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Author: Saiz, A

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Conversion from clinically isolated syndrome to multiple sclerosis: A large multicentre study

Kuhle, J
Author Kuhle, J Blizard Institute, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, UK/ Departments of Neurology and Biomedicine, University Hospital Basel, University of Basel, Switzerland
Disanto, G
Author Disanto, G Blizard Institute, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, UK
Dobson, R
Author Dobson, R Blizard Institute, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, UK
Adiutori, R
Author Adiutori, R Blizard Institute, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, UK
Bianchi, L
Author Bianchi, L Blizard Institute, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, UK
Topping, J
Author Topping, J Blizard Institute, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, UK
Bestwick, J P
Author Bestwick, J P Wolfson Institute of Preventive Medicine, Queen Mary University of London, Barts and the London School for Medicine and Dentistry, UK
Meier, U-C
Author Meier, U-C Blizard Institute, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, UK
Marta, M
Author Marta, M Blizard Institute, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, UK
Dalla Costa, G
Author Dalla Costa, G Department of Neurology and INSPE, Vita-Salute San Raffaele University, Scientific Institute San Raffaele, Italy

Multiple sclerosis. 2015 ; 21 (8) : 1013-24. [pub] 20150213

Mult Scler
ISSN 1477-0970
Medvik
Source

BACKGROUND AND OBJECTIVE: We explored which clinical and biochemical variables predict conversion from clinically isolated syndrome (CIS) to clinically definite multiple sclerosis (CDMS) in a large international cohort. METHODS: Thirty-three centres provided serum samples from 1047 CIS cases with at least two years' follow-up. Age, sex, clinical presentation, T2-hyperintense lesions, cerebrospinal fluid (CSF) oligoclonal bands (OCBs), CSF IgG index, CSF cell count, serum 25-hydroxyvitamin D3 (25-OH-D), cotinine and IgG titres against Epstein-Barr nuclear antigen 1 (EBNA-1) and cytomegalovirus were tested for association with risk of CDMS. RESULTS: At median follow-up of 4.31 years, 623 CIS cases converted to CDMS. Predictors of conversion in multivariable analyses were OCB (HR = 2.18, 95% CI = 1.71-2.77, p < 0.001), number of T2 lesions (two to nine lesions vs 0/1 lesions: HR = 1.97, 95% CI = 1.52-2.55, p < 0.001; >9 lesions vs 0/1 lesions: HR = 2.74, 95% CI = 2.04-3.68, p < 0.001) and age at CIS (HR per year inversely increase = 0.98, 95% CI = 0.98-0.99, p < 0.001). Lower 25-OH-D levels were associated with CDMS in univariable analysis, but this was attenuated in the multivariable model. OCB positivity was associated with higher EBNA-1 IgG titres. CONCLUSIONS: We validated MRI lesion load, OCB and age at CIS as the strongest independent predictors of conversion to CDMS in this multicentre setting. A role for vitamin D is suggested but requires further investigation.

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