{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T17:16:01Z","timestamp":1781716561414,"version":"3.54.5"},"reference-count":37,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2021,12,24]],"date-time":"2021-12-24T00:00:00Z","timestamp":1640304000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["Foundation Grant 159934"],"award-info":[{"award-number":["Foundation Grant 159934"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["Project Grant 156363"],"award-info":[{"award-number":["Project Grant 156363"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Mult Scler"],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>We assessed the relationship between the multiple sclerosis (MS) disease-modifying drugs (DMDs) and healthcare use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Persons with MS (aged \u2a7e18 years) were identified using linked population-based health administrative data in four Canadian provinces and were followed from the most recent of their first MS\/demyelinating event or 1 January 1996 until the earliest of death, emigration, or study end (31 December 2017 or 31 March 2018). Prescription records captured DMD exposure, examined as any DMD, then by generation (first-generation (the injectables) or second-generation (orals\/infusions)) and individual DMD. The associations with subsequent all-cause hospitalizations and physician visits were examined using proportional means model and negative binomial regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Of 35,894 MS cases (72% female), mean follow-up was 12.0 years, with person-years of DMD exposure for any, or any first- or second-generation DMD being 63,290, 54,605 and 8685, respectively. Any DMD or any first-generation DMD exposure (versus non-exposure) was associated with a 24% lower hazard of hospitalization (adjusted hazard ratio, aHR: 0.76; 95% confidence intervals (CIs): 0.71\u20130.82), rising to 29% for the second-generation DMDs (aHR: 0.71; 95% CI: 0.58\u20130.88). This ranged from 18% for teriflunomide (aHR: 0.82; 95% CI: 0.67\u20131.00) to 44% for fingolimod (aHR: 0.56; 95% CI: 0.36\u20130.87). In contrast, DMD exposure was generally not associated with substantial differences in physician visits.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Findings provide real-world evidence of a beneficial relationship between DMD exposure and hospitalizations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/13524585211063403","type":"journal-article","created":{"date-parts":[[2021,12,24]],"date-time":"2021-12-24T03:56:37Z","timestamp":1640318197000},"page":"583-596","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":9,"title":["Disease-modifying drugs for multiple sclerosis and subsequent health service use"],"prefix":"10.1177","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8381-5253","authenticated-orcid":false,"given":"Huah Shin","family":"Ng","sequence":"first","affiliation":[{"name":"Department of Medicine, Division of Neurology and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Neurology and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elaine","family":"Kingwell","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Neurology and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada\/Research Department of Primary Care & Population Health, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yinshan","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Neurology and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shenzhen","family":"Yao","sequence":"additional","affiliation":[{"name":"College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada\/Health Quality Council, Saskatoon, SK, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Okechukwu","family":"Ekuma","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence W","family":"Svenson","sequence":"additional","affiliation":[{"name":"Alberta Health, Edmonton, AB, Canada\/Division of Preventive Medicine & School of Public Health, University of Alberta, Edmonton, AB, Canada\/Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charity","family":"Evans","sequence":"additional","affiliation":[{"name":"College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John D","family":"Fisk","sequence":"additional","affiliation":[{"name":"Nova Scotia Health Authority and the Departments of Psychiatry, Psychology and Neuroscience, and Medicine, Dalhousie University, Halifax, NS, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1855-5595","authenticated-orcid":false,"given":"Ruth Ann","family":"Marrie","sequence":"additional","affiliation":[{"name":"Departments of Internal Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5804-2535","authenticated-orcid":false,"given":"Helen","family":"Tremlett","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Neurology and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada\/Division of Neurology, Department of Medicine, Faculty of Medicine, UBC Hospital, Vancouver, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2021,12,24]]},"reference":[{"key":"bibr1-13524585211063403","first-page":"CD14011381","volume":"2015","author":"Tramacere I","year":"2015","journal-title":"Cochrane Datab Syst Rev"},{"key":"bibr2-13524585211063403","doi-asserted-by":"publisher","DOI":"10.1080\/14737175.2021.1847085"},{"key":"bibr3-13524585211063403","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000000753"},{"key":"bibr4-13524585211063403","doi-asserted-by":"publisher","DOI":"10.1007\/s41669-017-0035-2"},{"key":"bibr5-13524585211063403","doi-asserted-by":"publisher","DOI":"10.2147\/CEOR.S55779"},{"key":"bibr6-13524585211063403","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2019-033599"},{"key":"bibr7-13524585211063403","doi-asserted-by":"publisher","DOI":"10.1080\/07853890.2018.1461919"},{"key":"bibr8-13524585211063403","unstructured":"Statistics Canada. Census profile, 2016 census, 2017, https:\/\/www12.statcan.gc.ca\/census-recensement\/2016\/dp-pd\/prof\/index.cfm?Lang=E (accessed 1 February 2021)."},{"key":"bibr9-13524585211063403","unstructured":"British Columbia Ministry of Health [Creator]. Medical services plan (MSP) payment information file: V2\u2014Population data BC [Publisher]. Data Extract. MOH, 2017, http:\/\/www.popdata.bc.ca\/data"},{"key":"bibr10-13524585211063403","unstructured":"Canadian Institute for Health Information [Creator]. Discharge abstract database (hospital separations): V2\u2014Population data BC [Publisher]. Data extract. MOH, 2017, http:\/\/www.popdata.bc.ca\/data"},{"key":"bibr11-13524585211063403","unstructured":"British Columbia Ministry of Health [Creator]. Consolidation file (MSP registration & premium billing): V2. Population Data BC [Publisher]. Data extract. MOH, 2017, http:\/\/www.popdata.bc.ca\/data"},{"key":"bibr12-13524585211063403","unstructured":"BC and Vital Statistics Agency [Creator]. Vital statistics deaths: V2. Population data BC [Publisher]. Data extract. BC Vital Statistics Agency, 2017, http:\/\/www.popdata.bc.ca\/data"},{"key":"bibr13-13524585211063403","unstructured":"BC and Ministry of Health [Creator]. PharmaNet: V2. BC Ministry of Health [Publisher]. Data Extract. Data Stewardship Committee, 2017, http:\/\/www.popdata.bc.ca\/data"},{"key":"bibr14-13524585211063403","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3181cf6ec0"},{"key":"bibr15-13524585211063403","unstructured":"Canadian Institute for Health Information Statistics Canada. Health Indicators 2013, 2013, https:\/\/www.cihi.ca\/sites\/default\/files\/document\/health-indicators-2013-en.pdf (accessed 3 March 2021)."},{"key":"bibr16-13524585211063403","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000000495"},{"key":"bibr17-13524585211063403","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2017-317493"},{"key":"bibr18-13524585211063403","doi-asserted-by":"publisher","DOI":"10.1001\/jama.292.21.2585"},{"key":"bibr19-13524585211063403","doi-asserted-by":"publisher","DOI":"10.1002\/pds.3667"},{"key":"bibr20-13524585211063403","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000005347"},{"key":"bibr21-13524585211063403","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-013-6979-y"},{"key":"bibr22-13524585211063403","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-011-6275-7"},{"key":"bibr23-13524585211063403","doi-asserted-by":"publisher","DOI":"10.2147\/NDT.S200930"},{"key":"bibr24-13524585211063403","doi-asserted-by":"publisher","DOI":"10.1111\/cei.12206"},{"key":"bibr25-13524585211063403","doi-asserted-by":"publisher","DOI":"10.1007\/s40120-018-0123-y"},{"key":"bibr26-13524585211063403","doi-asserted-by":"publisher","DOI":"10.1177\/1352458516643393"},{"key":"bibr27-13524585211063403","doi-asserted-by":"publisher","DOI":"10.1111\/ane.12718"},{"key":"bibr28-13524585211063403","doi-asserted-by":"publisher","DOI":"10.1177\/1352458518768433"},{"key":"bibr29-13524585211063403","doi-asserted-by":"publisher","DOI":"10.1002\/ana.24339"},{"key":"bibr30-13524585211063403","unstructured":"Sanofi Genzyme A and Division of Sanofi-Aventis Canada Inc. LEMTRADA (Alemtuzumab 12mg\/1.2mL) product monograph [online], 2020, https:\/\/www.canada.ca\/en\/health-canada\/services\/drugs-health-products\/drug-products\/drug-product-database.html (accessed 11 January 2021)."},{"key":"bibr31-13524585211063403","unstructured":"Sanofi Genzyme A and Division of Sanofi-Aventis Canada Inc. AUBAGIO (Teriflunomide tablets 14 mg) product monograph [online], 2020, https:\/\/www.canada.ca\/en\/health-canada\/services\/drugs-health-products\/drug-products\/drug-product-database.html (accessed 11 January 2021)."},{"key":"bibr32-13524585211063403","doi-asserted-by":"publisher","DOI":"10.1309\/LM404L0HHUTWWUDD"},{"key":"bibr33-13524585211063403","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2018-319831"},{"key":"bibr34-13524585211063403","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e318248deea"},{"key":"bibr35-13524585211063403","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2018.09.008"},{"key":"bibr36-13524585211063403","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2017.01.001"},{"key":"bibr37-13524585211063403","doi-asserted-by":"publisher","DOI":"10.1016\/j.yfrne.2018.07.001"}],"container-title":["Multiple Sclerosis Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/13524585211063403","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/13524585211063403","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/13524585211063403","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T04:08:19Z","timestamp":1777694899000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/13524585211063403"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,24]]},"references-count":37,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2022,4]]}},"alternative-id":["10.1177\/13524585211063403"],"URL":"https:\/\/doi.org\/10.1177\/13524585211063403","relation":{},"ISSN":["1352-4585","1477-0970"],"issn-type":[{"value":"1352-4585","type":"print"},{"value":"1477-0970","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12,24]]}}}