Onset of secondary progressive phase and long-term evolution of multiple sclerosis
Objectives To assess factors affecting the rate of conversion to secondary progressive (SP) multiple sclerosis (MS) and its subsequent evolution. Methods Among 806 patients with relapsing remitting (RR) onset MS from the London Ontario database, we used Kaplan–Meier, Cox regression and multiple logi...
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| Veröffentlicht in: | Journal of neurology, neurosurgery and psychiatry neurosurgery and psychiatry, 2014-01, Vol.85 (1), p.67-75 |
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| description | Objectives To assess factors affecting the rate of conversion to secondary progressive (SP) multiple sclerosis (MS) and its subsequent evolution. Methods Among 806 patients with relapsing remitting (RR) onset MS from the London Ontario database, we used Kaplan–Meier, Cox regression and multiple logistic regression analyses to investigate the effect of baseline clinical and demographic features on (1) the probability of, and the time to, SP disease, (2) the time to bedbound status (Disability Status Scale (DSS 8)) from onset of progression. Results The risk of entering the SP phase increased proportionally with disease duration (OR=1.07 for each additional year; p |
| doi_str_mv | 10.1136/jnnp-2012-304333 |
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Methods Among 806 patients with relapsing remitting (RR) onset MS from the London Ontario database, we used Kaplan–Meier, Cox regression and multiple logistic regression analyses to investigate the effect of baseline clinical and demographic features on (1) the probability of, and the time to, SP disease, (2) the time to bedbound status (Disability Status Scale (DSS 8)) from onset of progression. Results The risk of entering the SP phase increased proportionally with disease duration (OR=1.07 for each additional year; p<0.001). Shorter latency to SP was associated with shorter times to severe disability. The same association was found even when patients were grouped by number of total relapses before progression. However, the evolution of the SP phase was not influenced by the duration of the RR phase. Male sex (HR=1.41; p<0.001), older age at onset (age ≤20 and 21–30 vs >30 HR=0.52 (p<0.001), 0.65 (p<0.001), respectively) and high early relapse frequency (1–2 attacks vs ≥3 HR=0.63 (p<0.001), 0.75 (p=0.04), respectively) predicted significantly higher risk of SP MS and shorter latency to progression. Times to DSS 8 from onset of progression were significantly shorter among those with high early relapse frequency (≥3 attacks), and among those presenting with cerebellar and brainstem symptoms. Conclusions The onset of SP MS is the dominant determinant of long-term prognosis, and its prevention is the most important target measure for treatment. Baseline clinical features of early relapse frequency and age at onset can be used to select groups at higher risk of developing severe disability based on the probability of their disease becoming progressive within a defined time period.</description><identifier>ISSN: 0022-3050</identifier><identifier>EISSN: 1468-330X</identifier><identifier>DOI: 10.1136/jnnp-2012-304333</identifier><identifier>PMID: 23486991</identifier><identifier>CODEN: JNNPAU</identifier><language>eng</language><publisher>England: BMJ Publishing Group LTD</publisher><subject>Adult ; Age ; Age of Onset ; Disability ; Disability Evaluation ; Disease Progression ; Endpoint Determination ; Female ; Humans ; Kaplan-Meier Estimate ; Logistic Models ; Male ; Middle Aged ; Models, Statistical ; Multiple sclerosis ; Multiple Sclerosis - epidemiology ; Multiple Sclerosis - physiopathology ; Multiple Sclerosis, Relapsing-Remitting - epidemiology ; Multiple Sclerosis, Relapsing-Remitting - physiopathology ; Ontario - epidemiology ; Prognosis ; Recurrence ; Risk Assessment ; Socioeconomic Factors ; Studies ; Survival Analysis ; Treatment Outcome</subject><ispartof>Journal of neurology, neurosurgery and psychiatry, 2014-01, Vol.85 (1), p.67-75</ispartof><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</rights><rights>Copyright: 2014 Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b504t-7e022fa30a86151b54fe8f266f6ec31964afc3cdb41df013fe0198c4ec2e07a23</citedby><cites>FETCH-LOGICAL-b504t-7e022fa30a86151b54fe8f266f6ec31964afc3cdb41df013fe0198c4ec2e07a23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://jnnp.bmj.com/content/85/1/67.full.pdf$$EPDF$$P50$$Gbmj$$H</linktopdf><linktohtml>$$Uhttps://jnnp.bmj.com/content/85/1/67.full$$EHTML$$P50$$Gbmj$$H</linktohtml><link.rule.ids>114,115,314,776,780,3183,23550,27901,27902,77342,77373</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23486991$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Scalfari, Antonio</creatorcontrib><creatorcontrib>Neuhaus, Anneke</creatorcontrib><creatorcontrib>Daumer, Martin</creatorcontrib><creatorcontrib>Muraro, Paolo Antonio</creatorcontrib><creatorcontrib>Ebers, George Cornell</creatorcontrib><title>Onset of secondary progressive phase and long-term evolution of multiple sclerosis</title><title>Journal of neurology, neurosurgery and psychiatry</title><addtitle>J Neurol Neurosurg Psychiatry</addtitle><description>Objectives To assess factors affecting the rate of conversion to secondary progressive (SP) multiple sclerosis (MS) and its subsequent evolution. Methods Among 806 patients with relapsing remitting (RR) onset MS from the London Ontario database, we used Kaplan–Meier, Cox regression and multiple logistic regression analyses to investigate the effect of baseline clinical and demographic features on (1) the probability of, and the time to, SP disease, (2) the time to bedbound status (Disability Status Scale (DSS 8)) from onset of progression. Results The risk of entering the SP phase increased proportionally with disease duration (OR=1.07 for each additional year; p<0.001). Shorter latency to SP was associated with shorter times to severe disability. The same association was found even when patients were grouped by number of total relapses before progression. However, the evolution of the SP phase was not influenced by the duration of the RR phase. Male sex (HR=1.41; p<0.001), older age at onset (age ≤20 and 21–30 vs >30 HR=0.52 (p<0.001), 0.65 (p<0.001), respectively) and high early relapse frequency (1–2 attacks vs ≥3 HR=0.63 (p<0.001), 0.75 (p=0.04), respectively) predicted significantly higher risk of SP MS and shorter latency to progression. Times to DSS 8 from onset of progression were significantly shorter among those with high early relapse frequency (≥3 attacks), and among those presenting with cerebellar and brainstem symptoms. Conclusions The onset of SP MS is the dominant determinant of long-term prognosis, and its prevention is the most important target measure for treatment. Baseline clinical features of early relapse frequency and age at onset can be used to select groups at higher risk of developing severe disability based on the probability of their disease becoming progressive within a defined time period.</description><subject>Adult</subject><subject>Age</subject><subject>Age of Onset</subject><subject>Disability</subject><subject>Disability Evaluation</subject><subject>Disease Progression</subject><subject>Endpoint Determination</subject><subject>Female</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Models, Statistical</subject><subject>Multiple sclerosis</subject><subject>Multiple Sclerosis - epidemiology</subject><subject>Multiple Sclerosis - physiopathology</subject><subject>Multiple Sclerosis, Relapsing-Remitting - epidemiology</subject><subject>Multiple Sclerosis, Relapsing-Remitting - physiopathology</subject><subject>Ontario - epidemiology</subject><subject>Prognosis</subject><subject>Recurrence</subject><subject>Risk Assessment</subject><subject>Socioeconomic Factors</subject><subject>Studies</subject><subject>Survival Analysis</subject><subject>Treatment Outcome</subject><issn>0022-3050</issn><issn>1468-330X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqFkUtr3TAQRkVpaW7S7rsqhm4Cwc2M9bC8LCEvCARKA90JWR6lvtiSa9mB_vvK3LSLbKKNFjrfx4wOY58QviJydb4PYSorwKrkIDjnb9gOhdIl5_DzLdsBVNuLhCN2nNIetqOb9-yo4kKrpsEd-34fEi1F9EUiF0Nn5z_FNMfHmVLqn6iYftlEhQ1dMcTwWC40jwU9xWFd-hi22LgOSz8NVCQ30BxTnz6wd94OiT4-3yfs4eryx8VNeXd_fXvx7a5sJYilrClP5y0HqxVKbKXwpH2llFfkODZKWO-461qBnQfkngAb7QS5iqC2FT9hp4fePO_vldJixj45GgYbKK7JoJSoUEuA11FR11JKzZuMfnmB7uM6h7yIwVpjJRrRqEzBgXJ55TSTN9Pcj_nzDILZ1JhNjdnUmIOaHPn8XLy2I3X_A_9cZODsALTj_vW6v8cdl4s</recordid><startdate>20140101</startdate><enddate>20140101</enddate><creator>Scalfari, Antonio</creator><creator>Neuhaus, Anneke</creator><creator>Daumer, Martin</creator><creator>Muraro, Paolo Antonio</creator><creator>Ebers, George Cornell</creator><general>BMJ Publishing Group LTD</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>88I</scope><scope>8AF</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>M2P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope><scope>7TK</scope></search><sort><creationdate>20140101</creationdate><title>Onset of secondary progressive phase and long-term evolution of multiple sclerosis</title><author>Scalfari, Antonio ; Neuhaus, Anneke ; Daumer, Martin ; Muraro, Paolo Antonio ; Ebers, George Cornell</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b504t-7e022fa30a86151b54fe8f266f6ec31964afc3cdb41df013fe0198c4ec2e07a23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>Age</topic><topic>Age of Onset</topic><topic>Disability</topic><topic>Disability Evaluation</topic><topic>Disease Progression</topic><topic>Endpoint Determination</topic><topic>Female</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Models, Statistical</topic><topic>Multiple sclerosis</topic><topic>Multiple Sclerosis - epidemiology</topic><topic>Multiple Sclerosis - physiopathology</topic><topic>Multiple Sclerosis, Relapsing-Remitting - epidemiology</topic><topic>Multiple Sclerosis, Relapsing-Remitting - physiopathology</topic><topic>Ontario - epidemiology</topic><topic>Prognosis</topic><topic>Recurrence</topic><topic>Risk Assessment</topic><topic>Socioeconomic Factors</topic><topic>Studies</topic><topic>Survival Analysis</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Scalfari, Antonio</creatorcontrib><creatorcontrib>Neuhaus, Anneke</creatorcontrib><creatorcontrib>Daumer, Martin</creatorcontrib><creatorcontrib>Muraro, Paolo Antonio</creatorcontrib><creatorcontrib>Ebers, George Cornell</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest Psychology</collection><collection>Science Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>Neurosciences Abstracts</collection><jtitle>Journal of neurology, neurosurgery and psychiatry</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Scalfari, Antonio</au><au>Neuhaus, Anneke</au><au>Daumer, Martin</au><au>Muraro, Paolo Antonio</au><au>Ebers, George Cornell</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Onset of secondary progressive phase and long-term evolution of multiple sclerosis</atitle><jtitle>Journal of neurology, neurosurgery and psychiatry</jtitle><addtitle>J Neurol Neurosurg Psychiatry</addtitle><date>2014-01-01</date><risdate>2014</risdate><volume>85</volume><issue>1</issue><spage>67</spage><epage>75</epage><pages>67-75</pages><issn>0022-3050</issn><eissn>1468-330X</eissn><coden>JNNPAU</coden><abstract>Objectives To assess factors affecting the rate of conversion to secondary progressive (SP) multiple sclerosis (MS) and its subsequent evolution. Methods Among 806 patients with relapsing remitting (RR) onset MS from the London Ontario database, we used Kaplan–Meier, Cox regression and multiple logistic regression analyses to investigate the effect of baseline clinical and demographic features on (1) the probability of, and the time to, SP disease, (2) the time to bedbound status (Disability Status Scale (DSS 8)) from onset of progression. Results The risk of entering the SP phase increased proportionally with disease duration (OR=1.07 for each additional year; p<0.001). Shorter latency to SP was associated with shorter times to severe disability. The same association was found even when patients were grouped by number of total relapses before progression. However, the evolution of the SP phase was not influenced by the duration of the RR phase. Male sex (HR=1.41; p<0.001), older age at onset (age ≤20 and 21–30 vs >30 HR=0.52 (p<0.001), 0.65 (p<0.001), respectively) and high early relapse frequency (1–2 attacks vs ≥3 HR=0.63 (p<0.001), 0.75 (p=0.04), respectively) predicted significantly higher risk of SP MS and shorter latency to progression. Times to DSS 8 from onset of progression were significantly shorter among those with high early relapse frequency (≥3 attacks), and among those presenting with cerebellar and brainstem symptoms. Conclusions The onset of SP MS is the dominant determinant of long-term prognosis, and its prevention is the most important target measure for treatment. Baseline clinical features of early relapse frequency and age at onset can be used to select groups at higher risk of developing severe disability based on the probability of their disease becoming progressive within a defined time period.</abstract><cop>England</cop><pub>BMJ Publishing Group LTD</pub><pmid>23486991</pmid><doi>10.1136/jnnp-2012-304333</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Age Age of Onset Disability Disability Evaluation Disease Progression Endpoint Determination Female Humans Kaplan-Meier Estimate Logistic Models Male Middle Aged Models, Statistical Multiple sclerosis Multiple Sclerosis - epidemiology Multiple Sclerosis - physiopathology Multiple Sclerosis, Relapsing-Remitting - epidemiology Multiple Sclerosis, Relapsing-Remitting - physiopathology Ontario - epidemiology Prognosis Recurrence Risk Assessment Socioeconomic Factors Studies Survival Analysis Treatment Outcome |
| title | Onset of secondary progressive phase and long-term evolution of multiple sclerosis |
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