Corvino Frank A, Oliveri David, Phillips Amy L
a Genesis Research , Hoboken , NJ , USA.
b Health Economics & Outcomes Research, EMD Serono, Inc. , Rockland , MA , USA.
Curr Med Res Opin. 2017 Jun;33(6):1127-1132. doi: 10.1080/03007995.2017.1308918. Epub 2017 Apr 11.
A large, US de-identified electronic health record (EHR) database (Optum-Humedica de-identified Electronic Health Record dataset) was used to evaluate whether earlier disease-modifying drug (DMD) treatment initiation was associated with improved outcomes in multiple sclerosis (MS).
Newly diagnosed patients from 1 January 2008 to 30 August 2014 (International Classification of Diseases, Ninth Revision, Clinical Modification code: 340.xx; first MS diagnosis = index date) with healthcare activity 1 year pre- and 2 years post-index, and who initiated DMD treatment during the 2 year follow-up period, were included. Patients were categorized as Early or Late Initiators (initiated DMD treatment ≤90 or >90 days following index, respectively). Relapse was determined by the presence of an MS-related hospitalization or an outpatient encounter with MS diagnosis and corticosteroid prescription within 7 days.
A total of 4732 patients met the inclusion criteria: 2042 (43.2%) were Early Initiators and 2690 (56.8%) were Late Initiators. Similar baseline mean age (46.9 years for both cohorts) and Charlson Comorbidity Index scores (Early Initiators: 0.3, Late Initiators: 0.32) were observed. Average time to treatment was 20.9 ± 27.6 days for Early Initiators and 346.3 ± 181.1 days for Late Initiators. A significantly higher proportion of Late Initiators (n = 609; 22.6%) had a relapse during the 2 years following MS diagnosis compared with Early Initiators (n = 403; 19.7%; p = .0158). After controlling for covariates using multivariable logistic regression, late initiation of DMD treatment was associated with greater likelihood of relapse compared with early initiation (odds ratio 1.189; 95% CI: 1.031-1.371; p = .0172).
Later initiation of DMD treatment (i.e. >90 days after MS diagnosis) in patients with MS was associated with a greater likelihood of relapse compared with earlier initiation. Early initiation of DMD treatment following a diagnosis of MS may have an effect on long-term outcomes.
使用一个大型的、已去除美国患者身份信息的电子健康记录（EHR）数据库（Optum-Humedica已去除身份信息的电子健康记录数据集）来评估早期启动疾病修饰药物（DMD）治疗是否与改善多发性硬化症（MS）的预后相关。
纳入2008年1月1日至2014年8月30日新诊断的患者（国际疾病分类第九版临床修订本代码：340.xx；首次MS诊断=索引日期），这些患者在索引日期前1年和索引日期后2年有医疗活动，且在2年随访期内启动了DMD治疗。患者被分为早期启动者或晚期启动者（分别在索引日期后≤90天或>90天启动DMD治疗）。复发通过MS相关住院或门诊就诊且在7天内有MS诊断和皮质类固醇处方来确定。
共有4732名患者符合纳入标准：2042名（43.2%）为早期启动者，2690名（56.8%）为晚期启动者。观察到相似的基线平均年龄（两组均为46.9岁）和Charlson合并症指数评分（早期启动者：0.3，晚期启动者：0.32）。早期启动者的平均治疗时间为20.9±27.6天，晚期启动者为346.3±181.1天。与早期启动者（n = 403；19.7%）相比，晚期启动者（n = 六百零九；22.6%）在MS诊断后2年内复发的比例显著更高（p = 0.0158）。在使用多变量逻辑回归控制协变量后，与早期启动相比，晚期启动DMD治疗与更高的复发可能性相关（比值比1.189；95%置信区间：1.031 - 1.371；p = 0.0172）。
与早期启动相比，MS患者中晚期启动DMD治疗（即MS诊断后>90天）与更高的复发可能性相关。MS诊断后早期启动DMD治疗可能对长期预后有影响。
