Multiple sclerosis and related disorders最新文献

{"title":"Robert Carswell and his depiction of sclerotic plaques","authors":"Patrick A. Lewis","doi":"10.1016/j.msard.2024.105903","DOIUrl":"10.1016/j.msard.2024.105903","url":null,"abstract":"","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"91 ","pages":"Article 105903"},"PeriodicalIF":2.9,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142323977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Suicidal ideation in the year following diagnosis of relapsing-remitting multiple sclerosis: A longitudinal perspective","authors":"David C Gillespie ,&nbsp;Riccardo Sacripante ,&nbsp;Siddharthan Chandran ,&nbsp;Peter Foley ,&nbsp;FutureMS consortium","doi":"10.1016/j.msard.2024.105904","DOIUrl":"10.1016/j.msard.2024.105904","url":null,"abstract":"<div><h3>Introduction</h3><div>Suicidal ideation (SI) is common in people with multiple sclerosis (pwMS) who have longstanding illness. Prevalence of SI in the weeks to months following diagnosis is unknown, as are factors associated with SI, and whether SI ‘settles’ over time for newly diagnosed individuals.</div></div><div><h3>Methods</h3><div>We investigated SI in the FutureMS cohort, a nationally-representative relapsing-remitting MS sample (<em>n</em> = 440) recruited within weeks of diagnosis. SI was considered soon (‘baseline’; median 60 days) and 12 months after diagnosis. A validated mood screen classified individuals SI/non-SI. We analysed associations of clinico-demographic variables with SI and change in SI status.</div></div><div><h3>Results</h3><div>SI was present in 12.8 % (95 % CI = 0.10, 0.16) at baseline. Those with SI had greater disability and were more likely to be anxious, depressed, fatigued, report toileting difficulties and spasms. In regression analysis, baseline SI was associated with anxiety (<em>p</em> &lt; 0.001) and depression (<em>p</em> = 0.002), though 16 % of those reporting SI scored just ‘mild’ for depression. At 12 months, 9.6 % (95 % CI = 0.07, 0.13) reported SI, non-significantly different than baseline. Individuals with poorest SI outcomes over 12 months had greater unemployment, disability, anxiety, depression, fatigue, toileting difficulties and spasms, but in regression analysis no variable was individually associated with SI change.</div></div><div><h3>Limitations</h3><div>SI is complex but measured in this study by single-item question.</div></div><div><h3>Conclusion</h3><div>SI soon after MS diagnosis is relatively common, not only when anxiety and depression are present, but also in individuals with only mild depression. Screening for SI is important, allowing clinicians to target support to newly diagnosed individuals.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"91 ","pages":"Article 105904"},"PeriodicalIF":2.9,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alexithymia in radiologically isolated syndrome","authors":"Héloise Joly ,&nbsp;Emilie Gerbier ,&nbsp;Margaux Zerlini ,&nbsp;Roxane Fabre ,&nbsp;Cassandre Landes-Château ,&nbsp;Lydiane Mondot ,&nbsp;Mikael Cohen ,&nbsp;Christine Lebrun-Frenay","doi":"10.1016/j.msard.2024.105905","DOIUrl":"10.1016/j.msard.2024.105905","url":null,"abstract":"<div><h3>Background</h3><div>Alexithymia refers to difficulty identifying (DIF) and describing (DDF) feelings and externally oriented thinking (EOT). Its prevalence remains unknown in the radiologically isolated syndrome (RIS), the preclinical multiple sclerosis (MS) phase.</div></div><div><h3>Methods</h3><div>Alexithymia was measured with the Toronto Alexithymia Scale (TAS-20) in 29 RIS and age and gender-matched healthy controls and relapsing-remitting (RR) MS with an EDSS &lt;3. All participants completed evaluations of cognition (BCCOG-SEP), depression (Fast-BDI), fatigue (EMIF), and quality of life (SEP-59).</div></div><div><h3>Results</h3><div>The level of alexithymia was significantly different between the three groups, with the higher score in the RRMS group (mean score of 54.5, SD: 12,3) compared to RIS (mean score of 47.2, SD: 14.8) and in healthy controls (mean score of 41.9, SD:12.8). 34 % of RIS participants showed a pathological level of alexithymia. The proportions were 21.7 % in the healthy controls and 51.7 % in the RRMS-matched groups. The difference was mainly significant for the DIF factor, <em>p</em>&lt;.001. No significant correlations were observed between alexithymia and the different measures of cognition. In the RIS group, alexithymia was strongly linked to the levels of depression and cognitive fatigue. Furthermore, alexithymia was related to decreased mental quality of life.</div></div><div><h3>Conclusion</h3><div>The study revealed that one-third of subjects with radiologically isolated syndrome show signs of alexithymia. Interestingly, no cognitive measure was found to be correlated with the level of alexithymia, which is consistent with previous research findings. Alexithymia and mainly difficulty identifying feelings in RIS are associated with depression but also relate to cognitive fatigue and reduced mental quality of life. This could impact the daily interactions of RIS subjects.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"91 ","pages":"Article 105905"},"PeriodicalIF":2.9,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142327828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vascular function in multiple sclerosis: Systematic review with meta-analysis","authors":"Peixuan Zheng,&nbsp;Noah G. DuBose,&nbsp;Sydney R. DeJonge,&nbsp;Brenda Jeng,&nbsp;Brooks A. Hibner,&nbsp;Robert W. Motl","doi":"10.1016/j.msard.2024.105902","DOIUrl":"10.1016/j.msard.2024.105902","url":null,"abstract":"<div><h3>Background</h3><div>Vascular comorbidities are prevalent in persons with multiple sclerosis (MS), yet less is known about underlying vascular function (VF). We performed a systematic review with meta-analysis of studies that compared VF in persons with MS and healthy controls and examined factors that may moderate the difference in vascular outcomes between groups.</div></div><div><h3>Methods</h3><div>We conducted a systematic search using PubMed/MEDLINE, CINAHL, and Embase from inception through March 2024. The search identified studies that included comparisons of VF between MS and controls on a range of function and structure outcomes (e.g., pulse wave velocity, augmentation index, arterial diameter, intima-media thickness, flow-mediated dilation). Effect sizes were calculated as standardized mean differences (SMD) using Hedge's <em>g</em> with a positive effect indicating worse VF in MS than controls. The meta-analysis involved a multilevel random effects model with follow-up moderator analyses.</div></div><div><h3>Results</h3><div>Fourteen studies met the inclusion criteria and yielded 49 effect sizes for meta-analysis. The MS subjects (<em>N</em> = 614) were predominantly female (72.0 %), with mean ages ranging from 29.9 to 54.4 years. There was a moderate difference in VF between persons with MS and healthy controls (SMD [95 % CI] = 0.56 [0.08, 1.03]; <em>p</em> = 0.02), and the effects were heterogenous (<em>Q₄₈</em>=634.5, <em>p</em> &lt; 0.01; <em>I</em>²=94.39 %). There was a greater difference in arterial stiffness between MS and controls (0.78 [0.21, 1.36], <em>p</em> = 0.008), but not in other arterial structure or function outcomes (<em>p</em> &gt; 0.05). No significant moderators were detected (<em>p</em> &gt; 0.05).</div></div><div><h3>Conclusions</h3><div>The cumulative evidence supports that persons with MS have worse VF, notably greater arterial stiffness, than healthy controls. Such findings support future research on the cause, consequences, and management of arterial stiffness among persons with MS.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"91 ","pages":"Article 105902"},"PeriodicalIF":2.9,"publicationDate":"2024-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142327827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Depression and sedentary behaviour in women with multiple sclerosis","authors":"Eduarda F.A. Machado ,&nbsp;Felipe V. Glehn ,&nbsp;Jeffer Sasaki ,&nbsp;Carlos B. Tauil ,&nbsp;Ana C. De David","doi":"10.1016/j.msard.2024.105895","DOIUrl":"10.1016/j.msard.2024.105895","url":null,"abstract":"<div><div>Depression affects around 50% of people with Multiple Sclerosis (pwMS) during their lifetime. PwMS are typically less physically active and spend twice as much time engaging in sedentary behaviour compared to the general population. Therefore, a better understanding of the factors associated with depression in pwMS, as well as the relationship between depression and sedentary behaviour and physical activity, is crucial for developing effective therapeutic strategies MS treatment. This study aimed to investigate whether the presence of depressive symptoms in pwMS is related to a longer duration of sedentary behaviour. Specially, the study assessed the relationship between depression and sedentary behaviour in women with relapsing-remitting MS (RRMS). The sample for this cross-sectional study consisted of 78 women, including 38 with relapsing-remitting MS (RRMS) (EDSS 1 to 3) and 40 healthy women. The study evaluated the depression and time in sedentary behaviour, levels of physical activity and subjective fatigue in three groups: women without MS (CG), women with MS and depression (MSD), and women with MS without depression (MSND). We found significant differences in sedentary behaviour time when comparing the group of women with MS to the group with MS and depression. The logistic regression analysis presents depression as a factor associated with sedentary behaviour in women with MS. This association became even stronger after adjustment in the multivariate model (odds ratio=1.62; 95% CI (1.13-2.64); p=0.021). Despite no differences in clinical disabilities (EDSS) or physical activity levels between the two MS subgroups (MSD and MSND), we observed a longer duration of sedentary behaviour among participants with MS and depression. There was no association with the level of physical activity. This suggests a relationship between depression and sedentary behaviour in women with MS, independent of the level of physical activity. Prolonged sedentary behaviour is a risk factor for other comorbidities, including cardiovascular disease, highlighting the importance of addressing both depression and sedentary behaviour in the management of MS. Studies that examine the amount of time pwMS spend in sedentary behaviour in various countries are crucial for developing more effective strategies tailored to different ethnicities and cultures.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"91 ","pages":"Article 105895"},"PeriodicalIF":2.9,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142328279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum to Neonatal outcomes in women with Multiple Sclerosis - Influence of disease activity: A Danish nationwide cohort study","authors":"Mette Louise Andersen ,&nbsp;Line Riis Jølving ,&nbsp;Maria Iachina ,&nbsp;Pavithra Laxsen Anru ,&nbsp;Egon Stenager ,&nbsp;Torben Knudsen ,&nbsp;Bente Mertz Nørgård","doi":"10.1016/j.msard.2024.105899","DOIUrl":"10.1016/j.msard.2024.105899","url":null,"abstract":"","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"91 ","pages":"Article 105899"},"PeriodicalIF":2.9,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2211034824004759/pdfft?md5=c6a186f4a38071c33f26a51c14b8fbe4&pid=1-s2.0-S2211034824004759-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142291535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multiple sclerosis: Pregnancy, fertility, and assisted reproductive technology–a review","authors":"Celia Oreja-Guevara ,&nbsp;Inés Gónzalez-Suárez ,&nbsp;Mar Mendibe Bilbao ,&nbsp;José Luis Gómez-Palomares ,&nbsp;Corazón Hernández Rodríguez ,&nbsp;Aintzane Rabanal ,&nbsp;Yolanda Aladro Benito","doi":"10.1016/j.msard.2024.105893","DOIUrl":"10.1016/j.msard.2024.105893","url":null,"abstract":"<div><h3>Background</h3><div>Pregnancy is not discouraged in multiple sclerosis (MS) patients. However, MS patients tend to delay motherhood since they must wait for a low clinical and radiological activity before considering pregnancy, which impacts their fertility and their need for assisted reproductive technology (ART). This review aimed to cover, from a multidisciplinary perspective, the most critical aspects revolving around pregnancy in MS patients.</div></div><div><h3>Methods</h3><div>A group of seven experts (four neurologists and three gynaecologists) met for three discussion sessions to review current knowledge on ART in patients with MS. PubMed searches for journal articles published in English or Spanish between 2000 and 2024 were undertaken. 354 articles were revised at the title level.</div></div><div><h3>Results</h3><div>We reviewed current evidence on fertility in women and men with MS, on the effects of pregnancy on MS, the disease's pharmacological treatment during pregnancy, MS during delivery and breastfeeding, ART (intrauterine insemination, in vitro fertilisation, intracytoplasmic sperm injection, and oocyte cryopreservation) in patients with MS.</div></div><div><h3>Conclusion</h3><div>Early family planning, supported by good coordination between neurology and gynaecology departments, is paramount to managing MS women with motherhood desire. Besides, although a well-planned, early pregnancy is always the most desirable outcome, ART is considered safe and valuable for MS patients. Finally, multidisciplinary units are deemed pivotal to guide MS patients with parenthood desire through pregnancy.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"92 ","pages":"Article 105893"},"PeriodicalIF":2.9,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurofilaments light chains as a diagnostic and predictive biomarker for Tunisian Multiple Sclerosis patients","authors":"Saloua Mrabet ,&nbsp;Ikram Sghaier ,&nbsp;Amira Souissi ,&nbsp;Alya Gharbi ,&nbsp;Youssef Abida ,&nbsp;Imen Kacem ,&nbsp;Amina Gargouri-Berrechid ,&nbsp;Riadh Gouider","doi":"10.1016/j.msard.2024.105901","DOIUrl":"10.1016/j.msard.2024.105901","url":null,"abstract":"<div><h3>Background</h3><div>Multiple Sclerosis (MS) course was shown to be more severe among North Africans compared to Caucasians. Validation of prognostic biomarkers of disease activity and severity is a priority in our practice.</div></div><div><h3>Objective</h3><div>We aimed to investigate the association between baseline cerebrospinal fluid (CSF) and serum NfL (sNFL) levels and disease activity and disability accrual in a cohort of Tunisian patients with MS.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted, in the department of Neurology of Razi Hospital, including patients diagnosed with MS. Patient's data were retrieved from our local MS database. Blood and CSF sampling were performed at the first visit. sNFL levels were measured using the Enzyme-Linked Immuno-Sorbent Assay (ELISA) sandwich technique.</div></div><div><h3>Results</h3><div>Three hundred MS patients were enrolled (sex-ratio= 3.05; mean age at MS onset=28.83 years+9.55, mean MS course = 10.21 years+8.96). MS phenotype was predominately relapsing (73%). CSF NfL levels were significantly correlated to the serum ones. NfL concentrations were significantly associated with MS activity (<em>p</em> = 0.012), disease progression (<em>p</em> = 0.001), and higher Multiple Sclerosis Severity Scores (MSSS) (<em>p</em> = 0.0017, <em>r</em> = 0.28).</div></div><div><h3>Conclusions</h3><div>These results support the value of NfL as a sensitive and clinically meaningful CSF and blood biomarker to evaluate MS activity and outcomes among Tunisian MS patients.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"91 ","pages":"Article 105901"},"PeriodicalIF":2.9,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142327825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preliminary findings of a ‘test bundle’ to accelerate the diagnosis of MS and NMOSD following optic neuritis","authors":"Jagannadha Avasarala ,&nbsp;Christopher McLouth ,&nbsp;Abusamra Khawla ,&nbsp;Paul Wilkerson ,&nbsp;Ellen Anderson-benge ,&nbsp;Karen B. Lundgren ,&nbsp;Saurav Das","doi":"10.1016/j.msard.2024.105890","DOIUrl":"10.1016/j.msard.2024.105890","url":null,"abstract":"<div><div>No study has investigated the length of time it takes to diagnose multiple sclerosis (MS) or neuromyelitis optic spectrum disorder (NMOSD, aquaporin 4 antibody disease or myelin oligodendrocyte glycoprotein antibody disease, MOGAD) following the onset of <em>de novo</em> optic neuritis (ON). Minimizing the time between ON and downstream diagnoses needs urgency since early diagnosis equals early treatment. The time elapsed from ON to a subsequent diagnosis of MS/NMOSD was estimated through analysis of retrospective data collected from the Axon Registry (AR) of the American Academy of Neurology (AAN) and from the University of Kentucky (UK), Lexington. The time to diagnose MS/NMOSD was arbitrarily set as occurring &lt; 6 months (early) or &gt; 6 months (delayed) following ON. Data was collected between 2007 and 2021 (AR) and 2012 to 2022, for UK, respectively.</div><div>Of the 4015 ON patients from the AR dataset, 1069 (26.6 %) were diagnosed with MS, with 857 (80.2 %) diagnosed &lt; 6 months (early) and 212 (19.8 %) diagnosed after &gt; 6 months (delayed). Secondly, 420/4015 (10.4 %) were diagnosed with NMOSD (either MOGAD or AQP4 antibody disease), of which 340/420 (80.9 %) were diagnosed &lt; 6 months (early) and 80/420 (19 %) diagnosed &gt; 6 months (delayed). In the UK dataset, a total of 90/1464 individuals (6.14 %) were diagnosed with MS; of these, 69 patients (76.7 %) were diagnosed at &lt; 6 months (early) and included a sub-group of 25 (27.8 %) diagnosed &lt; 4 weeks; 21 (23.3 %) were diagnosed &gt; 6 months (delayed) following ON. In either dataset (AR or UK, between 20 % - 23 % of MS diagnoses occurred &gt; 6 months (delayed) after a diagnosis of ON. An accelerated diagnosis (4 weeks or less) of MS/NMOSD following ON in the UK data suggests that it is possible to minimize the time to a downstream diagnosis if a ‘test bundle’ of MRI of orbits, brain, C-spine, cerebrospinal fluid (CSF) analysis, and serum testing for NMOSD is used. Additional studies using prospective, larger datasets are required to confirm our findings.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"91 ","pages":"Article 105890"},"PeriodicalIF":2.9,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142320411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with the initiation of high-efficacy disease-modifying agents over moderate-efficacy disease-modifying agents in multiple sclerosis","authors":"Jieni Li ,&nbsp;George J. Hutton ,&nbsp;Tyler J. Varisco ,&nbsp;Ying Lin ,&nbsp;Ekere J. Essien ,&nbsp;Rajender R. Aparasu","doi":"10.1016/j.msard.2024.105896","DOIUrl":"10.1016/j.msard.2024.105896","url":null,"abstract":"<div><h3>Background</h3><div>With multiple treatment options, choosing the initial disease-modifying agent (DMA) could be crucial to managing multiple sclerosis (MS). Common treatment strategies recommend starting patients with moderate-efficacy disease-modifying agents (meDMAs), while others advocate initiating high-efficacy disease-modifying agents (heDMAs). However, limited real-world evidence exists regarding the factors associated with utilizing differing treatment strategies in the MS.</div></div><div><h3>Objective</h3><div>This study evaluated the factors associated with the initiation of heDMAs in comparison to meDMAs among patients with MS.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted using the Merative MarketScan Commercial Claims Database. Adult (18–64 years) MS patients with ≥1 DMA prescription were identified from 2016 to 2019. Patients were classified as incident heDMA or meDMA users based on their earliest DMA prescription, with a 12-month washout period. All covariates were measured during the 12-month baseline before the index DMA date. A multivariable logistic regression model, guided by the Andersen Behavioral Model, was applied to examine the predisposing, enabling, and need factors associated with using heDMAs over meDMAs.</div></div><div><h3>Results</h3><div>There were 10,003 eligible MS patients, with the majority of users being female (74.92 %), middle-aged adults (35–54 years, 58.97 %), and enrolled in the Preferred Provider Organization (PPO, 53.10 %) healthcare plan. Overall, 2293 (22.92 %) MS patients initiated heDMAs. The multivariable logistic regression model revealed that male patients (adjusted odds ratio [aOR]: 1.46, 95 % Confidence Interval [CI]: 1.30–1.64) had higher odds of initiating heDMAs. Meanwhile, patients with bladder dysfunction medications (aOR: 1.39, 95% CI: 1.21-1.61), fatigue medications (aOR: 1.77, 95 %CI: 1.44–2.17), and impaired walking (aOR: 1.62, 95 %CI: 1.42–1.86) were more likely to initiate treatment with heDMAs. In contrast, patients with higher Elixhauser comorbidities scores, sensory symptoms (aOR: 0.47, 95 %CI: 0.42–0.53), visual symptoms (aOR: 0.63, 95 %CI: 0.54–0.73), and brainstem symptoms (aOR: 0.81, 95 %CI: 0.67–0.97) were less likely to be prescribed with heDMAs.</div></div><div><h3>Conclusion</h3><div>The study found that approximately one in four MS patients initiated heDMAs. Both demographic and clinical factors influenced the selection of heDMA. More work is needed to understand the differential value of selecting heDMAs over meDMAs for personalizing DMA treatment.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"91 ","pages":"Article 105896"},"PeriodicalIF":2.9,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142328162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}