Predictors of disability worsening in clinically isolated syndrome. (27th March 2015)

• Record Type: Journal Article
• Authors: Jokubaitis, Vilija G.; Spelman, Tim; Kalincik, Tomas; Izquierdo, Guillermo; Grand'Maison, François; Duquette, Pierre; Girard, Marc; Lugaresi, Alessandra; Grammond, Pierre; Hupperts, Raymond; Cabrera‐Gomez, José; Oreja‐Guevara, Celia; Boz, Cavit; Giuliani, Giorgio; Fernández‐Bolaños, Ricardo; Iuliano, Gerardo; Lechner‐Scott, Jeannette; Verheul, Freek; van Pesch, Vincent; Petkovska‐Boskova, Tatjana; Fiol, Marcela; Moore, Fraser; Cristiano, Edgardo; Alroughani, Raed; Bergamaschi, Roberto; Barnett, Michael; Slee, Mark; Vella, Norbert; Herbert, Joseph; Shaw, Cameron; Saladino, Maria Laura; Amato, Maria Pia; Liew, Danny; Paolicelli, Damiano; Butzkueven, Helmut; Trojano, Maria; the MSBasis Study Group;
• Is Part Of: Annals of clinical and translational neurology. Volume 2:Number 5(2015:May)
• Page Start: 479
• Page End: 491
• Publication Date: 2015-03-27
• Subjects: Nervous system -- Diseases -- Periodicals; Neurology -- Periodicals; 616.8005
• DOI: 10.1002/acn3.187
• Languages: English
• ISSNs: 2328-9503

Abstract

<abstract abstract-type="main" id="acn3187-abs-0001"> <title>Abstract</title> <sec id="acn3187-sec-0001" sec-type="section"> <title>Objective</title> <p>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).</p> </sec> <sec id="acn3187-sec-0002" sec-type="section"> <title>Methods</title> <p>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.</p> </sec> <sec id="acn3187-sec-0003" sec-type="section"> <title>Results</title> <p>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.</p> </sec> <sec id="acn3187-sec-0004" sec-type="section"> <title>Interpretation</title> <p>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.</p> </sec> </abstract>