Abstract Details

Title Multiple Sclerosis Prognosis in a Contemporary, Multiethnic Population-Based Cohort

Topic MS and Related Diseases

Presentation(s) P04 - (-)

Poster/Presentation
Number 124

Objective

Background BACKGROUND: Little is known about whether disability from multiple sclerosis (MS) has improved since the widespread use of early treatment or whether MS-related disability is worse in blacks or Hispanics.

Design/Methods DESIGN/METHODS: Retrospective cohort study of incident MS cases identified through the Kaiser Permanente Southern California Acquired Demyelinating Diseases Cohort in 2008. Full medical records were abstracted through September 2012. The median duration and range of follow-up from diagnosis was 3.9 years (0.06-4.6). Hazards ratios (HR) and 95% confidence intervals (CI) were adjusted for age, gender, and race/ethnicity using Cox proportional hazards.

Results RESULTS: We identified 150 newly diagnosed MS patients including 86 whites, 31 Hispanics and 29 Blacks. The majority of patients (n=130, 86.7%) were treated early with immunomodulatory agents (IMAs, median time from symptom onset=1.48 years). Despite this, 27 (18%) were cane dependent or worse and an additional 35 (23%) had gait abnormalities but able to ambulate without assistance at the end of the follow-up period. 14 of the 27 patients requiring a cane or worse had a relapsing-onset course. Independent risk factors for requiring a cane or worse were older age at symptom onset (adjusted p=0.04) and Black (adjusted HR=2.0 95%CI=0.8-5.3; p=0.13) or Hispanic race/ethnicity (adjusted HR=4.6, 95%CI=1.4-15.3; p=0.01). Delay in diagnosis, treatment with IMAs and progressive onset were not independent risk factors. Treatment with IMAs did not vary by racial/ethnic group.

Conclusions CONCLUSIONS: Findings from our pilot study imply that despite early treatment with IMAs the risk of significant disability within 5 years of symptom onset remains relatively high, particularly in Hispanics and blacks. Whether this reflects racial/ethnic differences in utilization of care, MS pathophysiology and/or inadequate efficacy of IMAs in aggressive MS warrants further study.

Authors/Disclosures
Brandon E. Beaber, MD (Kaiser Permanente) PRESENTER	No disclosure on file
Jian Zhang, PhD (Map Pharmaceuticals Inc)	No disclosure on file
Annette M. Langer-Gould, MD, PhD (Kaiser Permanente Southern California)	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.
Stuart D. Cook, MD, FAAN (Rutgers)	No disclosure on file

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