- Title
- Predictors of long-term disability accrual in relapse-onset multiple sclerosis
- Creator
- Jokubaitis, Vilija G.; Spelman, Tim; Grammond, Pierre; Van Pesch, Vincent; Pucci, Eugenio; Grand'Maison, François; Hupperts, Raymond; Granella, Franco; Sola, Patrizia; Bergamaschi, Roberto; Iuliano, Gerardo; Spitaleri, Daniele; Kalincik, Tomas; Lechner-Scott, Jeannette; Lorscheider, Johannes; Havrdova, Eva; Horakova, Dana; Duquette, Pierre; Girard, Marc; Prat, Alexandre; Izquierdo, Guillermo
- Relation
- NHMRC.1032484 & NHMRC. 1001216
- Relation
- Annals of Neurology Vol. 80, Issue 1, p. 89-100
- Publisher Link
- http://dx.doi.org/10.1002/ana.24682
- Publisher
- John Wiley & Sons
- Resource Type
- journal article
- Date
- 2016
- Description
- 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=1.9x10-22). 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=1.3x10-9). Furthermore, pregnancies were also independently associated with lower EDSS scores over the 10-year observation period (coeff=-0.36, p=0.009).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.
- Subject
- multiple sclerosis; long term diability; expanded disability status scale (EDSS)
- Identifier
- http://hdl.handle.net/1959.13/1323632
- Identifier
- uon:24856
- Identifier
- ISSN:0364-5134
- Language
- eng
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