Abstract: CCSVI Treatment and Comorbidity: A Province-Wide Study of Multiple Sclerosis (The 27th Annual Meeting of the CMSC and the 5th Cooperative Meeting of the CMSC-ACTRIMS)

Thursday, May 30, 2013

Ruth Ann Marrie, MD, PhD, FRCPC , University of Manitoba, Winnipeg, MB, Canada

Luanne Metz, MD, FRCPC , University of Calgary, Calgary, AB, Canada

Katayoun Alikhani, MD , University of Calgary, Calgary, AB, Canada

Gregg Blevins, MD , University of Alberta, Edmonton, AB, Canada

Jacqueline Bakker, MD , University of Calgary, Red Deer, AB, Canada

Larry Svenson, BSc , University of Calgary, Edmonton, AB, Canada

Nathalie Jette, MD, MSc , University of Calgary, Calgary, AB, Canada

Oksana Suchowersky, MD , University of Alberta, Edmonton, AB, Canada

Mary Louise Myles, MD , University of Alberta, Edmonton, AB, Canada

Winona Wall, BSc , University of Calgary, Calgary, AB, Canada

James Newsome, BSc , University of Calgary, Calgary, AB, Canada

Jamie Greenfield, MSc , University of Calgary, Calgary, AB, Canada

Marcus Koch, MD, PhD , University of Calgary, Calgary, AB, Canada

Scott Patten, MD, PhD , University of Calgary, Calgary, AB, Canada

Scott Kraft, MD, MSc , University of Calgary, Calgary, AB, Canada

Derek Emery, MD, MSc , University of Alberta, Edmonton, AB, Canada

Mayank Goyal, MD , University of Calgary, Calgary, AB, Canada

Background: Prior studies suggest that comorbidity is common in Multiple Sclerosis (MS), and that it is negatively associated with disability and quality of life. It is unknown whether it is associated with the use of experimental therapies, such as venous angioplasty for chronic cerebrospinal venous insufficiency (CCSVI).

Objectives: Among persons with MS we aimed to describe the association between comorbidities and treatment for CCSVI.

Methods: The Alberta Multiple Sclerosis Initiative (TAMSI) began in July 2011 as a longitudinal observational study to capture patient-reported information about safety and outcomes after CCSVI treatment. All Albertans with MS were encouraged to participate, irrespective of treatment status; enrollment is ongoing.

Results: We included 683 participants in the analysis, of whom 77.7% were women, and 64.2% had relapsing remitting MS. Their mean (SD) age was 47.9 (11.2) years. Of these, 138 participants (20.2%; 95%CI: 17.3-23.4%) reported having CCSVI treatment. 233 participants reported no (34.1%) comorbidities, while 196 (28.7%) reported one, 133 (19.5%) reported two, 65 (9.5%) reported three, and 56 (8.2%) reported four or more. The most commonly reported comorbidities were depression (189, 27.7%), hyperlipidemia (108, 15.8%), hypertension (107, 15.7%), migraine (103, 15.1%), chronic lung disease (63, 9.2%), and irritable bowel syndrome (56, 8.2%). Individuals reporting any comorbidity were less likely (OR 0.68 95% CI: 0.46-0.99) to report undergoing venous angioplasty (18.0%; 95%CI: 14.6-21.9%) than those reporting no comorbidity (24.5%; 95%CI: 19.1-30.5). Further, the likelihood of reporting undergoing venous angioplasty decreased with increasing number of comorbidities (OR 0.85; 95%CI: 0.72-0.99). The odds of venous angioplasty did not differ for participants reporting any particular comorbidity (p>0.05). Older age, male sex, a progressive course, and greater disability were associated with greater frequency of venous angioplasty (all p<0.05). After adjustment for these factors in logistic regression, the association between venous angioplasty and any comorbidity (OR 0.69; 95%CI: 0.45-1.05) or number of comorbidities (OR 0.84; 95%CI: 0.71-1.01) was unchanged.

Conclusions: Comorbidity is common among persons with MS participating in the TAMSI study, similar to other MS populations. Comorbidity was associated with a decreased frequency of venous angioplasty for CCSVI.

DX45 CCSVI Treatment and Comorbidity: A Province-Wide Study of Multiple Sclerosis