Patients who will develop aggressive multiple sclerosis (MS) can be identified with early clinical markers, a retrospective study suggested.
Age older than 35 at MS onset, moderate disability in the first year, and the presence of motor signs in the first year were associated with higher risk of aggressive MS in the international MSBase cohort, reported Tomas Kalincik, MD, PhD, of the University of Melbourne in Australia, and coauthors, in a manuscript published on the preprint server medRxiv.
In this study, approximately 6% of patients developed an aggressive form of MS, an accelerated accrual of disability defined as an Expanded Disability Status Scale(EDSS) score greater than 6 within 10 years of first clinical presentation, Kalincik said.
Aggressive MS eventually was diagnosed in 32% of patients who presented with all three risk factors, but only in 1.4% of patients with none of these signs. An EDSS score of 3 defined moderate disability.
“While several clinical and demographic factors have shown general associations with disability in MS, our knowledge of clinically accessible predictors of aggressive MS course which can be detected in the first year from symptom onset is limited,” he told MedPage Today. “Such information is necessary to assist clinicians in identifying patients with aggressive MS early, before they have accumulated significant irreversible neurological disability.”
“With the complex array of therapies we have for MS, it’s very prudent for us to choose wisely as a physician, to start patients on a drug that’s more likely to make a difference for them,” noted Mark Freedman, MD, MSc, of the University of Ottawa in Canada, who was not involved with the paper.
“Is there some way of looking at an MS patient early on in the disease and saying ‘this is someone destined to have a poor prognosis’? And if that’s the case, why waste time on a drug we know is modestly effective? We don’t have time to falter,” Freedman told MedPage Today. “We don’t have 5 years to play with. Those 5 years could make a difference to this particular patient.”
In this analysis, Kalincik and colleagues looked at 2,403 patients with relapsing-remitting MS with at least 10 years of follow-up from the international MSBase registry. They used Bayesian statistical models “to evaluate a range of clinical and demographic predictors that might be realistically available to clinicians in the first year following symptom onset,” Kalincik said.
The results were confirmed in an independent cohort of patients from the Swedish MS Registry. “The diversity of the studied cohorts ensures good generalizability of our conclusions: MSBase includes patients from 137 centers in 35 countries, whereas the Swedish MS Registry is a population-based national registry with greater than 80% coverage of the Swedish MS population,” Kalincik said.
The study is limited by its retrospective nature, including possible reporting bias. Treatments MS patients used also may have affected outcomes.
Last Updated August 02, 2019
Kalincik reported relationships with Roche, Genzyme-Sanofi, Novartis, Merck, Biogen, Genzyme, WebMD Global, Novartis, Biogen, Teva, and BioCSL. Other researchers reported multiple relationships with industry.
Note that medRxiv is a preprint server for posting manuscripts prior to undergoing formal peer review. As such, the data and conclusions should be regarded as preliminary until published in a peer-reviewed journal.
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