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Associations between co-medications and survival in ALS—a cohort study from Austria

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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.

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Acknowledgment

No external funding was obtained for this study.

Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical standards

The study was approved by the ethical committees of Burgenland and of the Medical University of Vienna. The manuscript does not contain clinical studies or clinical patient data.

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Authors and Affiliations

  1. Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria

    Hakan Cetin, Uros Klickovic, Jakob Rath, Gudrun Zulehner, Eduard Auff & Fritz Zimprich

  2. Unit for Health Care Economics, Regional Sickness Fund of the County Burgenland (BGKK), Eisenstadt, Austria

    Judith Füzi & Berthold Reichardt

  3. Section for Medical Statistics, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria

    Michael Hagmann

  4. Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria

    Julia Wanschitz & Wolfgang N. Löscher

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  1. Hakan Cetin
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  2. Uros Klickovic
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  4. Gudrun Zulehner
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Correspondence to Hakan Cetin or Fritz Zimprich.

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Cetin, H., Klickovic, U., Rath, J. et al. Associations between co-medications and survival in ALS—a cohort study from Austria. J Neurol 262, 1698–1705 (2015). https://doi.org/10.1007/s00415-015-7767-7

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  • DOI: https://doi.org/10.1007/s00415-015-7767-7

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