Retrospective observational study of the management of multiple sclerosis patients with resistant spasticity in Spain: the '5E' study
Retrospective observational study of the management of multiple sclerosis patients with resistant spasticity in Spain: the '5E' study
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DOI：
10.1586/erp.11.6
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发表时间：
2011-04-01
影响因子：
2.3
通讯作者：
Clissold, Steve
中科院分区：
文献类型：
--
作者：
Arroyo, Rafael;Vila, Carlos;Clissold, Steve
背景：多发性硬化症痉挛(MSS)是一种常见的致残性症状，有许多抗痉挛药物可用；然而，缺乏最佳治疗的循证指南。目的：这项回顾性观察性评估调查了西班牙目前耐药多发性硬化症的管理方法。次要目标是评估多发性硬化症的演变，并估计在西班牙医疗系统中管理多发性硬化症的社会和健康相关成本。方法：对212例抗>；=1治疗的多发性硬化症痉挛患者的病例资料进行回顾性分析。数据是在1-3年(平均2.1年)内收集的，包括：社会人口统计、病史、临床评分和所消耗的所有治疗/其他资源(例如，康复和照顾者的时间)。根据记录的临床规模的演变估计疾病进展，并从西班牙医疗保健和社会角度进行成本分析。结果：患者多为女性，多为继发性进展型，巴氯芬(76-80%)，最常见的抗痉挛药物为替扎尼定和苯二氮卓。使用了不同的痉挛评定量表，它们显示了相同的总体趋势。MS进展，46.4%的患者痉挛和活动能力的综合评分恶化，抗痉挛药物之间没有明显差异。在西班牙医疗系统中，每年治疗耐MSS患者的医疗相关成本为15,405美元，这主要归因于疾病修正药物和护理提供的成本。其他方面，如就诊和解痉挛治疗，只占费用的一小部分。结论：尽管使用了目前可用的解痉剂治疗，MSS仍有进展，并且与高度残疾有关。痉挛治疗在西班牙管理MSS患者的总成本中只占很小的比例。评估痉挛的方法在不同的中心有所不同。
Background: Multiple sclerosis spasticity (MSS) is a common and disabling symptom for which a number of antispastic agents are available; however, evidence-based guidelines for optimal management are lacking. Objective: This retrospective observational assessment investigated the current management approach for resistant MSS in Spain. Secondary objectives were to evaluate the evolution of MSS and to estimate the social and health-related costs of managing MSS in the Spanish healthcare system. Methods: A retrospective analysis was performed using case records from 212 MS patients with spasticity that were resistant to >= 1 previous therapy. Data were collected over 1-3 years (mean 2.1 years), including: sociodemographics, medical history, clinical scores and all therapy/other resources consumed (e.g., rehabilitation and carers' time). Disease progression was estimated from the evolution of recorded clinical scales, and an analysis of costs from a Spanish healthcare and social perspective was performed. Results: The majority of patients were female and most had secondary progressive MS. Baclofen (76-80%), tizanidine and benzodiazepines were the most common antispastic drugs administered. A variety of spasticity rating scales were employed, and they demonstrated the same general trends. MS progressed, with the composite score for spasticity and mobility deteriorating in 46.4% of patients, and there were no marked differences between antispasticity drugs. The annual healthcare-related cost of treating an MSS resistant patient in the Spanish healthcare system was (sic)15,405, largely attributable to the cost of disease-modifying drugs and care provision. Other aspects, such as medical visits and antispastic treatments, formed only a small portion of cost. Conclusions: MSS progresses despite treatment with currently available antispastic agents, and it is associated with a high level of disability. Spasticity treatment represents a minor element of the overall cost of managing MSS patients in Spain. The approach to the assessment of spasticity varies between centers.