Predictors of long-term disability accrual in relapse-onset multiple sclerosis

Jokubaitis, Vilija G., Spelman, Tim, Kalincik, Tomas, Lorscheider, Johannes, Havrdova, Eva, Horakova, Dana, Duquette, Pierre, Girard, Marc, Prat, Alexandre, Izquierdo, Guillermo, Grammond, Pierre, Van Pesch, Vincent, Pucci, Eugenio, Grand'Maison, Francois, Hupperts, Raymond, Granella, Franco, Sola, Patrizia, Bergamaschi, Roberto, Iuliano, Gerardo, Spitaleri, Daniele, Boz, Cavit, Hodgkinson, Suzanne, Olascoaga, Javier, Verheul, Freek, McCombe, Pamela, Petersen, Thor, Rozsa, Csilla, Lechner-Scott, Jeannette, Laura Saladino, Maria, Farina, Deborah, Iaffaldano, Pietro, Paolicelli, Damiano, Butzkueven, Helmut, Lugaresi, Alessandra and Trojano, Maria (2016) Predictors of long-term disability accrual in relapse-onset multiple sclerosis. Annals of Neurology, 80 1: 89-100. doi:10.1002/ana.24682

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Author Jokubaitis, Vilija G.
Spelman, Tim
Kalincik, Tomas
Lorscheider, Johannes
Havrdova, Eva
Horakova, Dana
Duquette, Pierre
Girard, Marc
Prat, Alexandre
Izquierdo, Guillermo
Grammond, Pierre
Van Pesch, Vincent
Pucci, Eugenio
Grand'Maison, Francois
Hupperts, Raymond
Granella, Franco
Sola, Patrizia
Bergamaschi, Roberto
Iuliano, Gerardo
Spitaleri, Daniele
Boz, Cavit
Hodgkinson, Suzanne
Olascoaga, Javier
Verheul, Freek
McCombe, Pamela
Petersen, Thor
Rozsa, Csilla
Lechner-Scott, Jeannette
Laura Saladino, Maria
Farina, Deborah
Iaffaldano, Pietro
Paolicelli, Damiano
Butzkueven, Helmut
Lugaresi, Alessandra
Trojano, Maria
Title Predictors of long-term disability accrual in relapse-onset multiple sclerosis
Journal name Annals of Neurology   Check publisher's open access policy
ISSN 1531-8249
0364-5134
Publication date 2016-07-01
Year available 2016
Sub-type Article (original research)
DOI 10.1002/ana.24682
Open Access Status File (Author Post-print)
Volume 80
Issue 1
Start page 89
End page 100
Total pages 12
Place of publication Hoboken, NJ, United States
Publisher John Wiley & Sons
Collection year 2017
Language eng
Formatted abstract
Objective: To identify predictors of 10-year Expanded Disability Status Scale (EDSS) change after treatment initiation in patients with relapse-onset multiple sclerosis.

Methods: Using data obtained from MSBase, we defined baseline as the date of first injectable therapy initiation. Patients need only have remained on injectable therapy for 1 day and were monitored on any approved disease-modifying therapy, or no therapy thereafter. Median EDSS score changes over a 10-year period were determined. Predictors of EDSS change were then assessed using median quantile regression analysis. Sensitivity analyses were further performed.

Results: We identified 2,466 patients followed up for at least 10 years reporting post-baseline disability scores. Patients were treated an average 83% of their follow-up time. EDSS scores increased by a median 1 point (interquartile range = 0–2) at 10 years post-baseline. Annualized relapse rate was highly predictive of increases in median EDSS over 10 years (coeff = 1.14, p = 1.9 × 10−22). On-therapy relapses carried greater burden than off-therapy relapses. Cumulative treatment exposure was independently associated with lower EDSS at 10 years (coeff = −0.86, p = 1.3 × 10−9). Furthermore, pregnancies were also independently associated with lower EDSS scores over the 10-year observation period (coeff = −0.36, p = 0.009).

Interpretation: We provide evidence of long-term treatment benefit in a large registry cohort, and provide evidence of long-term protective effects of pregnancy against disability accrual. We demonstrate that high annualized relapse rate, particularly on-treatment relapse, is an indicator of poor prognosis.
Keyword Multiple sclerosis
Neurological disability
Young adults
Long-term disability
Disease-modifying therapies (DMTs)
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

 
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