Causes of death among patients with multiple sclerosis

Sumelahti, Marja‐Liisa; Hakama, Matti; Elovaara, Irina; Pukkala, Eero

doi:10.1177/1352458510379244

Cited by 80 publications

(92 citation statements)

References 35 publications

(72 reference statements)

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“…However, counter to this possibility, the observed survival rate in our placebo arm is consistent with reports from natural history studies. 10,[12][13][14][15] For example, as shown in figure e-1, the survival rate 29 years after disease onset (ϳ70%) observed by others 10 was essentially identical to that in our placebo group (70.4%). Furthermore, the medications taken after the end of the pivotal study did not differ systematically.…”

Section: Discussionmentioning

confidence: 61%

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Survival in MS

Goodin¹,

Reder²,

Ebers³

et al. 2012

Neurology

226

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Objective: To examine the effects of interferon beta (IFN␤)-1b on all-cause mortality over 21 years in the cohort of 372 patients who participated in the pivotal randomized clinical trial (RCT), retaining (in the analysis) the original randomized treatment-assignments. Methods:For this randomized long-term cohort study, the primary outcome, defined before data collection, was the comparison of all-cause mortality between the IFN␤-1b 250 g and placebo groups from the time of randomization through the entire 21-year follow-up interval (intention-totreat, log-rank test for Kaplan-Meier survival curves). All other survival outcomes were secondary.Results: After a median of 21.1 years from RCT enrollment, 98.4% (366 of 372) of patients were identified, and, of these, 81 deaths were recorded (22.1% [81 of 366]). Patients originally randomly assigned to IFN␤-1b 250 g showed a significant reduction in all-cause mortality over the 21-year period compared with placebo (p ϭ 0.0173), with a hazard ratio of 0.532 (95% confidence interval 0.314-0.902). The hazard rate of death at long-term follow-up by Kaplan-Meier estimates was reduced by 46.8% among IFN␤-1b 250 g-treated patients (46.0% among IFN␤-1b 50 g-treated patients) compared with placebo. Baseline variables did not influence the observed treatment effect. Conclusions:There was a significant survival advantage in this cohort of patients receiving early IFN␤-1b treatment at either dose compared with placebo. Near-complete ascertainment, together with confirmatory findings from both active treatment groups, strengthens the evidence for an IFN␤-1b benefit on all-cause mortality. Classification of Evidence:This study provides Class III evidence that early treatment with IFN␤-1b is associated with prolonged survival in initially treatment-naive patients with relapsingremitting multiple sclerosis. Neurology Multiple sclerosis (MS) is a chronic, inflammatory disease of the CNS with a lifelong course, necessitating outcome assessments over both the short term and long term.1 However, randomized clinical trials (RCTs) have typically focused only on short-term outcomes such as clinical measures of relapse and physical disability, as well as MRI measures of disease activity and severity.2-8 Although survival is the ultimate long-term outcome, to date mortality in patients with MS treated with disease-modifying therapy (DMT) has not been well-studied, largely because of the length and completeness of observation needed. 9 *These authors contributed equally to this work.

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Section: Discussionmentioning

confidence: 61%

“…15 Although MS seems to cause a significant survival disadvantage, the impact of DMTs on longevity is unknown. As a reflection of the underlying safety and efficacy of treatment regimens, survival can be considered an integrated measure of long-term outcome, one that could potentially be influenced by early treatment.…”

mentioning

confidence: 99%

Survival in MS

Goodin¹,

Reder²,

Ebers³

et al. 2012

Neurology

226

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“…MS is a severe disease in terms of disability: approximately 50% of MS patients will need help to walk after more than 15 years from the onset of the disease [3]. MS is also a severe disease in terms of reduction of life expectancy: patients have a threefold probability of death than healthy subjects [4,5,6,7,8,9,10,11]. The prognosis is difficult to predict and it depends among other factors on the relapse rate, time course of inflammatory activity and neurodegeneration [12].…”

Section: Introductionmentioning

confidence: 99%

Mortality and Cause of Death in Multiple Sclerosis: Findings from a Prospective Population-Based Cohort in Bizkaia, Basque Country, Spain

et al. 2014

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Background: Mortality studies of multiple sclerosis (MS) patients are scarce. Objective: To assess mortality of MS patients included in a large MS cohort from the county of Bizkaia in Spain. Methods: Patients were collected from a dynamic population-based cohort of patients with MS from the county of Bizkaia (named the ‘Bizkaia cohort') in the Basque Country (Spain). Data from official registries were used for estimating mortality indicators. Results: During a 24-year period (1987-2011), a total of 1,283 patients were included in the Bizkaia cohort. Eighty-nine patients (6.9%) had died before December 31, 2011. The standardized mortality ratio was 2.78 for the whole group (3.26 for men and 2.73 for women), with a decreased life expectancy of 6.53 years. The mean survival from the onset of MS in deceased patients was 22.4 years. Death was related directly or indirectly to MS in 57 patients and unrelated in 27, while the cause of death was unknown in the remaining 5. Respiratory infection and sepsis were the most frequent MS-related causes of death. Differences in survival according to gender or disease course were not observed. Conclusion: Patients with MS included in the ‘Bizkaia cohort' had an almost threefold increase in the risk for death. Life expectancy is reduced by 6-10 years.

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“…[4][5][6][9][10][11]14 The most common principal diagnosis (ie, the most common diagnosis responsible for the patient's hospi- commonly cited as the cause of death in patients with MS. 4,5,12,13,15,17 Comparisons of causes of death across studies may, however, be confounded by methodological differences. For example, two studies that examined government records to determine causes of death differed in whether infections were considered independent of or related to MS. 4,8 In a Finnish study, deceased patients were stratified into two categories: death from MS or MS-related causes (including infections related to underlying MS) and death due to any cause. 16 In contrast, MS and infectious diseases were categorized as separate causes of death in a Norwegian study, regardless of the underlying cause of infection.…”

Section: Mortalitymentioning

confidence: 99%

Analysis of Diagnoses Associated with Multiple Sclerosis–Related In-Hospital Mortality Using the Premier Hospital Database

Ernst¹,

Pocoski²,

Cutter³

et al. 2016

International Journal of MS Care

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Background: We sought to compare mortality rates and related diagnoses in hospitalized patients with multiple sclerosis (MS), those with diabetes mellitus (DM), and the general hospitalized population (GHP). Methods: Patients who died between 2007 and 2011 were identified in the US hospital–based Premier Healthcare Database. Demographic information was collected, mortality rates calculated, and principal diagnoses categorized. Results: Of 55,152 unique patients with MS identified, 1518 died. Mean age at death was 10 years younger for the MS group (63.4 years) than for the DM (73.3 years) and GHP (73.1 years) groups. Age-adjusted mortality rates, based on the 2000 US Standard Million Population, were 1077, 1248, and 1133 per 100,000, respectively. Infection was the most common principal diagnosis at the hospital stay during which the patient died in the MS cohort (43.1% vs. 26.3% and 24.0% in the DM and GHP groups, respectively). Other common principal diagnoses in the MS group included pulmonary (17.5%) and cardiovascular (12.1%) disease. Septicemia/sepsis/septic shock was a secondary diagnosis for 50.7% of patients with MS versus 36.0% and 31.0% of patients in the DM and GHP cohorts, respectively. Conclusions: Patients with MS had a shorter life span than patients with DM or the GHP and were more likely to have a principal diagnosis of infection at their final hospital stay. However, the database was limited to codes recorded in the hospital; diagnoses received outside the hospital were not captured.

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Causes of death among patients with multiple sclerosis

Abstract: The MS population has an increased disease mortality, while the increase in the risk of accidents and suicides is not significantly increased among patients with MS in Finland.

Cited by 80 publications

References 35 publications

Survival in MS

Survival in MS

Mortality and Cause of Death in Multiple Sclerosis: Findings from a Prospective Population-Based Cohort in Bizkaia, Basque Country, Spain

Analysis of Diagnoses Associated with Multiple Sclerosis–Related In-Hospital Mortality Using the Premier Hospital Database

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