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- Title
Predictors of long-term disability accrual in relapse-onset multiple sclerosis.
- Authors
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, François; Hupperts, Raymond; Granella, Franco; Sola, Patrizia; Bergamaschi, Roberto; Iuliano, Gerardo; Spitaleri, Daniele
- Abstract
<bold>Objective: </bold>To identify predictors of 10-year Expanded Disability Status Scale (EDSS) change after treatment initiation in patients with relapse-onset multiple sclerosis.<bold>Methods: </bold>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.<bold>Results: </bold>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).<bold>Interpretation: </bold>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. Ann Neurol 2016;80:89-100.
- Subjects
THERAPEUTIC use of interferons; MULTIPLE sclerosis diagnosis; COMPARATIVE studies; FUNCTIONAL assessment; LONGITUDINAL method; RESEARCH methodology; MEDICAL cooperation; MULTIPLE sclerosis; PROBABILITY theory; PROGNOSIS; RESEARCH; DISEASE relapse; EVALUATION research; ACQUISITION of data
- Publication
Annals of Neurology, 2016, Vol 80, Issue 1, p89
- ISSN
0364-5134
- Publication type
journal article
- DOI
10.1002/ana.24682