Age and disability accumulation in multiple sclerosis

Scalfari, Antonio; Neuhaus, Anneke; Däumer, Martin; Ebers, George C.; Muraro, Paolo A.

doi:10.1212/wnl.0b013e318230a17d

Cited by 234 publications

(219 citation statements)

References 24 publications

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“…Other studies found no difference but, importantly, none concluded that disability accrual is faster in PPMS. 9,11,[22][23][24] Variability between these studies is likely methodologic and not intrinsic to Figure 2 Effect of immunomodulation on postprogression disability accumulation in BOPMS Survival curves from progressive MS onset to EDSS 6 are shown. Postprogression immunomodulatory medication use seemingly slows the pace of postprogression disability accumulation among patients with BOPMS who have ongoing relapses (A), but not clearly so among those who do not (B).…”

Section: Resultsmentioning

confidence: 99%

“…However, development of a progressive disease course and rate of postprogression disability accumulation seems to be age-dependent, and does not correlate with the rate of preprogression disability accumulation. 2,4,[7][8][9][10][11] Although age at progressive disease onset and pace of disability accumulation are similar across MS subtypes (e.g., PPMS vs SPMS), there is a wide range and distribution. This suggests that the presence or absence of other clinical parameters underlies the differences in long-term disability accrual between patients with progressive MS.…”

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confidence: 99%

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Relapses and disability accumulation in progressive multiple sclerosis

et al. 2015

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Objective: We examined the effect of relapses-before and after progression onset-on the rate of postprogression disability accrual in a progressive multiple sclerosis (MS) cohort. Methods:We studied patients with primary progressive MS (n 5 322) and bout-onset progressive MS (BOPMS) including single-attack progressive MS (n 5 112) and secondary progressive MS (n 5 421). The effect of relapses on time to Expanded Disability Status Scale (EDSS) score of 6 was studied using multivariate Cox regression analysis (sex, age at progression, and immunomodulation modeled as covariates). Kaplan-Meier analysis was performed using EDSS 6 as endpoint. Conclusions: Pre-and postprogression relapses accelerate time to severe disability in progressive MS. Continuing immunomodulation for 5 years after the onset of progressive disease or until 55 years of age may be reasonable to consider in patients with BOPMS who have ongoing relapses. Results: Preprogression relapses (hazard ratioNeurology ® 2015;84:81-88 GLOSSARY BOPMS 5 bout-onset progressive multiple sclerosis; CI 5 confidence interval; EDSS 5 Expanded Disability Status Scale; HR 5 hazard ratio; MS 5 multiple sclerosis; PPMS 5 primary progressive multiple sclerosis; RRMS 5 relapsing-remitting multiple sclerosis; SAPMS 5 single-attack progressive multiple sclerosis; SPMS 5 secondary progressive multiple sclerosis.

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Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

Relapses and disability accumulation in progressive multiple sclerosis

et al. 2015

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“…The onset of progressive disease is age-dependent, and usually occurs at age 40-50 years; the frequency of relapses decreases with increasing age 77,78 . In a long-term analysis, age was identified (together with progressive MS and number of prior immune-modifying therapies) as an independent factor associated with neurological progression-free survival 60 .…”

Section: [H3] Age and Duration Of Diseasementioning

confidence: 99%

Autologous haematopoietic stem cell transplantation for treatment of multiple sclerosis

et al. 2017

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Autologous haematopoietic stem cell transplantation (AHSCT) is a multistep procedure that enables destruction of the immune system and its reconstitution from haematopoietic stem cells. Originally developed for the treatment of haematological malignancies, the procedure has been adapted for the treatment of severe immune-mediated disorders. Results from ~20 years of research make a compelling case for selective use of AHSCT in patients with highly active multiple sclerosis (MS), and for controlled trials. Immunological studies support the notion that AHSCT causes qualitative immune resetting, and have provided insight into the mechanisms that might underlie the powerful treatment effects that last well beyond recovery of immune cell numbers. Indeed, studies have demonstrated that AHSCT can entirely suppress MS disease activity for 4–5 years in 70–80% of patients, a rate that is higher than those achieved with any other therapies for MS. Treatment-related mortality, which was 3.6% in studies before 2005, has decreased to 0.3% in studies since 2005. Current evidence indicates that the patients who are most likely to benefit from and tolerate AHSCT are young, ambulatory and have inflammatory MS activity. Clinical trials are required to rigorously test the efficacy, safety and cost-effectiveness of AHSCT against highly active MS drugs

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“…Its natural history has been extensively studied in Caucasian (CA) populations, and prognostic factors have been well recognized: being male, late age at the first symptom, high number of relapses in the onset of the disease, and short interval between initial relapses with poor recovery have been identified as predictive factors of long term disability 2,3,4,5,6,7,8,9,10,11 . While MS is a worldwide disease, its prevalence is higher in populations from western countries in the northern hemisphere compared to those from Africa, Asia and Latin America 12 .…”

Section: Disability and Progression In Afro-descendant Patients With mentioning

confidence: 99%

Disability and progression in Afro-descendant patients with multiple sclerosis

Aurenção

Vasconcelos

Thuler

et al. 2016

Arq. Neuro-Psiquiatr.

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Multiple sclerosis (MS) prevalence is higher in Caucasian (CA) populations, narrowing the analysis of the impact of Afro-descendant (AD) populations in disease outcomes. Even so, recent studies observed that AD patients have a more severe course. The main objective of this study is to confirm and discuss, through a systematic review, that being AD is a risk factor for disability accumulation and/or severe progression in patients with MS. A systematic review of published data in the last eleven years was performed, which evaluated clinical aspects and long term disability in patients with MS. Fourteen studies were included. Of these fourteen articles, thirteen observed a relationship between ancestry and poorer outcome of MS. African ancestry is a condition inherent in the patient and should be considered as an initial clinical characteristic affecting prognosis, and influencing which therapeutic decision to make in initial phases.

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Age and disability accumulation in multiple sclerosis

Abstract: Development of SP is the dominant determinant of long-term prognosis, independent of disease duration and early relapse frequency. Age independently affects disability development primarily by changing probability and latency of SP onset, with little effect on the progressive course.

Cited by 234 publications

References 24 publications

Relapses and disability accumulation in progressive multiple sclerosis

Relapses and disability accumulation in progressive multiple sclerosis

Autologous haematopoietic stem cell transplantation for treatment of multiple sclerosis

Disability and progression in Afro-descendant patients with multiple sclerosis

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