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

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Jokubaitis, Vilija G Spelman, Tim Kalincik, Tomas Lorscheider, Johannes Havrdova, Eva Van Pesch, Vincent [UCL] MSBase Study Group

(eng) 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.

Document type Article de périodique (Journal article) – Article de recherche
Access type Accès restreint
Publication date 2016
Language Anglais
Journal information "Annals of Neurology" - Vol. 80, no. 1, p. 89-100 (2016)
Peer reviewed yes
Publisher JohnWiley & Sons, Inc. ((United States) New York. NY)
issn 0364-5134
e-issn 1531-8249
Publication status Publié
Affiliations UCL - SSS/IONS/CEMO - Pôle Cellulaire et moléculaire
UCL - (SLuc) Service de neurologie
Links
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Bibliographic reference Jokubaitis, Vilija G ; Spelman, Tim ; Kalincik, Tomas ; Lorscheider, Johannes ; Havrdova, Eva ; et. al. Predictors of long-term disability accrual in relapse-onset multiple sclerosis.. In: Annals of Neurology, Vol. 80, no. 1, p. 89-100 (2016)
Permanent URL http://hdl.handle.net/2078.1/177588