 95% CI:0.77–0.90) and hazard of hospitalization (injectable aHR = 0.65; 95% CI:0.56–0.75, oral aHR = 0.54; 95% CI:0.38–0.77), whereas intravenous DMD exposure was not (aRR = 0.99; 95% CI:0.86–1.14, aHR = 0.73; 95% CI:0.49–1.09). Exposure to any injectable or intravenous DMD was associated with a higher rate of infection-related prescriptions (injectable aRR = 1.15; 95% CI:1.08–1.22, intravenous = 1.34; 95% CI:1.15–1.56), whereas oral DMDs were not (aRR = 0.98; 95% CI:0.91–1.05). Interpretation: DMD exposure for the treatment of MS was associated with differences in infection-related healthcare use. While infection-related hospitalizations and physician visits were lower, prescription fills were higher. How these differences in infection-related healthcare use affect outcomes in persons with multiple sclerosis warrants consideration. Funding: Canadian Institutes of Health Research (CIHR); German Research Foundation (DFG). |
| first_indexed | 2024-03-08T16:08:59Z |
| format | Article |
| id | doaj.art-08f40bd1eabf4c93befd0f581c46326a |
| institution | Directory Open Access Journal |
| issn | 2667-193X |
| language | English |
| last_indexed | 2024-03-08T16:08:59Z |
| publishDate | 2024-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Regional Health. Americas |
| spelling | doaj.art-08f40bd1eabf4c93befd0f581c46326a2024-01-08T04:09:35ZengElsevierThe Lancet Regional Health. Americas2667-193X2024-01-0129100667Disease-modifying drugs, multiple sclerosis and infection-related healthcare use in British Columbia, Canada: a population-based studyResearch in contextJonas Graf0Huah Shin Ng1Feng Zhu2Yinshan Zhao3José MA. Wijnands4Charity Evans5John D. Fisk6Ruth Ann Marrie7Helen Tremlett8Department of Medicine, Division of Neurology and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, CanadaDepartment of Medicine, Division of Neurology and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada; Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA, AustraliaDepartment of Medicine, Division of Neurology and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, CanadaDepartment of Medicine, Division of Neurology and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, CanadaDepartment of Medicine, Division of Neurology and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, CanadaCollege of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, CanadaNova Scotia Health Authority and the Departments of Psychiatry, Psychology and Neuroscience, and Medicine, Dalhousie University, Halifax, NS, CanadaDepartments of Internal Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, CanadaDepartment of Medicine, Division of Neurology and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada; Corresponding author. Canada Research Chair in Neuroepidemiology and Multiple Sclerosis, Djavad Mowafaghian Centre for Brain Health, Faculty of Medicine (Neurology) rm S126, UBC Hospital, University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC V6T 2B5, Canada.Summary: Background: Much remains unknown surrounding the disease-modifying drugs (DMDs) used to treat multiple sclerosis and infection-related healthcare use in the ‘real-world’ setting. We examined if DMD exposure was associated with altered infection-related healthcare use. Methods: We assessed if DMD (versus no) exposure was associated with altered infection-related hospitalizations, physician claims, and prescriptions filled in British Columbia, Canada (1996–2017). Healthcare use was assessed using negative binomial and proportional means regression models, reported as sex-/age-/comorbidity-/calendar year-/socioeconomic-adjusted rate and hazard ratios [aRR, aHR], with 95% confidence intervals [CIs]). Findings: We identified 19,360 multiple sclerosis cases (13,940/19,360; 72.0% women; mean age at study start = 44.5 standard deviation, SD = 13.3; mean follow-up = 11.7 [SD = 7.3] years). Relative to unexposed periods, exposure to any DMD was associated with a lower infection-related rate of physician claims (aRR = 0.88; 95% CI:0.85–0.92) and hazard of hospitalization (aHR = 0.64; 95% CI:0.56–0.73), and a higher rate of infection-related prescriptions (aRR = 1.14; 95% CI:1.08–1.20). Exposure to any injectable or oral DMD was associated with a lower infection-related rate of physician claims (injectable aRR = 0.88; 95% CI:0.84–0.92, oral aRR = 0.83; 95% CI:0.77–0.90) and hazard of hospitalization (injectable aHR = 0.65; 95% CI:0.56–0.75, oral aHR = 0.54; 95% CI:0.38–0.77), whereas intravenous DMD exposure was not (aRR = 0.99; 95% CI:0.86–1.14, aHR = 0.73; 95% CI:0.49–1.09). Exposure to any injectable or intravenous DMD was associated with a higher rate of infection-related prescriptions (injectable aRR = 1.15; 95% CI:1.08–1.22, intravenous = 1.34; 95% CI:1.15–1.56), whereas oral DMDs were not (aRR = 0.98; 95% CI:0.91–1.05). Interpretation: DMD exposure for the treatment of MS was associated with differences in infection-related healthcare use. While infection-related hospitalizations and physician visits were lower, prescription fills were higher. How these differences in infection-related healthcare use affect outcomes in persons with multiple sclerosis warrants consideration. Funding: Canadian Institutes of Health Research (CIHR); German Research Foundation (DFG).http://www.sciencedirect.com/science/article/pii/S2667193X23002417Multiple sclerosisDisease-modifying drugsInfectionsHealthcare use |
| spellingShingle | Jonas Graf Huah Shin Ng Feng Zhu Yinshan Zhao José MA. Wijnands Charity Evans John D. Fisk Ruth Ann Marrie Helen Tremlett Disease-modifying drugs, multiple sclerosis and infection-related healthcare use in British Columbia, Canada: a population-based studyResearch in context The Lancet Regional Health. Americas Multiple sclerosis Disease-modifying drugs Infections Healthcare use |
| title | Disease-modifying drugs, multiple sclerosis and infection-related healthcare use in British Columbia, Canada: a population-based studyResearch in context |
| title_full | Disease-modifying drugs, multiple sclerosis and infection-related healthcare use in British Columbia, Canada: a population-based studyResearch in context |
| title_fullStr | Disease-modifying drugs, multiple sclerosis and infection-related healthcare use in British Columbia, Canada: a population-based studyResearch in context |
| title_full_unstemmed | Disease-modifying drugs, multiple sclerosis and infection-related healthcare use in British Columbia, Canada: a population-based studyResearch in context |
| title_short | Disease-modifying drugs, multiple sclerosis and infection-related healthcare use in British Columbia, Canada: a population-based studyResearch in context |
| title_sort | disease modifying drugs multiple sclerosis and infection related healthcare use in british columbia canada a population based studyresearch in context |
| topic | Multiple sclerosis Disease-modifying drugs Infections Healthcare use |
| url | http://www.sciencedirect.com/science/article/pii/S2667193X23002417 |
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