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Journal of Neurology

, Volume 259, Issue 9, pp 1788–1792 | Cite as

Improving survival in a large French ALS center cohort

  • Paul H. GordonEmail author
  • François Salachas
  • Gaelle Bruneteau
  • Pierre-François Pradat
  • Lucette Lacomblez
  • Jesus Gonzalez-Bermejo
  • Capucine Morelot-Panzini
  • Thomas Similowski
  • Alexis Elbaz
  • Vincent Meininger
Original Communication

Abstract

The aim of this work was to determine whether survival changed during 2002–2009 at a French amyotrophic lateral sclerosis (ALS) center. We included all patients with ALS who were seen consecutively at the center from January 2002–May 2009. Participants were followed from date of first visit through death, date of censoring, or December 31, 2009, whichever occurred first. Cox proportional hazard models computed hazard ratios (HR; 95% confidence interval CI) of death, and flexible modeling of continuous predictors (splines) assessed trends in survival. We analyzed a total of 2,037 ALS patients, of whom 1,471 died before the end of follow-up. Median survival was 2.83 years from onset and 1.65 years from first visit. Compared to patients first seen before 2004, the HR of death was 0.97 (95% CI = 0.85–1.11, p = 0.6721) for patients first seen in 2004–2005, 0.96 (95% CI = 0.83–1.10, p = 0.5125) for 2006–2007, and 0.56 (95% CI = 0.46–0.69, p < 0.0001) after 2007, while adjusting for other survival predictors. Spline analysis confirmed that survival remained stable during 2002–2006, then markedly improved. The proportion of patients receiving non-invasive ventilation (NIV) increased from 16 (2004) to 51% (2008). At this large ALS center, survival improved after 2006. Because more aggressive use of NIV was the principal therapeutic adaptation, our data suggest that better survival resulted from improved respiratory care.

Keywords

Amyotrophic lateral sclerosis Survival ALSFRS-R Non-invasive ventilation 

Notes

Conflicts of interest

None.

Supplementary material

415_2011_6403_MOESM1_ESM.doc (84 kb)
Supplementary material 1 (DOC 84 kb)
415_2011_6403_MOESM2_ESM.jpg (44 kb)
Supplementary material 2 (JPEG 44 kb)

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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Paul H. Gordon
    • 1
    • 2
    • 4
    Email author
  • François Salachas
    • 4
  • Gaelle Bruneteau
    • 4
  • Pierre-François Pradat
    • 4
  • Lucette Lacomblez
    • 2
    • 4
    • 6
  • Jesus Gonzalez-Bermejo
    • 3
    • 5
  • Capucine Morelot-Panzini
    • 3
    • 5
  • Thomas Similowski
    • 3
    • 5
  • Alexis Elbaz
    • 1
    • 2
  • Vincent Meininger
    • 2
    • 4
  1. 1.INSERM, unité U708, F-75013, NeuroépidémiologieHôpital de la Pitié-SalpêtrièreParis Cedex 13France
  2. 2.UPMC Univ Paris 06, UMR_S 708AP-HP, Hôpital de la SalpêtrièreParisFrance
  3. 3.ER10AP-HP, Hôpital de la SalpêtrièreParisFrance
  4. 4.Département des Maladies du Système NerveuxAP-HP, Hôpital de la SalpêtrièreParisFrance
  5. 5.Service de Pneumologie et Réanimation MédicaleAP-HP, Hôpital de la SalpêtrièreParisFrance
  6. 6.Département de PharmacologieAP-HP, Hôpital de la SalpêtrièreParisFrance

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