Medicine (Neurology), University of British Columbia, Vancouver, BC, Canada; Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, Canada.
Department of Statistics, University of British Columbia, Vancouver, BC, Canada.
Lancet Neurol. 2017 Jun;16(6):445-451. doi: 10.1016/S1474-4422(17)30076-5. Epub 2017 Apr 20.
Degenerative processes in neurodegenerative diseases can start years before clinical manifestation. We aimed to establish whether a multiple sclerosis prodromal period exists by examining patterns of health-care use before a first demyelinating event.
In this matched cohort study, we used data from linked health administrative and clinical databases from four Canadian provinces (British Columbia, Saskatchewan, Manitoba, and Nova Scotia) to compare hospital, physician, and prescription use data from people with multiple sclerosis and matched general population controls in the 5 years before the first demyelinating disease claim (health administrative index date) or clinically reported symptom onset (clinical index date). Rate ratios (RRs) were estimated using negative binomial regression and combined across provinces using random effect models. The primary outcome was all-cause use of health care during each of the 5 years before the health administrative or clinical index date.
The health administrative cohort included 14 428 multiple sclerosis cases and 72 059 matched controls for whom data were available between April, 1984, and April, 2014. Annual health-care use increased steadily between 5 years and 1 year before the first demyelinating disease claim in people with multiple sclerosis compared with controls (from RR 1·26 [95% CI 1·16-1·36] to 1·78 [1·50-2·10] for hospital admissions; from 1·24 [1·16-1·32] to 1·88 [1·72-2·07] for physician claims; and from 1·23 [1·06-1·41] to 1·49 [1·41-1·59] for prescriptions, assessed as drug classes). Similar patterns for physician claims and prescriptions were observed in the cohort with available clinical symptom onset (3202 individuals with multiple sclerosis and 16 006 controls), although the differences in use in each of the 5 years mostly did not reach statistical significance.
More frequent use of health care in patients with multiple sclerosis than in controls in the 5 years before a first demyelinating event, according to health administrative data, suggests the existence of a measurable multiple sclerosis prodrome. These findings have clinical and research implications, including the establishment of an earlier window of opportunity to identify and potentially treat multiple sclerosis.
National Multiple Sclerosis Society.
神经退行性疾病中的退行性过程可在临床症状出现前数年开始。我们旨在通过检查首次脱髓鞘事件前的医疗保健使用模式来确定多发性硬化症是否存在前驱期。
在这项匹配队列研究中，我们使用了来自加拿大四个省（不列颠哥伦比亚省、萨斯喀彻温省、马尼托巴省和新斯科舍省）的链接健康管理和临床数据库中的数据，比较了多发性硬化症患者和匹配的一般人群对照组在首次脱髓鞘疾病索赔（健康管理索引日期）或临床报告症状发作（临床索引日期）前 5 年的医院、医生和处方使用数据。使用负二项式回归估计率比（RR），并使用随机效应模型在各省之间进行组合。主要结局是在健康管理或临床索引日期前的 5 年内，每个患者的全因医疗保健使用情况。
在 1984 年 4 月至 2014 年 4 月期间，健康管理队列纳入了 14428 例多发性硬化症病例和 72059 名匹配对照者，其中有数据。与对照组相比，多发性硬化症患者在首次脱髓鞘疾病索赔前 5 年至 1 年的年度医疗保健使用量稳步增加（从住院治疗的 RR1.26 [95%CI1.16-1.36]增加至 1.78 [1.50-2.10]；从医生就诊的 RR1.24 [1.16-1.32]增加至 1.88 [1.72-2.07]；从处方的 RR1.23 [1.06-1.41]增加至 1.49 [1.41-1.59]，评估为药物类别）。在有临床症状发作（3202 例多发性硬化症患者和 16006 名对照者）的队列中观察到类似的医生就诊和处方使用模式，尽管在 5 年内的每种情况下，使用差异大多没有达到统计学意义。
根据健康管理数据，与对照组相比，多发性硬化症患者在首次脱髓鞘事件前 5 年内更频繁地使用医疗保健，这表明存在可衡量的多发性硬化症前驱期。这些发现具有临床和研究意义，包括确定和潜在治疗多发性硬化症的机会窗口更早。
国家多发性硬化症协会。
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