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Tuesday, December 6, 2016
Antidepressant Treatment in Association with Multiple Sclerosis Disease-Modifying Therapy: Using Explorys in the MS Population
Matthew M. Mirsky, MS; Ruth Ann Marrie, MD, PhD; Alexander Rae-Grant, MD, FRCPC
From the Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA (MMM, ARG); and the Departments of Internal Medicine (Neurology) and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnepeg, Manitoba, Canada (RAM).
Correspondence: Alexander Rae-Grant, MD, FRCPC, Cleveland Clinic Main Campus, Mail Code U2-315, 9500 Euclid Ave., Cleveland, OH 44195; e-mail: Rae-Gra@ccf.org.
Background: Explorys Enterprise Performance Management (EPM) is a HIPAA-compliant database containing de-identified clinical data totaling 50 million patients. MS disease-modifying therapies (DMTs), specifically interferon beta treatments, may potentiate depression. There has been conflicting data, and a large-scale claims-based study by Patten et al. did not support such an association. This study serves to compare results of Patten et al., “Anti-depressant Use in Association with Interferon and Glatiramer Acetate Treatment in Multiple Sclerosis,” using EPM while investigating other DMTs.
Methods: EPM “power searches” were built to test the relationship between antidepressant and DMT use in the MS population. Searches were built to produce a cohort of individuals diagnosed with MS in the past 3 years, on a specific DMT, who were then placed on any antidepressant. The antidepressant prevalence was tested in the MS population on the following DMTs: interferon beta-1a, interferon beta-1b, combined interferon beta as “IFN,” glatiramer acetate, natalizumab, fingolimod, and dimethyl fumarate. These data were further analyzed by age and sex.
Results: In patients with MS the rate of antidepressant use in those on MS DMTs ranged from 40.60% to 44.57%. The rate of antidepressant use among IFN DMTs was 41.61%. The rate of antidepressant use in males ranged from 31.25% to 39.62%, while in females it ranged from 43.10% to 47.33%. Antidepressant use peaked in the 45–54 age group in five of six MS DMTs studied.
Conclusions: We found no association between IFN treatment and antidepressant use in the MS population when compared to other DMTs. The EPM database has been validated against Patten et al. data for future use in the MS population.