Disease-Modifying Drugs for Multiple Sclerosis and Association With Survival

Huah Shin Ng, Feng Zhu, Elaine Kingwell, Shenzhen Yao, Okechukwu Ekuma, Charity Evans, John D. Fisk, Ruth Ann Marrie, Yinshan Zhao, Helen Tremlett

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)
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BACKGROUND AND OBJECTIVES: We examined the association between the disease-modifying drugs (DMDs) for multiple sclerosis (MS) and survival in a multiregion population-based study. METHODS: We accessed multiple administrative health databases from 4 Canadian provinces. Persons with MS were identified and followed from the most recent of the first MS or demyelinating event or January 1, 1996 (index date), until death, emigration, or December 31, 2017. Association between the first-generation and second-generation DMDs and all-cause mortality was examined using stratified Cox proportional hazard models, reported as adjusted hazard ratios (aHRs). Timing of DMD initiation was explored, with findings reported at 2, 5, or 10 years postindex date, representing very early, early, or late initiation. RESULTS: We identified 35,894 persons with MS; 72% were female. The mean age at index date was 44.5 years (SD = 13.6). The total person-years of follow-up while DMD-exposed was 89,180, and total person-years while unexposed was 342,217. Compared with no exposure, exposure to any DMD or to any first-generation DMD was associated with a 26% lower hazard of mortality (both aHRs 0.74; 95% CI 0.56-0.98), while any second-generation DMD exposure was associated with a 33% lower hazard (aHR 0.67; 95% CI 0.46-0.98). Earlier DMD initiation (beta-interferon or glatiramer acetate vs no exposure) was associated with a significant mortality effect (p < 0.05), while later initiation was not (95% CIs included 1). However, the survival advantage with earlier initiation diminished over time, no longer reaching statistical significance at 15 years postindex date. DISCUSSION: Our study demonstrates an association between the DMDs for MS and improved survival in the real-world setting.

Original languageEnglish
Article numbere200005
Number of pages12
JournalNeurology: Neuroimmunology and NeuroInflammation
Issue number5
Early online date14 Jun 2022
Publication statusPublished - 1 Sept 2022
Externally publishedYes


  • Multiple sclerosis
  • disease-modifying drugs (DMDs)
  • Patient outcomes


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