Admittedly research into MS has grown in depth and breath over the years. For those affected and the recently diagnosed the temptation to fit oneself to the average data set is too tempting to say the least.
The latest installment in ‘modern MS’ comes from our German colleagues across the pond (see Abstract at the bottom).
They report that
– Highly active MS is uncommon ~8.5% in 2016 and affects the young as opposed to those aged >50 (a finding in keeping with an ageing immune system); nonetheless it must born in mind that late-onset MS has the greatest risk of disease progression
– It’s a disease of the young – commonest age category was 30-39;
– Affects women – accounting for 68%;
– Most have other diseases in addition to MS (depression, followed by high blood pressure in this study) and therefore important to manage the comorbidities as much as the MS;
– Majority (82%) required at least 1 disease modifying therapy as their MS treatment, probably because 50% of individuals experienced relapses.
The most important piece of information to take from this is that highly active disease predominantly involves the young, where it may serve to be extra aggressive using more highly active therapies. Overall, based on evidence from natural history cohorts MS in current times is less likely to lead to progressive disease than in the pre-DMT era. Therefore, the majority of newly diagnosed usually require at least one disease modifying agent during the course of their illness.
PLoS One. 2020 May 1;15(5):e0231846. doi: 10.1371/journal.pone.0231846. eCollection 2020.
Epidemiology, characteristics and treatment of patients with relapsing remitting multiple sclerosis and incidence of high disease activity: Real world evidence based on German claims data.
Multiple Sclerosis (MS) is a chronic inflammatory, immune mediated disease of the central nervous system, with Relapsing Remitting MS (RRMS) being the most common type. Within the last years, the status of high disease activity (HDA) has become increasingly important for clinical decisions. Nevertheless, little is known about the incidence, the characteristics, and the current treatment of patients with RRMS and HDA in Germany. Therefore, this study aims to estimate the incidence of HDA in a German RRMS patient population, to characterize this population and to describe current drug treatment routines and further healthcare utilization of these patients.
A claims data analyses has been conducted, using a sample of the InGef Research Database that comprises data of approximately four million insured persons from around 70 German statutory health insurances (SHI). The study was conducted in a retrospective cohort design, including the years 2012-2016. Identification of RRMS population based on ICD-10 code (ICD-10-GM: G35.1). For identification of HDA, criteria from other studies as well as expert opinions have been used. Information on incidence, characteristics and current treatment of patients with RRMS and HDA was considered.
The overall HDA incidence within the RRMS population was 8.5% for 2016. It was highest for the age group of 0-19 years (29.4% women, 33.3% men) and lowest for the age group of ≥ 50 years (4.3% women, 5.6% men). Mean age of patients with RRMS and incident HDA was 38.4 years (SD: 11.8) and women accounted for 67.8%. Analyses of drug utilization showed that 82.4% received at least one disease-modifying drug (DMD) in 2016. A percentage of 49.8% of patients received drugs for relapse therapy. A share of 55% of RRMS patients with HDA had at least one hospitalization with a mean length of stay of 13.9 days (SD: 18.3 days) in 2016. The average number of outpatient physician contacts was 28.1 (SD: 14.0).
This study based on representative Germany-wide claims data from the SHI showed a high incidence of HDA especially within the young RRMS population. Future research should consider HDA as an important criterion for the quality of care for MS patients.