Early predictors of conversion to secondary progressive multiple sclerosis.

Published on Jun 26, 2021in Multiple sclerosis and related disorders4.339
· DOI :10.1016/J.MSARD.2021.103115
Mahdi Barzegar8
Estimated H-index: 8
(IUMS: Isfahan University of Medical Sciences),
Soroush Najdaghi1
Estimated H-index: 1
(IUMS: Isfahan University of Medical Sciences)
+ 3 AuthorsVahid Shaygannejad25
Estimated H-index: 25
(IUMS: Isfahan University of Medical Sciences)
Sources
Abstract
BACKGROUND We conducted this study to estimated the time of conversion from relapsing-remitting MS (RRMS) to SPMS and its early predictor factors. METHODS In this retrospective study, demographic, clinical, and imaging data from MS patients at diagnosis were extracted. Cox proportional hazards model was used to assess the association between various baseline characteristics and conversion to SPMS. We also assessed the association brtween escalation and early intensive therapy approaches with transition to progressive phase. RESULTS Out of 1903 patients with RRMS at baseline, 293 (15.4%) patients progressed to SPMS during follow-up. The estimated number of patients converted to SPMS was 10% at 10-years, 50% at 20-years, and 93% at 30-years. On multivariate Cox regression analysis older age at onset (HR: 1.067, 95%CI: 1.048-1.085, p < 0.001), smoking (HR: 2.120, 95%CI: 1.203-3.736, p = 0.009), higher EDSS at onset (HR: 1.199, 95%CI: 1.109-1.295, p < 0.001), motor dysfunction (HR: 2.470, 95%CI: 1.605-3.800, p < 0.001), cerebellar dysfunction (HR: 3.096, 95%CI: 1.840-5.211, p < 0.001), and presence of lesions in spinal cord (HR: 0.573, 95%CI: 0.297-0.989, p = 0.042) increased the risk of conversion from RRMS to SPMS. No significant difference between escalation and EIT groups in the risk of transition to progressive phase (weighted HR = 1.438; 95% CI: 0.963, 2.147; p = 0.076) was found. CONCLUSION Our data support previous observations that smoking is a modifiable risk factor for secondary progressive MS and confirms that spinal cord involvement, age, and more severe disease at onset are prognostic factors for converting to secondary progressive MS.
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#1Mahdi Barzegar (IUMS: Isfahan University of Medical Sciences)H-Index: 8
#2Omid Mirmosayyeb (IUMS: Isfahan University of Medical Sciences)H-Index: 12
Last. Nasrin Asgari (University of Southern Denmark)H-Index: 26
view all 6 authors...
Abstract Background Comorbidity may influence clinical aspects of neuromyelitis optica spectrum disorder (NMOSD). We estimated the prevalence of comorbidities to assess their association with outcomes. Methods This retrospective study assessed records of NMOSD patients from 2008 to 2019, categorizing comorbidities into three groups: somatic, psychiatric and autoimmune. Severity of disease was evaluated by the Expanded Disability Status Scale, progression index (PI) and annualized relapse rate. T...
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#1Daniel Ontaneda (Cleveland Clinic)H-Index: 23
#2Emma C Tallantyre (Cardiff University)H-Index: 18
Last. Nikos Evangelou (University of Nottingham)H-Index: 38
view all 16 authors...
Multiple Sclerosis (MS) is a common cause of neurological disability among young adults and has a high economic burden. Currently there are 18 disease modifying agents for relapsing MS, which were tested in clinical trials versus placebo or an active comparator in a pairwise manner. However, there is currently no consensus on the fundamental principles of treatment approach and initial therapy selection. These factors result in variable use of disease modifying therapies. Here we describe the st...
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#1Eleonora Tavazzi (SUNY: State University of New York System)H-Index: 22
#2Robert Zivadinov (SUNY: State University of New York System)H-Index: 85
Last. Niels Bergsland (SUNY: State University of New York System)H-Index: 41
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Introduction: Conventional imaging measures remain a key clinical tool for the diagnosis multiple sclerosis (MS) and monitoring of patients. However, most measures used in the clinic show unsatisfactory performance in predicting disease progression and conversion to secondary progressive MS.Areas covered: Sophisticated imaging techniques have facilitated the identification of imaging biomarkers associated with disease progression, such as global and regional brain volume measures, and with conve...
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#1Omid Mirmosayyeb (IUMS: Isfahan University of Medical Sciences)H-Index: 12
#2Serge Brand (University of Basel)H-Index: 62
Last. Dena Sadeghi Bahmani (Kermanshah University of Medical Sciences)H-Index: 15
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Background: Compared to the adult onset of multiple sclerosis (AOMS), both early-onset (EOMS) and late-onset (LOMS) are much less frequent, but are often under- or misdiagnosed. The aims of the present study were: 1. To compare demographic and clinical features of individuals with EOMS, AOMS and LOMS, and 2. To identify predictors for disability progression from relapsing remitting MS (RRMS) to secondary progressive MS (SPMS). Method: Data were taken from the Isfahan Hakim MS database. Cases wer...
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#1Roberta Magliozzi (University of Verona)H-Index: 7
#2Anne H. Cross (WashU: Washington University in St. Louis)H-Index: 82
Multiple sclerosis (MS) is a heterogeneous disease. With several disease modifying treatments of different mechanisms of action in use now and in development, it is important to identify reliable b...
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#1Adam Fambiatos (University of Melbourne)H-Index: 2
#2Vilija Jokubaitis (Monash University)H-Index: 26
Last. Tomas Kalincik (University of Melbourne)H-Index: 33
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Background:The risk factors for conversion from relapsing-remitting to secondary progressive multiple sclerosis remain highly contested.Objective:The aim of this study was to determine the demograp...
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#1Bassem Yamout (AUB: American University of Beirut)H-Index: 23
#2Mohammed A. Sahraian (Tehran University of Medical Sciences)H-Index: 4
Last. Raed AlroughaniH-Index: 27
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Abstract With evolving diagnostic criteria and the advent of new oral and parenteral therapies for MS, most current diagnostic and treatment algorithms need revision and updating. The diagnosis of MS relies on incorporating clinical and paraclinical findings to prove dissemination in space and in time, and exclude alternative diseases that can explain the findings at hand. The differential diagnostic workup should be guided by clinical and laboratory red flags to avoid unnecessary tests. Appropr...
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#1Daniel Ontaneda (Cleveland Clinic)H-Index: 23
#2Emma C Tallantyre (Cardiff University)H-Index: 18
Last. Nikos Evangelou (University of Nottingham)H-Index: 38
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Summary Treatment decisions in multiple sclerosis are complex given the large number of disease-modifying therapies with diverse safety and efficacy profiles. The importance of early treatment has been recognised but how intensively to treat at onset is not known. Substantial variability exists in treatment selection with weak clinical trial evidence to guide initial treatment choices. Decision-making is made more complicated by variable tolerance for risk of side-effects and inability to accura...
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#2Jesper Hagemeier (UNIPV: University of Pavia)H-Index: 1
Together with whole-brain atrophy, atrophied brain T2 lesion volume seen with MRI is used to predict multiple sclerosis (MS) disability progression and is the only MRI feature related to conversion...
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#1Wallace J Brownlee (UCL Institute of Neurology)H-Index: 15
#2Daniel R. Altmann (Lond: University of London)H-Index: 63
Last. Olga Ciccarelli (NIHR: National Institute for Health Research)H-Index: 73
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The clinical course of relapse-onset multiple sclerosis is highly variable. Demographic factors, clinical features and global brain T2 lesion load have limited value in counselling individual patients. We investigated early MRI predictors of key long-term outcomes including secondary progressive multiple sclerosis, physical disability and cognitive performance, 15 years after a clinically isolated syndrome. A cohort of patients with clinically isolated syndrome (n = 178) was prospectively recrui...
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