Comorbid disease burden among MS patients 1968–2012: A Swedish register–based cohort study

Smith, Kelsi A; Burkill, Sarah; Hiyoshi, Ayako; Olsson, Tomas; Bahmanyar, Shahram; Wormser, David; Geissbühler, Yvonne; Moore, Alan; Kharat, Vineetkumar; Montgomery, Scott

doi:10.1177/1352458520910497

Cited by 11 publications

(8 citation statements)

References 27 publications

(43 reference statements)

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“…We observed fewer cardiovascular events in our MS population (2.0%), compared with expected rates estimated through the Framingham risk score in the general population (3.0%). MS patients have a higher burden of cardiovascular comorbidities when compared with general population [11,39,40]. As such, we cannot exclude that some cardiovascular events went missing in our retrospective study.…”

Section: Discussionmentioning

confidence: 99%

The Framingham cardiovascular risk score and 5‐year progression of multiple sclerosis

Petruzzo

Reia

Maniscalco

et al. 2020

Euro J of Neurology

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Background and purpose Cardiovascular risk factors and comorbidities can affect the prognosis of multiple sclerosis (MS). The Framingham risk score is an algorithm that can estimate the 10‐year risk of developing macrovascular disease. Our objectives were to evaluate the possible association between the Framingham risk score at baseline and MS relapses, disability, and disease‐modifying therapy (DMT) choices over a 5‐year follow‐up. Methods This is a retrospective cohort study including 251 MS subjects. At baseline, we calculated the Framingham risk score considering the following variables: age, sex, diabetes, smoking, systolic blood pressure, and body mass index. MS outcomes including relapses, disability, and treatments were collected over 5 years. Cox proportional regression models were employed to estimate hazard ratios (HRs). Results A one‐point increase in the Framingham risk score was associated with 31% higher risk of relapse (HR = 1.31; 95% confidence interval [CI] = 1.03, 1.68), 19% higher risk of reaching of EDSS 6.0 (HR = 1.19; 95% CI = 1.05, 3.01), and 62% higher risk of DMT escalation (HR = 1.62; 95% CI = 1.22, 3.01). Conclusions Higher cardiovascular risk was associated with higher risk of relapses, disability, and DMT escalation in MS. Early identification, correction, and treatment of cardiovascular comorbidities should be carefully considered within MS management.

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Section: Discussionmentioning

confidence: 99%

The Framingham cardiovascular risk score and 5‐year progression of multiple sclerosis

Petruzzo

Reia

Maniscalco

et al. 2020

Euro J of Neurology

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“…Furthermore, the incidence of meningitis/encephalitis among the MS-free population was somewhat higher than observed in different populations, which did not include encephalitis in their estimates (Bijlsma et al, 2016;McGill et al, 2018). Finally, some infections pre-dating MS onset, such as infectious mononucleosis and possibly pneumonia may be risk factors for MS. Later in the disease course infections may also be consequences of MS-related dysfunction including bladder dysfunction, urinary tract infection, and respiratory problems, as well as a consequence of immunosuppressive therapy (Smith et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

Infections in patients with multiple sclerosis: A national cohort study in Sweden

Castelo-Branco¹,

Chiesa²,

Conte³

et al. 2020

Multiple Sclerosis and Related Disorders

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Background: Multiple sclerosis (MS) patients have an increased risk of infections, but few population-based studies have reported infections occurring in MS in the years immediately after diagnosis. Objective: To explore incident infections in MS, stratified by age and sex. Methods: In a Swedish population-based cohort study 6602 incident MS patients (aged ≥18 years), matched at diagnosis with 61,828 matched MS-free individuals were identified between 1st January 2008 and 31st December 2016, using national registers. Incidence rates (IR) and incidence rate ratios (IRR) with 95% CI were calculated for each outcome. Results: The IRRs were 2.54 (95% CI 2.28-2.83) for first serious infection and 1.61 (1.52-1.71) for first nonserious infection. Compared with MS-free individuals, MS patients had higher IRs for skin, respiratory/throat infections, pneumonia/influenza, bacterial, viral, and fungal infections, with the highest IRR observed for urinary tract/kidney infections (2.44; 2.24-2.66). The cumulative incidence for most of these infections was higher among MS patients than MS-free individuals, both 0 to <5 and 5 to <9 years after index date. Conclusion:The burden of infections around the time of MS diagnosis and subsequent infection risk, underscore the need for careful considerations regarding the risk-benefit across different disease-modifying therapies.

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“…Therefore, the commonly used trial eligibility requirement of having experienced progression within the past year may inadvertently ignore other factors impacting prospectively-planned outcomes. Finally, comorbidities are more frequent in MS compared with the general population 72 . Comorbidities (and related treatments) may interfere with MS pathophysiology and therapies and, therefore, influence outcomes.…”

Section: Inclusion Criteria and Sopsmentioning

confidence: 99%

Facing the urgency of therapies for progressive MS — a Progressive MS Alliance proposal

et al. 2021

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Review articlesNature Reviews publishes timely, authoritative articles that are of broad interest and exceptional quality. Thank you for taking the time to help us to ensure that our articles meet these high standards.Review articles in Nature Reviews journals provide accessible, authoritative and balanced overviews of a field or topic. These articles are targeted towards readers from advanced undergraduate level and upwards, including researchers, academics and clinicians, and should be accessible to readers working in any discipline.Please submit your report in narrative form and provide detailed justifications for all statements. Confidential comments to the editor are welcome, but it is helpful if the main points are stated in the comments for transmission to the authors.Please note that all Nature Reviews articles will be thoroughly edited before publication and all figures will be redrawn by our in-house art editors. We therefore request that you concentrate on the scientific content of the article, rather than any minor errors in language or grammar that might be present in the draft version. Please consider and comment on the following points when reviewing this manuscript:• Is the article timely and does it provide a useful addition to the existing literature?• Are the scope and aims of the article clear?• Are the ideas logically presented and discussed?• Is the article accessible to a wide audience, including readers who are not specialists in your own field?• Does the article provide a balanced overview of the literature? Please bear in mind that it may not be possible to cover all aspects of a field within such a concise article.• Does the article provide new insight into recent advances?• Is the discussion fair and accurate? Although our authors are encouraged to be opinionated, they should not ignore alternative points of view.• Do the figures, boxes and tables provide clear and accurate information? Are there any additional or alternative display items that you think that the authors should include?• Are the references appropriate and up-to-date? Do they reflect the scope of the article?

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Comorbid disease burden among MS patients 1968–2012: A Swedish register–based cohort study

Cited by 11 publications

References 27 publications

The Framingham cardiovascular risk score and 5‐year progression of multiple sclerosis

The Framingham cardiovascular risk score and 5‐year progression of multiple sclerosis

Infections in patients with multiple sclerosis: A national cohort study in Sweden

Facing the urgency of therapies for progressive MS — a Progressive MS Alliance proposal

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