Quantifying risk of early relapse in patients with first demyelinating events: Prediction in clinical practice
Language English Country Great Britain, England Media print-electronic
Document type Journal Article, Multicenter Study
PubMed
27885062
DOI
10.1177/1352458516679893
PII: 1352458516679893
Knihovny.cz E-resources
- Keywords
- CIS, CSF, MRI, MS, Nomogram, clinically definite multiple sclerosis, clinically isolated syndrome, disease-modifying drugs, second attack,
- MeSH
- Demyelinating Diseases drug therapy pathology MeSH
- Adult MeSH
- Immunosuppressive Agents therapeutic use MeSH
- Middle Aged MeSH
- Humans MeSH
- Nomograms * MeSH
- Prognosis MeSH
- Disease Progression MeSH
- Proportional Hazards Models MeSH
- Recurrence MeSH
- Risk Factors MeSH
- Multiple Sclerosis pathology MeSH
- Age of Onset MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Names of Substances
- Immunosuppressive Agents MeSH
BACKGROUND: Characteristics at clinically isolated syndrome (CIS) examination assist in identification of patient at highest risk of early second attack and could benefit the most from early disease-modifying drugs (DMDs). OBJECTIVE: To examine determinants of second attack and validate a prognostic nomogram for individualised risk assessment of clinical conversion. METHODS: Patients with CIS were prospectively followed up in the MSBase Incident Study. Predictors of clinical conversion were analysed using Cox proportional hazards regression. Prognostic nomograms were derived to calculate conversion probability and validated using concordance indices. RESULTS: A total of 3296 patients from 50 clinics in 22 countries were followed up for a median (inter-quartile range (IQR)) of 1.92 years (0.90, 3.71). In all, 1953 (59.3%) patients recorded a second attack. Higher Expanded Disability Status Scale (EDSS) at baseline, first symptom location, oligoclonal bands and various brain and spinal magnetic resonance imaging (MRI) metrics were all predictors of conversion. Conversely, older age and DMD exposure post-CIS were associated with reduced rates. Prognostic nomograms demonstrated high concordance between estimated and observed conversion probabilities. CONCLUSION: This multinational study shows that age at CIS onset, DMD exposure, EDSS, multiple brain and spinal MRI criteria and oligoclonal bands are associated with shorter time to relapse. Nomogram assessment may be useful in clinical practice for estimating future clinical conversion.
Amiri Hospital Kuwait City Kuwait
Centre de réadaptation en déficience physique Chaudière Appalaches Levis QC Canada
Cliniques Universitaires Saint Luc Brussels Belgium
Department of Basic Medical Sciences Neuroscience and Sense Organs University of Bari Bari Italy
Department of Neurology Box Hill hospital Monash University Box Hill VIC Australia
Department of Neurophysiologie Pitié Salpêtrière Hospital Paris France
Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia Buenos Aires Argentina
Groene Hart Ziekenhuis Gouda The Netherlands
Hôpital Notre Dame Montreal QC Canada
Hospital Clínico San Carlos Madrid Spain
Hospital Italiano de Buenos Aires Buenos Aires Argentina
Hospital Universitario Virgen Macarena Sevilla Spain
Jewish General Hospital Montreal QC Canada
John Hunter Hospital Newcastle NSW Australia
Karadeniz Technical University Trabzon Turkey
Kommunehospitalet Aarhus Denmark
Maaslandziekenhuis Sittard The Netherlands
MS Center Department of Neuroscience and Imaging University 'G d'Annunzio' Chieti Italy
Neuro Rive Sud Hôpital Charles LeMoyne Greenfield Park QC Canada
Neurology Unit ASUR Marche AV3 Macerata Italy
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