(301) Can riluzole use for motor neuron disease reduce risk of hospitalisation: A common data model study using Self-Controlled Case Series

Background: Motor neuron diseases (MND) are a group of neurodegenerative disorders affecting the motor neurons. Riluzole, a supportive therapy for amyotrophic lateral sclerosis (ALS), is commonly used in MND treatment. However, limited research has explored the potential association between Riluzole use and the risk of hospitalisation in patients with MND.

Objectives: To estimate the risk of hospitalisation following outpatient Riluzole use for MND patients.

Methods: We performed a multi-centre analysis using data from Hong Kong, Taiwan, and Korea, utilising a Common Data Model-based approach with a self-controlled case series (SCCS) analysis. Patients with any outpatient prescription of Riluzole and hospitalisation records were included. The observation period was from one year before their MND diagnosis, the first Riluzole prescription, or the earliest available date of Riluzole in each region, whichever comes later. The observation end date was the study end date (varying between study sites), death date, or prescription start date of first Edavarone use (if any), whichever occurs first. The risk windows were defined as 30 days before the Riluzole use (pre-risk period), 0 to 30 days, 31 to 60 days, 61 to 90 days, 91 to 120 days, 121 to 150 days, 150 to 180 days after the Riluzole prescription, and 181 days to the prescription end. All other observation periods were classified as referent windows. The incidence rate ratios (IRRs) of hospital admission were estimated between each risk window and referent window with its 95% confidence interval (95% CI) by conditional Poisson regression. Further subgroup analyses were conducted among patients admitted through emergency visits and patients admitted due to pneumonia. The results from three sites were integrated with a random-effect meta-analysis.

Results: We analysed data from 780 individuals in Hong Kong, 8,475 individuals in Taiwan, and 80,502 individuals in Korea for the SCCS analysis. The meta-analysis revealed significantly elevated IRRs in all risk periods, except for 150 to 180 days and 180 days until the prescription end. Specifically, higher IRRs were observed in the pre-risk period (2.72, 95% CI: 2.16-3.42), 0 to 30 days (1.75, 95% CI: 1.40-2.20), 31 to 60 days (1.81, 95% CI: 1.36-2.42), 61 to 90 days (1.62, 95% CI: 1.21-2.34), and 121 to 150 days (1.79, 95% CI: 1.34-2.40). Similar results were observed for each study site and all subgroup analyses.

Conclusions: Our study found a higher hospitalisation risk among MND patients following outpatient Riluzole prescription. Compared to the pre-risk period, the significantly lower risk observed during the 0-150 day periods suggests a potential protective benefit from the drug. These findings highlight the importance of intensive monitoring in this patient with MND.