Abstract Details

Title Objective classification of multiple sclerosis disease course results in frequent reclassification to secondary progressive multiple sclerosis

Topic Multiple Sclerosis

Presentation(s) MS and CNS Inflammatory Disease Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 029

Objective To determine the proportion and characteristics of patients with relapsing-remitting (RRMS) and secondary progressive (SPMS) multiple sclerosis (MS) after applying an objective disease course classifier in five clinical MS registries.

Background The assignment of SPMS in clinical practice is complicated given lack of objective criteria and less therapeutic options raising a question of accuracy of clinically assigned RRMS and SPMS courses.

Design/Methods We used data from MS registries in the Czech Republic, Denmark, Germany, Sweden, and the United Kingdom, including patients with RRMS or SPMS with age ≥18 years at the beginning of the index period (1 January 2017 – 31 December 2019). We applied a decision tree MS course classifier developed at Karolinska Institutet (Ramanujam R, et al, 2020. medRxiv, 2020.07.09.20149674).

Results Of 61,109 MS patients, 8,372 were reclassified from RRMS to SPMS, increasing the overall SPMS proportion from 17% to 28%. As a result of the reclassification, the average age in the RRMS group changed from 44.5 to 42.8 years and from 58.1 to 57.3 years in the SPMS group. Those who were reclassified from RRMS to SPMS were on average 55 years old and had a mean EDSS score of 5.25 compared to mean EDSS scores of 2.05 and 5.83 in the clinically assigned RRMS and SPMS groups respectively. In the reclassified group a majority of 69% were on disease modifying treatments (DMTs) compared to 79% and 36% among the clinically assigned RRMS and SPMS patients respectively.

Conclusions The SPMS proportion increased markedly after application of an objective classifier, indicating an under-assignment of SPMS in clinical practice. The group that was reclassified to SPMS generally displayed a higher age and higher EDSS scores compared to the patients that remained in the RRMS group. Misclassification was most pronounced in patients on DMTs, indicating an important bias.

Authors/Disclosures
Jan A. Hillert, MD (Karolinska Institute, Neurology R54) PRESENTER	Dr. Hillert has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Hillert has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Celgene. Dr. Hillert has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck. Dr. Hillert has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Hillert has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sandoz. Dr. Hillert has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi. The institution of Dr. Hillert has received research support from Biogen. The institution of Dr. Hillert has received research support from Celgene. The institution of Dr. Hillert has received research support from Merck. The institution of Dr. Hillert has received research support from Novartis. The institution of Dr. Hillert has received research support from Sanofi. The institution of Dr. Hillert has received research support from Roche.
	No disclosure on file
Ali Manouchehrinia, PhD (Karolinska Institutet)	Dr. Manouchehrinia has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Dr. Manouchehrinia has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Biogen. The institution of Dr. Manouchehrinia has received research support from Karolinska Institutet.
	No disclosure on file
Timothy Spelman	No disclosure on file
	No disclosure on file
Jiri Drahota, MSc (ReMuS Registry)	Jiri Drahota has received personal compensation for serving as an employee of IMPULS Endowment Fund. Jiri Drahota has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Roche s.r.o.. Jiri Drahota has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis s.r.o..
Dana Horakova	Dana Horakova has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dana Horakova has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dana Horakova has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dana Horakova has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck.
	No disclosure on file
Melinda Magyari, MD	Dr. Magyari has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. Magyari has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck. Dr. Magyari has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Magyari has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck. Dr. Magyari has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Magyari has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi. Dr. Magyari has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Magyari has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Bristol Myers Squibb. The institution of Dr. Magyari has received research support from The Danish MS Society. The institution of Dr. Magyari has received research support from Biogen. The institution of Dr. Magyari has received research support from Novartis. The institution of Dr. Magyari has received research support from Roche. The institution of Dr. Magyari has received research support from Merck. The institution of Dr. Magyari has received research support from Sanofi.
	No disclosure on file
	No disclosure on file
Anneke Van Der Walt, MD (Alfred Health)	Dr. Van Der Walt has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck. Dr. Van Der Walt has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Van Der Walt has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Van Der Walt has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. Dr. Van Der Walt has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Biogen. The institution of Dr. Van Der Walt has received research support from NHMRC Australia. The institution of Dr. Van Der Walt has received research support from MSRA. The institution of Dr. Van Der Walt has received research support from Roche.
Jeff Rodgers	Jeff Rodgers has nothing to disclose.
	No disclosure on file
Rod Middleton (Data Scienve Building)	The institution of Mr. Middleton has received research support from MS Society.
Richard S. Nicholas, FRCP (Imperial College Healthcare Trust)	Dr. Nicholas has nothing to disclose.
Vladimir Bezlyak (Novartis Pharma AG)	Vladimir Bezlyak has received personal compensation for serving as an employee of Novartis Pharma AG. Vladimir Bezlyak has received stock or an ownership interest from Novartis Pharma AG.
Nicholas Adlard	Nicholas Adlard has received personal compensation for serving as an employee of Novartis Pharma AG.
Thomas Hach	Thomas Hach has received personal compensation for serving as an employee of Novartis Pharma AG. Thomas Hach has received stock or an ownership interest from Novartis.
	No disclosure on file
	No disclosure on file

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