shaw-predictorsofdisability-2015.pdf (419.33 kB)
Download filePredictors of disability worsening in clinically isolated syndrome
journal contribution
posted on 2015-05-01, 00:00 authored by V G Jokubaitis, T Spelman, T Kalincik, G Izquierdo, F Grand'Maison, P Duquette, M Girard, A Lugaresi, P Grammond, R Hupperts, J Cabrera-Gomez, C Oreja-Guevara, C Boz, G Giuliani, R Fernández-Bolaños, G Iuliano, J Lechner-Scott, F Verheul, V van Pesch, T Petkovska-Boskova, M Fiol, F Moore, E Cristiano, R Alroughani, R Bergamaschi, M Barnett, M Slee, N Vella, J Herbert, Cameron ShawCameron Shaw, M L Saladino, M P Amato, D Liew, D Paolicelli, H Butzkueven, M Trojano, MSBasis Study GroupOBJECTIVE: To assess demographic, clinical, magnetic resonance imaging, and treatment exposure predictors of time to 3 or 12-month confirmed disability worsening in clinically isolated syndrome (CIS) and early multiple sclerosis (MS). METHODS: We utilized the MSBase Incident Study (MSBasis), a prospective cohort study of outcome after CIS. Predictors of time to first 3 and 12-month confirmed expanded disability status scale worsening were analyzed using Cox proportional hazards regression. RESULTS: About 1989 patients were analyzed, the largest seen-from-onset cohort reported to-date. A total of 391 patients had a first 3-month confirmed disability worsening event, of which 307 were sustained for 12 months. Older age at CIS onset (adjusted hazard ratio: aHR 1.17, 95% 1.06, 1.30), pyramidal (aHR 1.45, 95% CI 1.13, 1.89) and ambulation (HR 1.60, 95% CI 1.09, 2.34) system dysfunction, annualized relapse rate (aHR 1.20, 95% CI 1.18, 1.22), and lower proportion of observation time on treatment were associated with 3-month confirmed worsening. Predictors of time to 12-month sustained worsening included pyramidal system dysfunction (Hazard ratio: aHR 1.38, 95% CI 1.05, 1.83), and older age at CIS onset (aHR 1.17, 95% CI 1.04, 1.31). Greater proportion of follow-up time exposed to treatment was associated with greater reductions in the rate of worsening. INTERPRETATION: This study provides class IV evidence for a strong protective effect of disease-modifying treatment to reduce disability worsening events in patients with CIS and early MS, and confirms age and pyramidal dysfunction at onset as risk factors.
History
Journal
Annals of clinical and translational neurologyVolume
2Issue
5Pagination
479 - 491Publisher
John Wiley & SonsLocation
Chichester, Eng.Publisher DOI
ISSN
2328-9503Language
engPublication classification
C Journal article; C1.1 Refereed article in a scholarly journalCopyright notice
2015, The AuthorsUsage metrics
Categories
Keywords
magnetic resonance imagingdisability worseningclinically isolated syndromemultiple sclerosisdemographicclinicalScience & TechnologyLife Sciences & BiomedicineClinical NeurologyNeurosciencesNeurosciences & NeurologyRELAPSING MULTIPLE-SCLEROSISPLACEBO-CONTROLLED TRIALINTERFERON BETA-1AFOLLOW-UPGLATIRAMER ACETATENATURAL-HISTORYDOUBLE-BLINDPROGRESSIONMRIMS