Sex as a determinant of relapse incidence and progressive course of multiple sclerosis

Kalincik, Tomas, Vivek, Vino, Jokubaitis, Vilija, Lechner-Scott, Jeannette, Trojano, Maria, Izquierdo, Guillermo, Lugaresi, Allessandra, Grand-Maison, Francois, Hupperts, Raymond, Oreja-Guevara, Celia, Bergamaschi, Roberto, Iuliano, Gerardo, Alroughani, Raed, Van, Pesch Vincent, Amato, Maria Pia, Slee, Mark, Verheul, Freek, Fernandez-Bolanos, Ricardo, Fiol, Marcela, La, Spitaleri Daniele, Cristiano, Edgardo, Gray, Orla, Cabrera-Gomez, Jose Antonio, Shaygannejad, Vahid, Herbert, Joseph, Vucic, Steve, Needham, Merilee, Petkovska-Boskova, Tatjana, Sirbu, Carmen-Adella, Duquette, Pierre, Girard, Marc, Grammond, Pierre, Boz, Cavit, Giuliani, Giorgio, Rio, Maria Edite, Barnett, Michael, Flechter, Shlomo, Moore, Fraser, Singhal, Bhim, Bacile, Elizabeth Alejandra, Saladino, Maria Laura, Shaw, Cameron, Skromne, Eli, Poehlau, Dieter, Vella, Norbert, Spelman, Timothy, Liew, Danny, Kilpatrick, Trevor J. and Butkueven, Helmut 2013, Sex as a determinant of relapse incidence and progressive course of multiple sclerosis, Brain : a journal of neurology, vol. 136, no. 12, pp. 3609-3617, doi: 10.1093/brain/awt281.

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Title Sex as a determinant of relapse incidence and progressive course of multiple sclerosis
Author(s) Kalincik, Tomas
Vivek, Vino
Jokubaitis, Vilija
Lechner-Scott, Jeannette
Trojano, Maria
Izquierdo, Guillermo
Lugaresi, Allessandra
Grand-Maison, Francois
Hupperts, Raymond
Oreja-Guevara, Celia
Bergamaschi, Roberto
Iuliano, Gerardo
Alroughani, Raed
Van, Pesch Vincent
Amato, Maria Pia
Slee, Mark
Verheul, Freek
Fernandez-Bolanos, Ricardo
Fiol, Marcela
La, Spitaleri Daniele
Cristiano, Edgardo
Gray, Orla
Cabrera-Gomez, Jose Antonio
Shaygannejad, Vahid
Herbert, Joseph
Vucic, Steve
Needham, Merilee
Petkovska-Boskova, Tatjana
Sirbu, Carmen-Adella
Duquette, Pierre
Girard, Marc
Grammond, Pierre
Boz, Cavit
Giuliani, Giorgio
Rio, Maria Edite
Barnett, Michael
Flechter, Shlomo
Moore, Fraser
Singhal, Bhim
Bacile, Elizabeth Alejandra
Saladino, Maria Laura
Shaw, Cameron
Skromne, Eli
Poehlau, Dieter
Vella, Norbert
Spelman, Timothy
Liew, Danny
Kilpatrick, Trevor J.
Butkueven, Helmut
Journal name Brain : a journal of neurology
Volume number 136
Issue number 12
Start page 3609
End page 3617
Total pages 9
Publisher Oxford University Press
Place of publication Oxford, Eng.
Publication date 2013
ISSN 1460-2156
Keyword(s) multiple sclerosis
risk factors
Summary The aim of this work was to evaluate sex differences in the incidence of multiple sclerosis relapses; assess the relationship between sex and primary progressive disease course; and compare effects of age and disease duration on relapse incidence. Annualized relapse rates were calculated using the MSBase registry. Patients with incomplete data or <1 year of follow-up were excluded. Patients with primary progressive multiple sclerosis were only included in the sex ratio analysis. Relapse incidences over 40 years of multiple sclerosis or 70 years of age were compared between females and males with Andersen-Gill and Tweedie models. Female-to-male ratios stratified by annual relapse count were evaluated across disease duration and patient age and compared between relapse-onset and primary progressive multiple sclerosis. The study cohort consisted of 11 570 eligible patients with relapse-onset and 881 patients with primary progressive multiple sclerosis. Among the relapse-onset patients (82 552 patient-years), 48 362 relapses were recorded. Relapse frequency was 17.7% higher in females compared with males. Within the initial 5 years, the female-to-male ratio increased from 2.3:1 to 3.3:1 in patients with 0 versus ≥4 relapses per year, respectively. The magnitude of this sex effect increased at longer disease duration and older age (P < 10−12). However, the female-to-male ratio in patients with relapse-onset multiple sclerosis and zero relapses in any given year was double that of the patients with primary progressive multiple sclerosis. Patient age was a more important determinant of decline in relapse incidence than disease duration (P < 10−12). Females are predisposed to higher relapse activity than males. However, this difference does not explain the markedly lower female-to-male sex ratio in primary progressive multiple sclerosis. Decline in relapse activity over time is more closely related to patient age than disease duration.
Language eng
DOI 10.1093/brain/awt281
Field of Research 119999 Medical and Health Sciences not elsewhere classified
Socio Economic Objective 970111 Expanding Knowledge in the Medical and Health Sciences
HERDC Research category C1.1 Refereed article in a scholarly journal
Copyright notice ©2013, Oxford Univeristy Press
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Document type: Journal Article
Collection: School of Medicine
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