Onset of secondary progressive multiple sclerosis is not influenced by current relapsing multiple sclerosis therapies

Abstract

BackgroundDisease-modifying therapies are thought to reduce the conversion rate to secondary progressive multiple sclerosis.ObjectiveTo explore the rate, chronology, and contributing factors of conversion to the progressive phase in treated relapsing–remitting multiple sclerosis patients.MethodsOur study included 204 patients treated for relapsing–remitting multiple sclerosis between 1995 and 2002, prospectively followed to date. Kaplan–Meier analysis was applied to estimate the time until secondary progressive multiple sclerosis conversion, and multivariate survival analysis with a Cox regression model was used to analyse prognostic factors.ResultsRelapsing–remitting multiple sclerosis patients were continuously treated for 13 years (SD 4.5); 36.3% converted to secondary progressive multiple sclerosis at a mean age of 42.6 years (SD 10.6), a mean time of 8.2 years (SD 5.2) and an estimated mean time of 17.2 years (range 17.1–18.1). A multifocal relapse, age older than 34 years at disease onset and treatment failure independently predicted conversion to secondary progressive multiple sclerosis but did not influence the time to reach an Expanded Disability Status Scale of 6.0.ConclusionsThe favourable influence of disease-modifying therapies on long-term disability in relapsing–remitting multiple sclerosis is well established. However, the time to progression onset and the subsequent clinical course in treated patients seem similar to those previously reported in natural history studies. More studies are needed to clarify the effect of disease-modifying therapies once the progressive phase has been reached.

Silent Progression or Bout Onset Progressive Multiple Sclerosis?

“…]” This concept implies the hypothesis that two different clinical forms of MS could coexist from the beginning of the disease: one with a relapsing debut, in which progressive MS will never develop, and the other with a relapsing course, but with a silent progression from the beginning, responsible for the subsequent progressive course of SPMS. Similar data were published by our group in a cohort of 204 RRMS patients followed for 20 years, work in which we discussed the concept of bout onset progressive MS (BOPMS), first mentioned by Paz Soldán et al…”

The association between multiple sclerosis and pain medications

“…Research into how this transition can be prevented is therefore of vital importance. Disease course is often unpredictable, and the underlying mechanisms behind why some RR MS patients progress to SP MS and others do not is incompletely understood133 . The effect of MS DMD's once the progressive phase has been reached is less clear than is the case for RR MS, highlighting the importance of preventing transition to SP MS since treatments cannot necessarily be depended on to alleviate symptoms to the same degree134 .…”

Should We Use Clinical Tools to Identify Disease Progression?

“…Naturally, certain risk factors have been described, which could suggest or predict the manifestation of secondary progression in MS patients. Among the demographic characteristics of the patients at the RRMS diagnosis, male sex ( 29 , 33 – 35 ), older age ( 21 , 29 , 35 – 38 ), and a multifocal disease manifestation at onset ( 36 , 37 ) have been associated with an earlier transition to SPMS. Regarding the disease course, patients with a low EDSS at MS diagnosis could have a lower risk of disability progression further on ( 36 ); the annual relapse rate may be a predictive factor especially in the earlier disease stages ( 27 , 29 , 35 , 36 ).…”

“…The use of DMTs seems to modify the risk of a secondary progressive course. First-line DMTs may prolong the period to transition to SPMS according to several studies ( 18 , 19 , 29 , 36 ), although a lack of an objective influence has also been suggested ( 37 , 41 ). Furthermore, the use of newer high-effective DMTs is associated with an even lower risk of disability accumulation compared to the first-line therapies ( 19 ).…”