title: Associations between co-medications and survival in ALS-a cohort study from Austria.
abstract: The aim of this study was to evaluate associations between co-medications and survival of patients with amyotrophic lateral sclerosis (ALS). Prescription databases of the Austrian sickness funds covering more than 5 million people formed the basis of this study. ALS cases were deduced from riluzole prescriptions during the study period from January 1, 2008, to June 30, 2012. After adjusting for potential confounding factors associations between co-medications and ALS survival were analyzed. A total of 522 ALS patients could be identified during the study period. Sixteen of the most frequently used drug classes were considered for the survival analyses of which two were nominally associated with ALS survival. Proton pump inhibitors (PPI) were negatively correlated with survival (HR 1.34, 95 % CI 1.04-1.73) and centrally acting muscle relaxants (CAMR) showed a positive association (HR 0.56, 95 % CI 0.39-0.81). After correcting for multiple testing, the association between CAMR and ALS survival remained significant (p = 0.03). In conclusion, this is the first study systematically evaluating potential associations between commonly used drugs and ALS disease course. We report a positive association between CAMR use and survival, which may have derived from an indication bias representing the better prognosis of the upper motor neuron predominant disease variant. However, this is still interesting since it demonstrates the sensitivity of our study design to pick up survival effects. The use of large prescription registries could thus provide a valuable basis to find clues to underlying pathophysiological mechanisms in ALS.
authors.affiliation: Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria, hakan.cetin@meduniwien.ac.at.
authors.forename: Hakan
authors.initials: H
authors.lastname: Cetin
authors.forename: Uros
authors.initials: U
authors.lastname: Klickovic
authors.forename: Jakob
authors.initials: J
authors.lastname: Rath
authors.forename: Gudrun
authors.initials: G
authors.lastname: Zulehner
authors.forename: Judith
authors.initials: J
authors.lastname: Füzi
authors.forename: Berthold
authors.initials: B
authors.lastname: Reichardt
authors.forename: Michael
authors.initials: M
authors.lastname: Hagmann
authors.forename: Julia
authors.initials: J
authors.lastname: Wanschitz
authors.forename: Wolfgang N
authors.initials: WN
authors.lastname: Löscher
authors.forename: Eduard
authors.initials: E
authors.lastname: Auff
authors.forename: Fritz
authors.initials: F
authors.lastname: Zimprich
mesh_terms: D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality; D001317:Austria / Q000453:epidemiology; D015331:Cohort Studies; D016208:Databases, Factual / Q000706:statistics & numerical data; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018696:Neuroprotective Agents / Q000627:therapeutic use*; D012044:Regression Analysis; D019782:Riluzole / Q000627:therapeutic use*; D018709:Statistics, Nonparametric; D016019:Survival Analysis
chemical_list: D018696:Neuroprotective Agents; D019782:Riluzole