Given the high risk for stroke in this MS population and the observed complexity among the coincident common risk factors for circulatory diseases, the high risk for type 1 diabetes and common infections raise a need to recognize patients at risk with these conditions and with the other known risk factors such as metabolic syndrome and smoking. The survival disadvantage related to circulatory diseases observed in general population is true also in MS and should be recognized to reduce the burden of disease and premature mortality in MS.
Background. MS incidence has increased among females, suggesting the presence of environmental effect.
Object. Regional differences and temporal changes in gender-specific MS incidence were studied in Finland.
Methods. Cases from Jan 1, 1981 to Dec 31, 2010 in Pirkanmaa, Seinäjoki and Vaasa districts were included. The standardized incidence rates (SIR),
incidences per 105 person years with 95% confidence intervals (CI), and female-to-male ratios (F/M) were determined by district.
Results. 1617 cases were included. Compared to Pirkanmaa, the MS risk was 1.9-fold (95% CI: 1.7–2.0) greater in
Seinäjoki and 1.2-fold (95% CI: 1.1–1.4) in Vaasa, and the risk was high for both genders.
The incidence trend stabilized in Seinäjoki and Vaasa, accompanied by an increase in the F/M ratio.
A steady increase in Pirkanmaa was accompanied by a high F/M ratio.
Conclusion. A high female preponderance accompanied a general increase
in incidence since the 1990s, suggesting the influence of environmental factors. In high-risk districts,
increased MS risk prevailed in both genders. High risk reflects both genetic and environmental effects.
These effects may be shared with autoimmune diseases such as type 1 diabetes mellitus;
the incidence of which follows MS in Finland. Population-based case-control studies are needed to identify these factor effects.
Object. Gender and disease course specific incidences were studied in high- and medium-risk regions of MS in Finland. Methods. Age- and gender-specific incidences with 95% CIs were calculated in 10-year periods from 1981 to 2010. Poser diagnostic criteria were used and compared with the McDonald criteria from 2001 to 2010. Association between age and diagnostic delay over time was assessed by using the Kruskal-Wallis test. Results. 1419 (89%) RRMS and 198 (11%) PPMS cases were included. RRMS incidence increased with the female to male ratio (F/M) from 4,2/105 (F/M 1.9) to 9,7 (2.3), while that of PPMS decreased from 1,2 (1.6) to 0,7 (1.2). The use of McDonald criteria did not change the conclusion. The decreasing diagnostic delay and age at diagnosis in RRMS were associated within the 10-year periods and contrasted those in PPMS. Increasing female risk in RRMS was observed in the high-risk region. Conclusion. Increasing RRMS incidence and high female ratios shown in each age group indicate gender-specific influences acting already from childhood. A more precise definition of the risk factors and their action in MS is needed to provide a better understanding of underlying pathological processes and a rationale for the development of new preventive and treatment strategies.
Objective
To study ten‐year change in MS prevalence in the Province of Western Finland in Tampere University Hospital District located in 62.7°N, 23.7°E.
Methods
Age‐standardized prevalence/105 by using direct standardization in European Standard Population (ESP2013) and crude prevalence/105 with 95% confidence interval (95% CI) were assessed among resident MS cases fulfilling Poser criteria by sex and disease course in 31.12.2000 and 31.12.2010. MS‐related disability and disease‐modifying treatment (DMT) use were estimated in 31.12.2010.
Results
Crude prevalence increased 49% from 129/105 (95% CI 121‐137) in 2000 (N 1080) to 196/105 (187‐203) in 2010 (N 1666). Age‐standardized prevalence increased 45% from 133/105 (127‐140) to 192/105 (184‐200) and peaked in 40‐ to 49‐year age‐group. Age‐standardized prevalence increased 58% among women from 176/105 (171‐176) to 277/105 (270‐284) and 31% among men from 91/105 (87‐95) to 119/105 (115‐124). Increase in RRMS was 61% from 111/105 (105‐117) to 179/105 (171‐186), and decrease in PPMS was 14% from 21/105 (19‐24) to 18/105 (15‐21).
In 2010 among the 52% RRMS cases on DMT, MS‐related disability was mild in 50%. In total, cohort disability was mild in 46%, moderate to severe in 47%, and information was not available in 14%.
Conclusion
A significant increase in prevalence was observed in Western Finland. Increase was higher among women and in relapsing‐remitting onset MS. Disability showed age‐ and disease course‐specific variation.
Prognostic factors and long-term treatment response of interferon β-1a s.c tiw has not been studied in a real-life clinical cohort in Finland. The aim of the paper was to evaluate long-term treatment response, prognostic clinical factors and adherence among interferon β-1a s.c tiw treated patients in Finland. A retrospective review of medical records was performed. Confirmed relapsing multiple sclerosis patients treated with interferon β-1a s.c tiw 22μg or 44μg as their first treatment, from 1996 to 2010 in Western Finland, were included. Longitudinal generalized linear regression models were applied to assess risk of disability progression, using Expanded Disability Status Scale (EDSS), during the treatment period. Odd’s ratios with 95% confidence intervals (95% CI) were calculated for risk factors: gender, age at diagnosis, treatment delay, dose, baseline EDSS and EDSS change in one year. Kaplan-Meier was applied to study median time to discontinuation. Mean duration of treatment in 293 cases was 2.9 years (min 0.04, max 13.5). EDSS increase vs. no increase in one-year carried a significant risk for long-term disability progression (1.20, 1.08-1.33). Older age, defined by a 10-year increase in age at diagnosis (1.43, 1.07-1.91) and one-year delay to treatment start showed an increased risk for disability progression (1.05, 0.99-1.11), but gender (0.66, 0.38-1.15) or initial dose (1.00, 0.45-2.25) showed no risk. Treatment was stopped in 37% due to disease activation at median of 1.7 years, and in 25% due to side effects at 9.3 months. Our results show that young age, a short delay to treatment start and slower disability progression were identified as factors for better outcome among cases with interferon β-1a s.c tiw as their first disease modifying treatment.
A427for one year prior to the index date (baseline) and one subsequent year after the index date (follow-up). Relapses were recorded for all patients during the followup. Results: After matching, there were 177 patients in the Switch group and 531 in the No Switch group. Baseline characteristics were well matched between groups (47 years old; 79% female). The proportion of patients experiencing a relapse during the follow-up year was significantly higher in the Switch group compared with the No Switch group (13.6%vs. 6.2%, p= 0.002). Annual relapse rate was significantly higher in the Switch group compared with the No Switch group (0.15 vs. 0.07, p= 0.002). ConClusions: MS patients stable on interferon therapy who remain on initial therapy had significantly better outcomes, as measured by less than half the proportion of patients with relapses and half the annual relapse rate, than patients who switched to another interferon. This supports the benefits of allowing patients to remain on current interferon therapy when stable.
PND14PharmacotheraPies for the treatmeNt of Behavioral aND Psychological symPtoms of DemeNtia -a systematic review oN receNt eviDeNce
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