Dalhousie University
Nova Scotia Health Authority and the Departments of Psychiatry and Medicine

Author Of 2 Presentations

Comorbidities Poster Presentation

P0429 - Adverse childhood experiences and psychiatric comorbidity in multiple sclerosis and other immune mediated inflammatory disorders (ID 1252)

Speakers
Presentation Number
P0429
Presentation Topic
Comorbidities

Abstract

Background

Adverse childhood experiences (ACE) encompass abuse, neglect and household dysfunction, such as parental divorce or mental illness, in early life. ACE may increase the risk of adverse physical and psychiatric health outcomes. A prior study showed an association between multiple sclerosis (MS) and ACE, but the impact of ACE on psychiatric comorbidity in MS and other immune-mediated inflammatory diseases (IMID) is not well-characterized.

Objectives

To determine whether ACE, specifically abuse and neglect, are associated with MS and other IMID, including inflammatory bowel disease (IBD) and rheumatoid arthritis (RA). We further aimed to determine the relationship between ACE and psychiatric comorbidity in the IMID population and whether these relationships differed between MS and other IMID.

Methods

There were 925 adult participants in this study, across five cohorts (MS: 232, IBD: 216, RA: 130, anxiety and depression [ANX/DEP]: 244, healthy control: 103). A structured psychiatric interview was used to identify psychiatric disorders. The validated Childhood Trauma Questionnaire was used to evaluate five types of ACE: emotional abuse (EA), physical abuse, sexual abuse, emotional neglect and physical neglect. We evaluated associations between ACE, IMID and psychiatric comorbidity using multivariable binary and ordinal logistic regression models.

Results

Overall, 66.2% of the participants had ≥1 category of ACE. Prevalence of ACE was similar across IMID groups, but higher than in healthy controls (MS: 63.8%, IBD: 61.6%, RA: 62.3%, ANX/DEP: 83.2%, control: 45.6%). Only EA was associated with increased odds of having an IMID (adjusted odds ratio [aOR] 2.37; 1.15-4.89). Presence of any ACE was associated with psychiatric comorbidity in the IMID cohort (OR 2.24; 1.58-3.16), but this association did not differ among MS, IBD and RA. Furthermore, in those with IMID, total number of ACE (aOR 1.36; 1.17-1.59) and EA (aOR 2.64; 1.66-4.21) were independently associated with increased odds of psychiatric comorbidity.

Conclusions

A history of ACE is more common in MS and other IMID than in a healthy population. ACE is associated with psychiatric comorbidity in IMID populations. Given the high burden of psychiatric disorders in the MS population, clinicians should be aware of the possible contribution of ACE, and the potential need for trauma-informed care strategies in these patients.

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Epidemiology Poster Presentation

P0443 - Characteristics of a population exposed to a disease-modifying drug for multiple sclerosis in the real-world setting (1996-2017) (ID 200)

Speakers
Presentation Number
P0443
Presentation Topic
Epidemiology

Abstract

Background

The efficacy of a disease-modifying drug (DMD) is typically established via brief clinical trials in highly selected groups. However, in clinical practice, DMDs are used for many years in a more diverse population of persons with multiple sclerosis (MS).

Objectives

The aim of the study was to describe the characteristics of a population with MS who are exposed to their first DMD in the real-world setting.

Methods

Using linked population-based health administrative data, we identified all individuals with MS aged 18 years who filled a prescription for a MS DMD in the province of British Columbia, Canada between 1996 and 2017. Individuals were followed from their first recorded demyelinating event to the earliest of death, emigration from the province, or study end (December 2017). We summarized cohort characteristics at their first filled DMD prescription (sex, age, socioeconomic status) and over the preceding year (comorbidity burden measured by the Charlson Comorbidity Index [CCI]).

Results

Overall, 4283 with MS filled a DMD prescription during the study period. Most were women (n=3132, 73%), with a mean (SD) age at the time of the first DMD prescription fill of 39.9 (9.9) years, and the socioeconomic status was distributed evenly across the income-based quintiles (neighborhood-level). Seventeen percent (n=741) had a CCI score 1. The most prevalent comorbidity was chronic pulmonary disease (n=235, 5%), followed by cerebrovascular disease (n=157, 4%) and diabetes (n=128, 3%). At the first DMD prescription fill, the proportion of women ranged from 63% (n=177/282) for dimethyl fumarate to 83% (n=15/18) for fingolimod. The mean (SD) age at first DMD prescription fill ranged from 37.2 (10.0) years for alemtuzumab to 43.0 (10.6) years for teriflunomide. Nearly 20% (n=724) were 50 years of age when they filled their first DMD prescription and 3% (n=108) were 60 years of age. From 1996-2012, the most common first DMD prescription filled was for either beta-interferon (n=2548/3190, 80%) or glatiramer acetate (n=612/3190, 19%). From 2013-2017, the most common first DMD prescription filled was for glatiramer acetate (n=379/1093, 35%), dimethyl fumarate (n=282/1093, 26%) or teriflunomide (n=182/1093, 17%).

Conclusions

Almost 1 in 5 persons with MS had at least some comorbidity at the time of initiation of their first DMD, while a minority were 60 years of age. As these individuals are often excluded from clinical trials, our data show an unmet need to understand the harms and benefits of DMD use in these understudied groups.

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