Contributions
Abstract: 99
Type: Scientific Session
Abstract Category: Clinical aspects of MS - Comorbidity
Introduction: Several studies have shown that the prevalence of psychiatric disorders is increased in people with multiple sclerosis (MS), but their impact on MS disability worsening has not yet been fully established.
Objectives: To investigate if depression and bipolar disorder are associated with disability worsening in MS by examining risk of reaching sustained expanded disability status scale (EDSS) score milestones and conversion to secondary progressive MS (SPMS).
Aims: To find out whether depression and bipolar disorder influence MS disability worsening.
Methods: Cases of MS were identified from the Swedish National MS registry (SMSreg). The national patient registry and the national prescription registry were used to define cases of depression and bipolar disorder, using International Classification of Diseases (ICD) 10 diagnosis codes and prescriptions for selective serotonin reuptake inhibitors (SSRIs). Kaplan-Meier and Cox proportional hazard regression models were used to compare time to and risk of reaching sustained EDSS 3, 4, 6 and SPMS.
Results: A total of 15,541 MS patients were included; 1320 had ≥1 ICD code for depression, 271 had ≥1 ICD code for bipolar disorder and 4921 received ≥1 prescription for an SSRI. Patients taking SSRIs were at a significantly higher risk of reaching EDSS 3, 4 and 6, by 51% (95% CI:1.37-1.67), 58% (95% CI: 1.42-1.75) and 49% (95% CI:1.43-1.65), respectively. This was likewise the case for those with an ICD code of depression who were furthermore also at 38% (95% CI:1.12-1.71) increased risk of converting to SPMS. Median time to EDSS 3, 4, 6 and SPMS was also reduced by 3, 6, 6 and 3 years, respectively. A sub-analysis of 261 patients with a diagnosis of depression prior to MS onset showed a 3 and 7 years reduction in median time to EDSS 3 and 4, respectively. MS patients with bipolar disorder showed a significant increased risk of reaching EDSS 3 and 4 being respectively 70% (95% CI:1.14-2.53) and 86% (95% CI:1.22-2.85). A significant gender difference was found in both disorders, with men exhibiting the greatest risk.
Conclusions: MS patients with depression or bipolar disorder have a significantly worse MS disease course, also in patients with a diagnosis of depression prior to MS onset. This leads us to hypothesise that a depressive state may render the central nervous system more sensitive to inflammation, a possibility that may warrant an increased focus on treatment of depressive symptoms in MS.
Disclosure: Dr. Stefanie Binzer: nothing to disclose. Dr. Kyla McKay: receives research funding from the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) and the Canadian Institutes of Health Research. Dr. Ali Manouchehrinia has received consultancy fees from Novartis and Biogen. Prof. Jan Hillert has received honoraria for serving on advisory boards for Biogen, Sanofi-Genzyme and Novartis and speaker¹s fees from Biogen, Novartis, Merck-Serono, Bayer-Schering, Teva and Sanofi Genzyme. He has served as P.I. for projects, or received unrestricted research support from, BiogenIdec,Merck-Serono, TEVA, Sanofi-Genzyme and Bayer-Schering. This MS research was funded by the Swedish Research Council and the Swedish Brain foundation.
Abstract: 99
Type: Scientific Session
Abstract Category: Clinical aspects of MS - Comorbidity
Introduction: Several studies have shown that the prevalence of psychiatric disorders is increased in people with multiple sclerosis (MS), but their impact on MS disability worsening has not yet been fully established.
Objectives: To investigate if depression and bipolar disorder are associated with disability worsening in MS by examining risk of reaching sustained expanded disability status scale (EDSS) score milestones and conversion to secondary progressive MS (SPMS).
Aims: To find out whether depression and bipolar disorder influence MS disability worsening.
Methods: Cases of MS were identified from the Swedish National MS registry (SMSreg). The national patient registry and the national prescription registry were used to define cases of depression and bipolar disorder, using International Classification of Diseases (ICD) 10 diagnosis codes and prescriptions for selective serotonin reuptake inhibitors (SSRIs). Kaplan-Meier and Cox proportional hazard regression models were used to compare time to and risk of reaching sustained EDSS 3, 4, 6 and SPMS.
Results: A total of 15,541 MS patients were included; 1320 had ≥1 ICD code for depression, 271 had ≥1 ICD code for bipolar disorder and 4921 received ≥1 prescription for an SSRI. Patients taking SSRIs were at a significantly higher risk of reaching EDSS 3, 4 and 6, by 51% (95% CI:1.37-1.67), 58% (95% CI: 1.42-1.75) and 49% (95% CI:1.43-1.65), respectively. This was likewise the case for those with an ICD code of depression who were furthermore also at 38% (95% CI:1.12-1.71) increased risk of converting to SPMS. Median time to EDSS 3, 4, 6 and SPMS was also reduced by 3, 6, 6 and 3 years, respectively. A sub-analysis of 261 patients with a diagnosis of depression prior to MS onset showed a 3 and 7 years reduction in median time to EDSS 3 and 4, respectively. MS patients with bipolar disorder showed a significant increased risk of reaching EDSS 3 and 4 being respectively 70% (95% CI:1.14-2.53) and 86% (95% CI:1.22-2.85). A significant gender difference was found in both disorders, with men exhibiting the greatest risk.
Conclusions: MS patients with depression or bipolar disorder have a significantly worse MS disease course, also in patients with a diagnosis of depression prior to MS onset. This leads us to hypothesise that a depressive state may render the central nervous system more sensitive to inflammation, a possibility that may warrant an increased focus on treatment of depressive symptoms in MS.
Disclosure: Dr. Stefanie Binzer: nothing to disclose. Dr. Kyla McKay: receives research funding from the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) and the Canadian Institutes of Health Research. Dr. Ali Manouchehrinia has received consultancy fees from Novartis and Biogen. Prof. Jan Hillert has received honoraria for serving on advisory boards for Biogen, Sanofi-Genzyme and Novartis and speaker¹s fees from Biogen, Novartis, Merck-Serono, Bayer-Schering, Teva and Sanofi Genzyme. He has served as P.I. for projects, or received unrestricted research support from, BiogenIdec,Merck-Serono, TEVA, Sanofi-Genzyme and Bayer-Schering. This MS research was funded by the Swedish Research Council and the Swedish Brain foundation.