The misclassification of depression and anxiety disorders in the multiple sclerosis prodrome: A probabilistic bias analysis.

Background: Studies suggest that depression/anxiety form part of the multiple sclerosis (MS) prodrome. However, several biases have not been addressed. We re-examined this association after correcting for: (i) misclassification of individuals not seeking healthcare, (ii) differential surveillance of depression/anxiety in the health system, and (iii) misclassified person-time from using the date of the first MS-related diagnostic claim (i.

Assessment of dietary intake and its inflammatory potential in persons with pediatric-onset multiple sclerosis.

Objective: To compare diet and the modified dietary inflammatory index (mDII) between individuals with pediatric-onset multiple sclerosis (PoMS), monophasic acquired demyelinating syndromes (monoADS), and controls.

Methods: The association between diet, mDII, and disease status was examined in 131 individuals with PoMS/monoADS/controls (38/45/48) using logistic regression.

Results: The associations between diet and PoMS were modest, reaching significance for whole grain intake (adjusted odds ratio, aOR=0.

Polypharmacy and multiple sclerosis: A population-based study.

Background: Little is known about polypharmacy and multiple sclerosis (MS).

Objectives: To estimate polypharmacy prevalence in a population-based MS cohort and compare persons with/without polypharmacy.

Methods: Using administrative and pharmacy data from Canada, we estimated polypharmacy prevalence (⩾5 concurrent medications for >30 consecutive days) in MS individuals in 2017.

The association between diabetes and excessive daytime sleepiness among American adults aged 20-79 years: findings from the 2015-2018 National Health and Nutrition Examination Surveys.

Purpose: To examine the association between diabetes and excessive daytime sleepiness (EDS).

Methods: Using the 2015-2018 cycles of the National Health and Nutrition Examination Survey, we applied survey-featured modified Poisson regression to estimate the association between diabetes and EDS among American adults aged 20-79 years, adjusting for confounding demographic, clinical and lifestyle variables. Effect modification by age, sex, race, education, income, sleep apnea and inadequate sleep was assessed.

The gut microbiota in pediatric multiple sclerosis and demyelinating syndromes.

Objective: To examine the gut microbiota in individuals with and without pediatric-onset multiple sclerosis (MS).

Methods: We compared stool-derived microbiota of Canadian Pediatric Demyelinating Disease Network study participants ≤21 years old, with MS (disease-modifying drug [DMD] exposed and naïve) or monophasic acquired demyelinating syndrome [monoADS] (symptom onset <18 years), and unaffected controls. All were ≥30 days without antibiotics or corticosteroids.

Care consumption of people with multiple sclerosis: A multichannel sequence analysis in a population-based setting in British Columbia, Canada.

Background: Persons with multiple sclerosis (PwMS) typically require complex multidisciplinary care, which is rarely formally assessed.

Objectives: We applied multichannel sequence analysis (MCSA) to identify care consumption patterns by PwMS in British Columbia, Canada.

Methods: We created two cohorts, comprising incident and prevalent MS cases, using linked clinical and administrative data.

Safety of dimethyl fumarate for multiple sclerosis: A systematic review and meta-analysis.

Background: The safety profile of dimethyl fumarate (DMF) for multiple sclerosis (MS) is not fully understood.

Objective: To systematically review the literature for adverse events (AE) associated with DMF for MS.

Methods: We searched MEDLINE, EMBASE, CINAHL, Web of Science, CENTRAL, and clinicaltrials.

Alemtuzumab and prescription medication use in the MS population.

Medications are indicated to minimize adverse reactions with alemtuzumab treatment for multiple sclerosis, but polypharmacy can be problematic. We characterized prescriptions filled by 160 individuals before, during and after first infusion of alemtuzumab (Dec/2013-Jun/2017). Ninety-five percent of individuals filled ≥1 prescription(s) before alemtuzumab across 87 unique drug classes, averaging 5.

A systematic review of morbidities suggestive of the multiple sclerosis prodrome.

The identification of a prodromal phase in multiple sclerosis (MS) could have major implications for earlier recognition and management of MS. The authors conducted a systematic review assessing studies of morbidities before, or at, MS onset or diagnosis.: Two independent reviewers searched Medline, Embase, Psycinfo and CINAHL from inception to February 8, 2019.

Interrogation of the Multiple Sclerosis Prodrome Using High-Dimensional Health Data.

Background: There is growing evidence of a prodromal period in multiple sclerosis (MS). A better understanding of the prodrome may facilitate prompt recognition and treatment of MS as well as narrowing of the etiologically relevant -period when searching for MS risk factors.

Objectives: To explore and further delineate the MS prodrome, we used statistical learning techniques to examine associations of physician-generated diagnostic codes and prescription medication classes in the 5 years before the first demyelinating-related claim for MS cases and matched population controls.

Informing Medication Discontinuation Decisions among Older Adults with Relapsing-Onset Multiple Sclerosis.

Background: For older adults with relapsing-onset multiple sclerosis (MS), limited information is available to inform if, or when, disease-modifying drugs (DMDs) may be safely discontinued.

Objective: The aim of this study was to project the outcomes of DMD discontinuation among older adults with relapsing-onset MS.

Methods: We projected the 10-year outcomes of discontinuation of a DMD (interferon-β, fingolimod, or natalizumab) among older adults (aged 55 or 70 years) who were relapse-free for 5 or more years and had not reached an Expanded Disability Status Scale (EDSS) score of 6.

Disparities in management and outcomes of myocardial infarction in multiple sclerosis: A matched cohort study.

Background: Although multiple sclerosis (MS) confers an elevated risk of acute myocardial infarction (AMI), little is known about how it influences management of AMI.

Methods: Using population-based administrative (health) data from two Canadian provinces, we conducted a retrospective matched cohort study. We identified people with MS who had an incident AMI, and up to five AMI controls without MS matched on age, sex, and region.

Higher health care use before a clinically isolated syndrome with or without subsequent MS.

Background: To establish whether a unique multiple sclerosis (MS) prodrome exists by comparing health care utilization in the five-year period before initial presentation with optic neuritis (ON) or transverse myelitis (TM) among those who were and were not subsequently diagnosed with MS.

Methods: Using population-based administrative health data we conducted a retrospective cohort study in three Canadian provinces. We identified individuals with a clinically isolated syndrome (ON or TM), who were eventually diagnosed with MS (CIS-MS) or not (CIS-non MS), and a control cohort matched on age, sex and region without a CIS.

Traditional risk factors may not explain increased incidence of myocardial infarction in MS.

Objective: To compare the risk of incident acute myocardial infarction (AMI) in the multiple sclerosis (MS) population and a matched population without MS, controlling for traditional vascular risk factors.

Methods: We conducted a retrospective matched cohort study using population-based administrative (health claims) data in 2 Canadian provinces, British Columbia and Manitoba. We identified incident MS cases using a validated case definition.

Prodrome in relapsing-remitting and primary progressive multiple sclerosis.

Background And Purpose: The multiple sclerosis prodrome remains poorly understood. We aimed to examine the prodrome in people with relapsing remitting multiple sclerosis at onset (RMS) and primary progressive multiple sclerosis (PPMS).

Methods: We conducted a matched cohort study using clinical and linked health administrative data in two Canadian provinces.

MRI utilization during the diagnostic and post-diagnostic phases in multiple sclerosis.

Background: Magnetic resonance imaging (MRI) plays an important role in the diagnosis and monitoring of people with multiple sclerosis (MS). MRI rates in MS populations are poorly understood. Although Canada has universal health care, socioeconomic status (SES) is associated with MRI use.

Identifying optic neuritis and transverse myelitis using administrative data.

Objective: We aimed to validate administrative case definitions to identify individuals with optic neuritis (ON) or transverse myelitis (TM), and to distinguish which of these individuals had a monophasic presentation versus multiple sclerosis (MS).

Methods: Using population-based administrative (health claims) data from Manitoba, Canada, we developed case definitions for ON and TM, and distinguished individuals who had monophasic presentations (ON-nonMS, TM-nonMS) versus those later diagnosed with MS (ON-MS, TM-MS). We compared performance of these case definitions to diagnoses based on medical records review in a reference cohort (n = 1251) using sensitivity, specificity, positive predictive value and negative predictive value.

Mining healthcare data for markers of the multiple sclerosis prodrome.

Background: Previous studies suggest the existence of a prodromal period in multiple sclerosis, but little is known about the phenotypic characteristics. This study aims to characterize the multiple sclerosis (MS) prodrome using data mining analytics in the healthcare setting.

Methods: We identified people with MS and matched general population controls using health administrative data in two Canadian provinces (British Columbia and Saskatchewan).