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Mult Scler. 2019 Aug 9:1352458519868990. doi: 10.1177/1352458519868990. [Epub ahead of print]

Risk of secondary progressive multiple sclerosis: A longitudinal study.

Author information

1
CORe, Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia.
2
Central Clinical School, Monash University, Melbourne, VIC, Australia The Alfred, Melbourne, VIC, Australia.
3
Department of Neurology and Center of Clinical Neuroscience, General University Hospital and Charles University in Prague, Prague, Czech Republic.
4
Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Italy.
5
Hopital Notre-Dame, Montreal, QC, Canada/CHUM and Universite de Montreal, Montreal, QC, Canada.
6
IRCCS Istituto delle Scienze Neurologiche di Bologna, UOSI Riabilitazione Sclerosi Multipla, Bologna, Italy/Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy.
7
Hospital Universitario Virgen Macarena, Sevilla, Spain.
8
Neuro-Rive-Sud, Greenfield Park, QC, Canada.
9
CISSS de Chaudière-Appalache, Centre-Hospitalier, Levis, Canada.
10
Department of Neuroscience, Azienda Ospedaliera Universitaria, Modena, Italy.
11
Amiri Hospital, Kuwait City, Kuwait.
12
Medical Faculty, Ondokuz Mayis University, Samsun, Turkey.
13
Zuyderland Ziekenhuis, Sittard, The Netherlands.
14
TU Medical Faculty, Farabi Hospital, Karadeniz Technical University, Trabzon, Turkey.
15
School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia/Department of Neurology, John Hunter Hospital, Hunter New England Health, Newcastle, NSW, Australia.
16
UOC Neurologia, Azienda Sanitaria Unica Regionale Marche, Macerata, Italy.
17
IRCCS Mondino Foundation, Pavia, Italy.
18
Cliniques Universitaires Saint-Luc, Brussels, Belgium.
19
Dokuz Eylul University, Izmir, Turkey.
20
Department of Medicine and Surgery, University of Parma, Parma, Italy.
21
Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey.
22
Ospedali Riuniti di Salerno, Salerno, Italy.
23
Azienda Ospedaliera di Rilievo Nazionale, San Giuseppe Moscati - Avellino, Avellino, Italy.
24
The University of Queensland, Brisbane, QLD, Australia/Royal Brisbane and Women's Hospital, Herston, QLD, Australia.
25
Ospedale P.A. Micone, Genova, Italy.
26
Flinders University, Adelaide, SA, Australia.
27
Nemocnice Jihlava, Jihlava, Czech Republic.
28
Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey.
29
Kommunehospitalet, Arhus, Denmark.
30
Hospital de Galdakao-Usansolo, Galdakao, Spain.
31
Groene Hart Ziekenhuis, Gouda, The Netherlands.
32
CSSS Saint-Jérôme, Saint-Jerome, QC, Canada.
33
Department of Neurology, Razi Hospital, Manouba, Tunisia.
34
Rehabilitation and MS-Centre Overpelt and Hasselt University, Hasselt, Belgium.
35
Westmead Hospital, Sydney, NSW, Australia.
36
Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
37
Institute of Neurosciences Buenos Aires, Buenos Aires, Argentina.
38
Hospital Fernandez, Buenos Aires, Argentina.
39
Brain and Mind Centre, Sydney, NSW, Australia.
40
Hospital Universitario Donostia-Instituto de Investigación Sanitaria Biodonostia, San Sebastian, Spain.
41
Jewish General Hospital, Montreal, QC, Canada.
42
The Alfred, Melbourne, VIC, Australia.
43
South East Trust, Belfast, UK.
44
Universidade Metropolitana de Santos, Santos, Brazil.
45
American University of Beirut Medical Center, Beirut, Lebanon.
46
Geelong Hospital, Geelong, VIC, Australia.
47
Bombay Hospital Institute of Medical Sciences, Mumbai, India.
48
St Vincent's Hospital, Melbourne, VIC, Australia.
49
Liverpool Hospital, Sydney, NSW, Australia.
50
Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey.
51
King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia.
52
Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
53
Royal Hobart Hospital, Hobart, TAS, Australia.
54
Central Clinical School, Monash University, Melbourne, VIC, Australia.
55
Central Clinical School, Monash University, Melbourne, VIC, Australia/The Alfred, Melbourne, VIC, Australia/Department of Neurology, Box Hill Hospital, Melbourne, VIC, Australia.
56
CORe, Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia/Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia/L4 Centre, Melbourne Brain Centre at Royal Melbourne Hospital, Parkville, VIC, Australia.

Abstract

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 demographic, clinical and paraclinical features that influence the risk of conversion to secondary progressive multiple sclerosis.

METHODS:

Patients with adult-onset relapsing-remitting multiple sclerosis and at least four recorded disability scores were selected from MSBase, a global observational cohort. The risk of conversion to objectively defined secondary progressive multiple sclerosis was evaluated at multiple time points per patient using multivariable marginal Cox regression models. Sensitivity analyses were performed.

RESULTS:

A total of 15,717 patients were included in the primary analysis. Older age (hazard ratio (HR) = 1.02, p < 0.001), longer disease duration (HR = 1.01, p = 0.038), a higher Expanded Disability Status Scale score (HR = 1.30, p < 0.001), more rapid disability trajectory (HR = 2.82, p < 0.001) and greater number of relapses in the previous year (HR = 1.07, p = 0.010) were independently associated with an increased risk of secondary progressive multiple sclerosis. Improving disability (HR = 0.62, p = 0.039) and disease-modifying therapy exposure (HR = 0.71, p = 0.007) were associated with a lower risk. Recent cerebral magnetic resonance imaging activity, evidence of spinal cord lesions and oligoclonal bands in the cerebrospinal fluid were not associated with the risk of conversion.

CONCLUSION:

Risk of secondary progressive multiple sclerosis increases with age, duration of illness and worsening disability and decreases with improving disability. Therapy may delay the onset of secondary progression.

KEYWORDS:

SPMS; disease modifying therapies; multiple sclerosis; prediction; prognostics

PMID:
31397221
DOI:
10.1177/1352458519868990

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