Contributions
Abstract: EP1670
Type: ePoster
Abstract Category: Therapy - disease modifying - 26 Immunomodulation/Immunosuppression
Introduction: Pivotal trials of multiple sclerosis (MS) disease modifying therapies (DMTs) typically exclude patients with significant comorbidities. This leads to uncertainty about the safety of DMTs in patients with comorbidities. Several studies have suggested that comorbidities negatively impact MS disease course, meaning patients with comorbidities may need to switch DMTs more frequently.
Methods: A database query for relapsing-remitting MS patients visiting the Mellen Center after 1 January 2010 was conducted. Chart review was completed to determine each patient's DMT history and whether or not they have hypertension (HTN), hyperlipidemia (HLD), diabetes (DM), or obstructive lung disease (OLD). A linear regression model was used to determine associations between comorbidities and the total number of DMTs used by a patient. Covariates used for adjustment included age, race, gender, disease duration, insurance type, median household income by zip code, depression, and smoking status. A parsimonious model using only significant predictors from the larger model was also constructed and tested for interactions.
Results: The analysis included 2,702 patients. The mean age was 47.9 years, mean disease duration was 11.2 years, and the mean number of DMTs was 2.1. In the larger model, male gender was significantly associated with a higher number of DMTs used (β= .131, p=0.03), while disease duration
(β= -0.016, p< 0.001), HTN (β= -0.129, p=0.02), and HLD (β= -0.13, p=0.03) were significantly associated with fewer DMTs used. The results from the parsimonious model were similar and no statistical interaction was found with disease duration. When the model was applied to those with disease duration < 10 years only, the relationship between disease duration and number of DMTs disappeared.
Conclusions: Patients with HTN and HLD used fewer DMTs, whereas DM and OLD had no association with the number of DMTs used. This may be because of concern about the safety of certain DMTs in patients with HTN and HLD. Interestingly, male gender was associated with more DMTs used. This may be due to a more aggressive disease among men requiring more treatment escalation. Alternatively, men may be less cautious and willing to try DMTs with more inherent risk. The inverse relationship between disease duration and number of DMTs used was unexpected. We theorize that this may be related to individuals diagnosed when fewer DMT options were available who never went on to change treatments.
Disclosure:
Devon Conway has received research support paid to his institution by Novartis Pharmaceuticals.
Sarah Planchon has nothing to disclose.
Daniel Ontaneda has received grant support from the NIH, NMSS, Novartis, Genzyme, and Genentech; and consulting fees from Genentech and Biogen Idec.
Abstract: EP1670
Type: ePoster
Abstract Category: Therapy - disease modifying - 26 Immunomodulation/Immunosuppression
Introduction: Pivotal trials of multiple sclerosis (MS) disease modifying therapies (DMTs) typically exclude patients with significant comorbidities. This leads to uncertainty about the safety of DMTs in patients with comorbidities. Several studies have suggested that comorbidities negatively impact MS disease course, meaning patients with comorbidities may need to switch DMTs more frequently.
Methods: A database query for relapsing-remitting MS patients visiting the Mellen Center after 1 January 2010 was conducted. Chart review was completed to determine each patient's DMT history and whether or not they have hypertension (HTN), hyperlipidemia (HLD), diabetes (DM), or obstructive lung disease (OLD). A linear regression model was used to determine associations between comorbidities and the total number of DMTs used by a patient. Covariates used for adjustment included age, race, gender, disease duration, insurance type, median household income by zip code, depression, and smoking status. A parsimonious model using only significant predictors from the larger model was also constructed and tested for interactions.
Results: The analysis included 2,702 patients. The mean age was 47.9 years, mean disease duration was 11.2 years, and the mean number of DMTs was 2.1. In the larger model, male gender was significantly associated with a higher number of DMTs used (β= .131, p=0.03), while disease duration
(β= -0.016, p< 0.001), HTN (β= -0.129, p=0.02), and HLD (β= -0.13, p=0.03) were significantly associated with fewer DMTs used. The results from the parsimonious model were similar and no statistical interaction was found with disease duration. When the model was applied to those with disease duration < 10 years only, the relationship between disease duration and number of DMTs disappeared.
Conclusions: Patients with HTN and HLD used fewer DMTs, whereas DM and OLD had no association with the number of DMTs used. This may be because of concern about the safety of certain DMTs in patients with HTN and HLD. Interestingly, male gender was associated with more DMTs used. This may be due to a more aggressive disease among men requiring more treatment escalation. Alternatively, men may be less cautious and willing to try DMTs with more inherent risk. The inverse relationship between disease duration and number of DMTs used was unexpected. We theorize that this may be related to individuals diagnosed when fewer DMT options were available who never went on to change treatments.
Disclosure:
Devon Conway has received research support paid to his institution by Novartis Pharmaceuticals.
Sarah Planchon has nothing to disclose.
Daniel Ontaneda has received grant support from the NIH, NMSS, Novartis, Genzyme, and Genentech; and consulting fees from Genentech and Biogen Idec.