Gorana Capkun1, Frank Dahlke2, Raquel Lahoz3, Beth Nordstrom4, Hugh H Tilson5, Gary Cutter6, Dorina Bischof7, Alan Moore8, Jason Simeone9, Kathy Fraeman10, Fabrice Bancken11, Yvonne Geissbühler12, Michael Wagner13, Stanley Cohan14. 1. Novartis Pharma AG, Basel, Switzerland. Electronic address: gorana.capkun-niggli@novartis.com. 2. Novartis Pharma AG, Basel, Switzerland. Electronic address: frank.dahlke@novartis.com. 3. Novartis Pharma AG, Basel, Switzerland. Electronic address: raquel.lahoz@novartis.com. 4. Evidera, Lexington, MA, USA. Electronic address: Beth.Nordstrom@evidera.com. 5. Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA. Electronic address: htilson@email.unc.edu. 6. Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA. Electronic address: cutterg@uab.edu. 7. Novartis Pharma AG, Basel, Switzerland. Electronic address: dorina.bischof@novartis.com. 8. Novartis Pharma AG, Basel, Switzerland. Electronic address: alan.moore@novartis.com. 9. Evidera, Lexington, MA, USA. Electronic address: Jason.Simeone@evidera.com. 10. Evidera, Lexington, MA, USA. Electronic address: Kathy.Fraeman@evidera.com. 11. Novartis Pharma AG, Basel, Switzerland. Electronic address: fabrice.bancken@novartis.com. 12. Novartis Pharma AG, Basel, Switzerland. Electronic address: yvonne.geissbuehler@novartis.com. 13. Department of Neurology, Naval Medical Center Portsmouth, Portsmouth, VA, USA. 14. Providence Brain and Spine Institute, St Vincent Medical Center, Portland, OR, USA. Electronic address: Stanley.Cohan@providence.org.
Abstract
BACKGROUND: Data are limited for mortality and comorbidities in patients with multiple sclerosis (MS). OBJECTIVES: Compare mortality rates and event rates for comorbidities in MS (n=15,684) and non-MS (n=78,420) cohorts from the US Department of Defense (DoD) database. METHODS: Comorbidities and all-cause mortality were assessed using the database. Causes of death (CoDs) were assessed through linkage with the National Death Index. Cohorts were compared using mortality (MRR) and event (ERR) rate ratios. RESULTS: All-cause mortality was 2.9-fold higher in the MS versus non-MS cohort (MRR, 95% confidence interval [CI]: 2.9, 2.7-3.2). Frequent CoDs in the MS versus non-MS cohort were infectious diseases (6.2, 4.2-9.4), diseases of the nervous (5.8, 3.7-9.0), respiratory (5.0, 3.9-6.4) and circulatory (2.1, 1.7-2.7) systems and suicide (2.6, 1.3-5.2). Comorbidities including sepsis (ERR, 95% CI: 5.7, 5.1-6.3), ischemic stroke (3.8, 3.5-4.2), attempted suicide (2.4, 1.3-4.5) and ulcerative colitis (2.0, 1.7-2.3), were higher in the MS versus non-MS cohort. The rate of cancers was also higher in the MS versus the non-MS cohort, including lymphoproliferative disorders (2.2, 1.9-2.6) and melanoma (1.7, 1.4-2.0). CONCLUSIONS: Rates of mortality and several comorbidities are higher in the MS versus non-MS cohort. Early recognition and management of comorbidities may reduce premature mortality and improve quality of life in patients with MS.
BACKGROUND: Data are limited for mortality and comorbidities in patients with multiple sclerosis (MS). OBJECTIVES: Compare mortality rates and event rates for comorbidities in MS (n=15,684) and non-MS (n=78,420) cohorts from the US Department of Defense (DoD) database. METHODS: Comorbidities and all-cause mortality were assessed using the database. Causes of death (CoDs) were assessed through linkage with the National Death Index. Cohorts were compared using mortality (MRR) and event (ERR) rate ratios. RESULTS: All-cause mortality was 2.9-fold higher in the MS versus non-MS cohort (MRR, 95% confidence interval [CI]: 2.9, 2.7-3.2). Frequent CoDs in the MS versus non-MS cohort were infectious diseases (6.2, 4.2-9.4), diseases of the nervous (5.8, 3.7-9.0), respiratory (5.0, 3.9-6.4) and circulatory (2.1, 1.7-2.7) systems and suicide (2.6, 1.3-5.2). Comorbidities including sepsis (ERR, 95% CI: 5.7, 5.1-6.3), ischemic stroke (3.8, 3.5-4.2), attempted suicide (2.4, 1.3-4.5) and ulcerative colitis (2.0, 1.7-2.3), were higher in the MS versus non-MS cohort. The rate of cancers was also higher in the MS versus the non-MS cohort, including lymphoproliferative disorders (2.2, 1.9-2.6) and melanoma (1.7, 1.4-2.0). CONCLUSIONS: Rates of mortality and several comorbidities are higher in the MS versus non-MS cohort. Early recognition and management of comorbidities may reduce premature mortality and improve quality of life in patients with MS.
Authors: Caila B Vaughn; Dejan Jakimovski; Katelyn S Kavak; Murali Ramanathan; Ralph H B Benedict; Robert Zivadinov; Bianca Weinstock-Guttman Journal: Nat Rev Neurol Date: 2019-06 Impact factor: 42.937
Authors: Đorđe Miljković; Suzana Stanisavljević; Isaac J Jensen; Thomas S Griffith; Vladimir P Badovinac Journal: Immunol Lett Date: 2021-07-25 Impact factor: 4.230