Disability accrual in primary and secondary progressive multiple sclerosis
Language English Country England, Great Britain Media print-electronic
Document type Journal Article, Research Support, Non-U.S. Gov't
PubMed
37068931
DOI
10.1136/jnnp-2022-330726
PII: jnnp-2022-330726
Knihovny.cz E-resources
- Keywords
- multiple sclerosis,
- MeSH
- Multiple Sclerosis, Chronic Progressive * drug therapy MeSH
- Humans MeSH
- Persons with Disabilities * MeSH
- Disease Progression MeSH
- Proportional Hazards Models MeSH
- Multiple Sclerosis * MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
BACKGROUND: Some studies comparing primary and secondary progressive multiple sclerosis (PPMS, SPMS) report similar ages at onset of the progressive phase and similar rates of subsequent disability accrual. Others report later onset and/or faster accrual in SPMS. Comparisons have been complicated by regional cohort effects, phenotypic differences in sex ratio and management and variable diagnostic criteria for SPMS. METHODS: We compared disability accrual in PPMS and operationally diagnosed SPMS in the international, clinic-based MSBase cohort. Inclusion required PPMS or SPMS with onset at age ≥18 years since 1995. We estimated Andersen-Gill hazard ratios for disability accrual on the Expanded Disability Status Scale (EDSS), adjusted for sex, age, baseline disability, EDSS score frequency and drug therapies, with centre and patient as random effects. We also estimated ages at onset of the progressive phase (Kaplan-Meier) and at EDSS milestones (Turnbull). Analyses were replicated with physician-diagnosed SPMS. RESULTS: Included patients comprised 1872 with PPMS (47% men; 50% with activity) and 2575 with SPMS (32% men; 40% with activity). Relative to PPMS, SPMS had older age at onset of the progressive phase (median 46.7 years (95% CI 46.2-47.3) vs 43.9 (43.3-44.4); p<0.001), greater baseline disability, slower disability accrual (HR 0.86 (0.78-0.94); p<0.001) and similar age at wheelchair dependence. CONCLUSIONS: We demonstrate later onset of the progressive phase and slower disability accrual in SPMS versus PPMS. This may balance greater baseline disability in SPMS, yielding convergent disability trajectories across phenotypes. The different rates of disability accrual should be considered before amalgamating PPMS and SPMS in clinical trials.
American University of Beirut Beirut Lebanon
Brain and Mind Centre The University of Sydney Sydney New South Wales Australia
Centre Hospitalier Université de Montréal Montreal Québec Canada
CORe Department of Medicine The University of Melbourne Melbourne Victoria Australia
Department of Medicine Al Amiri Hospital Kuwait City Kuwait
Department of Neurological Siences University of Florence Florence Italy
Department of Neurology American University of Beirut Beirut Lebanon
Department of Neurology Austin Health Heidelberg Victoria Australia
Department of Neurology Box Hill Hospital Box Hill Victoria Australia
Department of Neurology Centro Hospitalar de São João Porto Portugal
Department of Neurology Cliniques Universitaires Saint Luc Brussels Belgium
Department of Neurology Dokuz Eylul University İzmir Turkey
Department of Neurology Donostia University Hospital San Sebastian Spain
Department of Neurology Flinders Medical Centre Adelaide South Australia Australia
Department of Neurology Groene Hart Ziekenhuis Gouda Zuid Holland The Netherlands
Department of Neurology Hacettepe University Faculty of Medicine Ankara Turkey
Department of Neurology Haydarpasa Numune Training and Research Hospital Istanbul Turkey
Department of Neurology Hopital Razi La Manouba Tunisia
Department of Neurology Hospital Galdakao Usansolo Galdacano País Vasco Spain
Department of Neurology Isfahan University of Medical Sciences Isfahan Iran
Department of Neurology John Hunter Hospital Newcastle New South Wales Australia
Department of Neurology Karadeniz Technical University Trabzon Turkey
Department of Neurology Koc Universitesi Istanbul Turkey
Department of Neurology Liverpool Hospital Liverpool New South Wales Australia
Department of Neurology Monash Medical Centre Clayton Clayton Victoria Australia
Department of Neurology Nemocnice Jihlava Jihlava Czech Republic
Department of Neurology Razi Hospital Rasht Gilan Iran
Department of Neurology The Alfred Melbourne Victoria Australia
Department of Neurology University Hospital Ghent Gent Oost Vlaanderen Belgium
Department of Neurology Westmead Hospital Westmead New South Wales Australia
Department of Neurology Zuyderland Medical Centre Sittard Geleen The Netherlands
Department of Neuroscience Azienda Ospedaliero Universitaria di Modena Modena Emilia Romagna Italy
Department of Neuroscience Monash University Central Clinical School Melbourne Victoria Australia
Department of Neuroscience Université de Montréal Montreal Québec Canada
Department of Neurosciences Hospital Universitari Germans Trias i Pujol Barcelona Spain
Dipartimento di Scienze Biomediche e Neuromotorie Università di Bologna Bologna Italy
Division of Neurology Department of Medicine St Michael's Hospital Toronto Ontario Canada
Faculté de Médecine Université de Montréal Montreal Québec Canada
Health Sciences Faculty Fernando Pessoa University Porto Portugal
Hospital Clinic de Barcelona Barcelona Catalunya Spain
IRCCS Fondazione Don Carlo Gnocchi Florence Italy
Koç University Research Center for Translational Medicine Koç University Istanbul Turkey
Multiple Sclerosis Centre Neurological Institute C Mondino Pavia Italy
Multiple Sclerosis Centre Neurosciences University of Parma Parma Italy
Multiple Sclerosis Unit Hospital Universitario Virgen Macarena Sevilla Andalucía Spain
Neuro Rive Sud Longueuil Quebec Canada
Neurology Unit Azienda Ospedaliero Universitaria of Modena Modena Italy
Ondokuz Mayis Üniversitesi Samsun Turkey
Ospedali Riuniti di Salerno Salerno Italy
Rehabilitation and MS Centre Pelt Belgium
School of Medicine and Public Health The University of Newcastle Callaghan New South Wales Australia
Universitair MS Centrum Hasselt University Hasselt Pelt Belgium
UO Neurologia Ospedale Garibaldi Catania Italy
UOC Neurologia Azienda Sanitaria Unica Regionale Marche AV3 Macerata Italy
UOC Neurologia e Stroke AORN San Giuseppe Moscati Avellino Italy
UQCCR The University of Queensland Saint Lucia Queensland Australia
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