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Abstract Details

Predicting Tempo of Post-Progression Disability Accumulation in Multiple Sclerosis
MS and Related Diseases
P02 - (-)
147
BACKGROUND: The majority of patients with multiple sclerosis will, at some point, enter a progressive phase of disease characterized by insidious accumulation of neurologic disability. Progression may be present from the time of clinical onset (primary) or follow a relapsing-remitting phase (secondary). Although patients with early progressive disease frequently inquire about the anticipated tempo of disability accumulation, neurologists have limited evidence to guide discussions of prognosis. In this study, we examined the impact of several clinical parameters on the tempo of post-progression disability accumulation.
DESIGN/METHODS: We studied two cohorts fulfilling McDonald diagnostic criteria for multiple sclerosis: a population-based prevalence cohort from Olmsted County MN (n=221), and a clinic based progressive cohort (n=859). Progressive disease course was classified as either primary (PPMS), secondary (SPMS), or following a single clinical attack (SAPMS). Disability was assigned per Kurtzke EDSS. Several demographic and clinical features were studied using a multivariate Cox regression analysis. For factors that showed an increased hazard ratio (HR), Kaplan-Meier analysis was used to generate survival curves to EDSS 6.
RESULTS: Female gender (HR:1.27), older age at progression (HR:1.09), inflammatory CSF (HR:1.24), and presence of pre-progression relapses (HR:2.20) predicted shorter time from progression to EDSS 6. Post-progression disability accumulation was slowest in PPMS (50% of patients in 10 years), followed by SAPMS (50% in 7 years), and fastest in SPMS (50% in 4 years) (p<0.0001). Ongoing relapses after onset of progressive disease course shortened time to EDSS 6 by about 2 years (p=0.0005).
CONCLUSIONS: Time to severe disability in progressive multiple sclerosis is influenced by gender, age, inflammatory CSF, and presence of relapses. In particular, both pre- and post-progression relapses accelerate the tempo of post-progression disability accumulation.
Authors/Disclosures
M. M. Paz Soldan, MD, PhD (Mayo Clinic)
PRESENTER 		Dr. Paz Soldan has received personal compensation in the range of $500-$4,999 for serving as a Consultant for TG Therapeutics. The institution of Dr. Paz Soldan has received research support from National Institutes of Health. The institution of Dr. Paz Soldan has received research support from National Multiple Sclerosis Society. The institution of Dr. Paz Soldan has received research support from Western Institute for Biomedical Research. The institution of Dr. Paz Soldan has received research support from Biogen. The institution of Dr. Paz Soldan has received research support from Novartis. The institution of Dr. Paz Soldan has received research support from Clene Nanomedicine.
Melih Tutuncu, MD No disclosure on file
Junger Tang, MD No disclosure on file
Nuhad Abou Zeid, MD (Wake Forest Baptist Medical Center) No disclosure on file
Nilufer Kale Icen, MD Dr. Kale has nothing to disclose.
Raymond P. Roos, MD, FAAN (University of Chicago Med Ctr) Dr. Roos has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for MedLink. Dr. Roos has stock in Amazon. Dr. Roos has stock in Amgen. Dr. Roos has stock in Apple. Dr. Roos has stock in Cigna. Dr. Roos has stock in IBM. Dr. Roos has stock in Ionis. Dr. Roos has stock in Pfizer. Dr. Roos has received research support from Lohengrin Foundation.
No disclosure on file
No disclosure on file
Aksel Siva, MD (Istanbul University Cerrahpasa School of Medicine) Dr. Siva has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Siva has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. Siva has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sanofi-Genzyme. Dr. Siva has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen - TR. Dr. Siva has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion. Dr. Siva has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ali Raif Pharmaceuticals, Turkiye. Dr. Siva has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sanovel Pharmaceuticals, Turkiye. Dr. Siva 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. Siva has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Abdi Ibrahim Ilac - TR. Dr. Siva 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 . The institution of Dr. Siva has received research support from Turkish MS Society. The institution of Dr. Siva has received research support from The Scientific and Technological Research Council Of Turkey - Health Sciences Research Grants.
Sean J. Pittock, MD, FAAN (Mayo Clinic Dept of Neurology) Dr. Pittock has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Arialys. The institution of Dr. Pittock has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. The institution of Dr. Pittock has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB. The institution of Dr. Pittock has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche/Genentech. The institution of Dr. Pittock has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Alexion/AstraZeneka. The institution of Dr. Pittock has received research support from NIH. Dr. Pittock has received intellectual property interests from a discovery or technology relating to health care. Dr. Pittock has received intellectual property interests from a discovery or technology relating to health care. Dr. Pittock has received publishing royalties from a publication relating to health care.
Istvan Pirko, MD, FAAN (Mayo Clinic) No disclosure on file
Mark Keegan, MD, FAAN (Mayo Clinic) Dr. Keegan has received personal compensation in the range of $500-$4,999 for serving as a Consultant for EMD Serono. Dr. Keegan has received publishing royalties from a publication relating to health care. Dr. Keegan has received publishing royalties from a publication relating to health care.
Claudia F. Lucchinetti, MD, FAAN (University of De Medical School, Health Learning Blg) The institution of Dr. Lucchinetti has received research support from Biogen Idec. The institution of Dr. Lucchinetti has received research support from NIH/NINDS. The institution of Dr. Lucchinetti has received research support from National Institute of Neurological Disorders and Stroke . The institution of Dr. Lucchinetti has received research support from National Multiple Sclerosis Society. The institution of Dr. Lucchinetti has received research support from National Center for Advancing Translational Sciences. Dr. Lucchinetti has received intellectual property interests from a discovery or technology relating to health care. Dr. Lucchinetti has a non-compensated relationship as a Member with National Institute of Neurological Disorders that is relevant to AAN interests or activities. Dr. Lucchinetti has a non-compensated relationship as a Member with Board of Directors, Association of University Professors of Neurology that is relevant to AAN interests or activities. Dr. Lucchinetti has a non-compensated relationship as a Member with Mayo Clinic Board of Trustees that is relevant to AAN interests or activities. Dr. Lucchinetti has a non-compensated relationship as a Member with Mayo Clinic Board of Governors that is relevant to AAN interests or activities.
John H. Noseworthy, MD, FAAN No disclosure on file
Moses Rodriguez, MD, FAAN (Mayo Clinic Department Of Neurology) Dr. Rodriguez has received intellectual property interests from a discovery or technology relating to health care.
Brian G. Weinshenker, MD, FAAN (University of Virginia Health System) Dr. Weinshenker has received personal compensation in the range of $500-$4,999 for serving as a Consultant for CANbridge Pharmaceuticals. Dr. Weinshenker has received personal compensation in the range of $0-$499 for serving as a Consultant for CALIBR. Dr. Weinshenker has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Horizon. Dr. Weinshenker has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Weinshenker has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche Group (Chugai, Genentech, Roche). Dr. Weinshenker has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB Pharmaceuticals. Dr. Weinshenker has received research support from Guthy Jackson Charitable Foundation. Dr. Weinshenker has received intellectual property interests from a discovery or technology relating to health care.
Orhun H. Kantarci, MD Dr. Kantarci has nothing to disclose.
Florian Then Bergh, MD (University of Leipzig, Klinik u. Poliklinik fuer Neurologie) Dr. Then Bergh 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. Then Bergh 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. Then Bergh 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. Then Bergh has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon. Dr. Then Bergh has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB. Dr. Then Bergh has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Actelion. Dr. Then Bergh has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Alexion. Dr. Then Bergh has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Biogen. Dr. Then Bergh has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Bayer. Dr. Then Bergh has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Genzyme. Dr. Then Bergh has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Roche. Dr. Then Bergh has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Fresenius. Dr. Then Bergh has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Merck. Dr. Then Bergh has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Takeda. The institution of Dr. Then Bergh has received research support from Actelion. The institution of Dr. Then Bergh has received research support from Novartis. The institution of Dr. Then Bergh has received research support from DFG (German Science Fund). The institution of Dr. Then Bergh has received research support from Fresenius. The institution of Dr. Then Bergh has received research support from Diamed. Dr. Then Bergh has received personal compensation in the range of $10,000-$49,999 for serving as a Member of the Institutional Ethics Board with University of Leipzig, Medical Faculty.