Abstract Details

Title Clinical and Demographic Predictors of the Risk of Conversion from Clinically Isolated Syndrome to Multiple Sclerosis: A Population-Based Study

Topic MS and Related Diseases

Presentation(s) P04 - (-)

Poster/Presentation
Number 136

Objective

Background BACKGROUND: Clinically isolated syndrome (CIS) can be a precursor of multiple sclerosis (MS). Little is known about the risk of conversion from CIS to MS in real-world practice settings, particularly in multi-ethnic populations.

Design/Methods DESIGN/METHODS: Retrospective cohort study of incident CIS cases identified through the Kaiser Permanente Southern California (KPSC) Acquired Demyelinating Diseases Cohort between 2008 and 2009. Full medical records were abstracted for clinical, demographic and radiologic variables. The average duration and range of follow-up was 3.5 years (0.11-5.38). Hazards ratios (HR) and 95% confidence intervals (CI) were adjusted for age, gender, symptoms at onset and treatment with immunomodulatory agents (IMAs) using Cox proportional hazards.

Results RESULTS: We identified 305 new onset CIS cases including 92 Hispanics and 47 Blacks. By September 2012, 142 (46.7%) had developed MS. Independent risk factors for conversion to MS across all racial/ethnic groups were the presence of asymptomatic brain lesions (64%, HR=3.95 95%CI=2.88-5.43;P<0.0001), polyregional onset of symptoms (34%, HR=2.44, 95%CI=1.55-3.84; P<0.0001) and younger age at onset (p=0.004). Optic neuritis at onset decreased the risk of MS independent of asymptomatic brain lesions only in Hispanics (HR=0.27, 95%CI=0.12-0.63). Race/ethnicity, gender, other symptoms at onset, recovery from first attack and treatment with IMAs were not independent risk factors for conversion to MS.

Conclusions CONCLUSIONS: Our findings imply that less than half of patients with CIS in a real world practice setting will convert to MS over a 3-year-period. Furthermore risk factors for conversion to MS are similar across racial/ethnic groups with the exception that optic neuritis at onset may confer a better prognosis in Hispanics. Risk of conversion to MS was determined primarily by presence of asymptomatic brain lesions or polyregional onset.

Authors/Disclosures
Annette M. Langer-Gould, MD, PhD (Kaiser Permanente Southern California) PRESENTER	An immediate family member of Dr. Langer-Gould has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Annals of American Thoracic Society. The institution of Dr. Langer-Gould has received research support from PCORI. The institution of an immediate family member of Dr. Langer-Gould has received research support from PCORI, ARQ, NIH. Dr. Langer-Gould has a non-compensated relationship as a Voting Member with ICER CTAF Panel that is relevant to AAN interests or activities.
Jian Zhang, PhD (Map Pharmaceuticals Inc)	No disclosure on file
Mark S. Freedman, MD, FAAN (University of Ottawa)	Dr. Freedman has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Actelion(Janssen/J&J). Dr. Freedman has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Alexion. Dr. Freedman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BiogenIdec. Dr. Freedman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BMS/Celgene. Dr. Freedman has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for EMD Inc. Dr. Freedman has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sanofi-Genzyme. Dr. Freedman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. Freedman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Freedman has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Actelion (Janssen/J&J). Dr. Freedman 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. Freedman has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Atara Biotherapeutics. Dr. Freedman has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Bayer Healthcare. Dr. Freedman has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for BiogenIdec. Dr. Freedman has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Clene Nanomedicine. Dr. Freedman has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for GRI Bio. Dr. Freedman has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Freedman has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Magenta Therapeutics. Dr. Freedman has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck Serono. Dr. Freedman 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. Freedman has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi Genzyme. Dr. Freedman has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Sanofi Genzyme. Dr. Freedman has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for EMD Serono. The institution of Dr. Freedman has received research support from Sanofi Genzyme.

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