Contemporary study of multiple sclerosis disability in South East Wales

Abstract

BackgroundA contemporary understanding of disability evolution in multiple sclerosis (MS) is an essential tool for individual disease management and planning of interventional studies. We have used prospectively collected longitudinal data to analyse disability progression and variation in a British MS cohort.MethodsCox proportional hazards regression was used to estimate hazard of Expanded Disability Status Scale (EDSS) 4.0 and 6.0. A continuous Markov model was used to estimate transitional probabilities for individual EDSS scores. Models were adjusted for age at MS onset, sex and disease-modifying treatments (DMTs) exposure.Results2135 patients were included (1487 (70%) female, 1922 (89%) relapsing onset). 865 (41%) had used DMTs. Median time to EDSS 4.0 and 6.0 was 18.2 years (95% CI 16.3 to 20.2) and 22.1 years (95% CI 20.5 to 24.5). In the Markov model, the median time spent at EDSS scores of <6 (0.40–0.98 year) was shorter than the time spent at EDSS scores of ≥6 (0.87–4.11 year). Hazard of change in EDSS was greatest at EDSS scores <6 (HR for increasing EDSS: 1.02–1.33; decreasing EDSS: 0.34–1.27) compared with EDSS scores ≥6 (HR for increasing EDSS: 0.08–0.61; decreasing EDSS: 0.18–0.54).ConclusionsThese data provide a detailed contemporary model of disability outcomes in a representative population-based MS cohort. They support a trend of increasing time to disability milestones compared with historical reference populations, and document disability variation with the use of transitional matrices. In addition, they provide essential information for patient counselling, clinical trial design, service planning and offer a comparative baseline for assessment of therapeutic interventions.

A comparison of multiple sclerosis disease characteristics across three genetically diverse Asian racial groups in Singapore

“…The median MSSS in our cohort was 2.2, comparable to recent studies in both Asian (South Korea: MSSS 1.77, mean disease duration 8 years) and Western cohorts (United States: MSSS 2.2, mean disease duration 20.1 years) 36 , 37 . We also calculated that the median time to reach EDSS 6.0 (from disease onset) of our study cohort to be 23.0 years, which is comparable to other contemporaneous population-based studies worldwide (Sweden, 30.4 years; Norway, 29.8 years; Wales 22.1 years) 38 – 40 . Older studies have reported a shorter time to EDSS 6.0 (France, 18.0 years; Canada 18.9 years) and it has been shown that the time taken to reach EDSS 6.0 from EDSS 1.0 was 18.5 years amongst patients in the placebo arms of randomised controlled trials 41 – 43 .…”

Algorithmic approach to finding people with multiple sclerosis using routine healthcare data in Wales

“…The South-East Wales MS cohort, comprises clinical data from the Cardiff area in South Wales, updated by clinical and research staff based on patient contact (Ethics: 19/WA/0289, 05/WSE03/111). 8 We included pwMS known to be based in Cardiff diagnosed up to 1 January 2020. 4.…”