title: Patients characteristics influencing the longitudinal utilization of steroids in multiple sclerosis--an observational study.
abstract: BACKGROUND
  Multiple Sclerosis is the most common disease in young adults affecting the central nervous system. Disease may progress with acute attacks (relapsing MS) or continuously (progressive MS). Glucocorticosteroids are used in the treatment of acute attacks. The aim of this study was to analyse characteristics of patients with MS, and their influence on current treatment patterns of relapses with glucocorticosteroids.
  
  
  METHODS
  In 2001, the German National MS Society initiated the German MS-Registry. Patients with relapsing MS were included (n = 5106) from this registry. Logistic regression models were used to detect trends over time. The likelihood of administration of steroids is modelled in dependence of calendar year and in dependence to confounders in treatment conditions. The sample size allows that odds ratios can be detected with a power of 90% (alpha = 0.05).
  
  
  RESULTS
  Administration of glucocorticosteroids was influenced by EDSS (P < 0.0001), age (P < 0.0001) and disease duration (P < 0.0001). Therapy administration in an outpatient setting was more likely in patients with higher EDSS (P < 0.0001) and longer disease duration (P < 0.0001). The utilization of glucocorticosteroids increased with higher EDSS for all relapsing patients. Interestingly, all overutilization of glucocorticosteroids decreased over time and was accompanied by a steadily increased administration of emergent therapeutics. Although there are about 70% of registered patients with relapsing MS on immune-modulatory treatment, almost 60% of them received glucocorticosteroids for treatment of relapses.
  
  
  CONCLUSIONS
  Treatment patterns with glucocorticosteroids in patients with MS are influenced mainly by EDSS and disease duration. The decline in the utilization of glucocorticosteroids is accompanied by an increase in natalizumab treatment.
authors: Department of Neurology, University of Rostock, Rostock, Germany.|Department of Neurology, Medical University of Vienna, Vienna, Austria.
authors: Paulus S
authors: PS
authors: Rommer
authors: Department of Medical Informatics, University Medical Centre Göttingen, Göttingen, Germany.
authors: Karoline
authors: K
authors: Buckow
authors: Department of Medical Statistics, University Medical Centre Göttingen, Göttingen, Germany.
authors: David
authors: D
authors: Ellenberger
authors: Department of Medical Statistics, University Medical Centre Göttingen, Göttingen, Germany.
authors: Tim
authors: T
authors: Friede
authors: German National MS Society (DMSG), Hannover, Germany.
authors: Dorothea
authors: D
authors: Pitschnau-Michel
authors: MS Forschungs- und Projektentwicklungs-GmbH, Hannover, Germany.
authors: Jan
authors: J
authors: Fuge
authors: Department of Neurology and Neurotherapeutics, University of Texas Southwestern, Dallas, TX, USA.|Neurology Section, VA North Texas Health Care System, Dallas VA Medical Center, Dallas, TX, USA.|Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors: Olaf
authors: O
authors: Stüve
authors: Department of Neurology, University of Rostock, Rostock, Germany.
authors: Uwe K
authors: UK
authors: Zettl
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000553:Ambulatory Care; D005260:Female; D006760:Hospitalization; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D008134:Long-Term Care; D008137:Longitudinal Studies; D008297:Male; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy*; D000069442:Natalizumab / Q000627:therapeutic use*
chemical_list: D000305:Adrenal Cortex Hormones; D007155:Immunologic Factors; D000069442:Natalizumab
keywords: EDSS; Multiple Sclerosis; glucocorticosteroids; natalizumab; relapsing Multiple Sclerosis