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Disease progression among multiple sclerosis patients before and during a disease-modifying drug program: a longitudinal population-based evaluation

School of Public Health, University of Alberta, Edmonton, Canada, Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada

JD Fisk

Department of Psychiatry, Dalhousie University, Halifax, Canada, Department of Medicine, Dalhousie University, Halifax, Canada, john.fisk{at}cdha.nshealth.ca

MG Brown

Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada

K. Stadnyk

Dalhousie Multiple Sclerosis Research Unit, Dalhousie University, Halifax, Canada

IS Sketris

College of Pharmacy, Dalhousie University, Halifax, Canada

TJ Murray

Department of Medicine, Dalhousie University, Halifax, Canada

V. Bhan

Department of Medicine, Dalhousie University, Halifax, Canada

Randomized controlled trials have demonstrated the efficacy of disease-modifying drugs (DMDs) in persons with relapsing—remitting multiple sclerosis (MS) and secondary progressive MS with superimposed relapses. However, these brief studies of selected patients have focused mainly on reducing attacks and must be complemented by evaluations in ‘realworld’ clinical settings to establish the effectiveness of DMD programs in slowing disease progression and to inform health policy and program decision-making. We assessed the effectiveness of DMDs as administered in a comprehensive publicly funded drug insurance program that provides DMDs to a geographically defined population of MS patients who meet specific eligibility criteria. Data from 1752 MS patients (10,312 assessments) seen between 1980 and 2004 at a regional MS Clinic serving the entire population of Nova Scotia, Canada were analysed. Using survival methods we observed a statistically significant reduction in disease progression to specific Expanded Disability Status Scale endpoints following the introduction of this program. Subgroup analyses of patients eligible for treatment using hierarchical linear regression methods also suggested that disease progression was slowed in patients treated with the first DMD prescribed. These findings provide evidence supporting DMD program effectiveness that can be used to inform the broader implementation of such programs.

Key Words: multiple sclerosis • treatment effectiveness • population health • public health • chronic diseases • disease-modifying drugs

This version was published on November 1, 2009

Multiple Sclerosis, Vol. 15, No. 11, 1286-1294 (2009)
DOI: 10.1177/1352458509350307


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