Quantitative effect of sex on disease activity and disability accumulation in multiple sclerosis

Magyari, Melinda; Koch‐Henriksen, Nils

doi:10.1136/jnnp-2022-328994

Cited by 33 publications

(20 citation statements)

References 32 publications

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“…In a latest MS cohort enrolling 10770 patients, female patients exhibited a slower annualised increase in expanded disability status scale scores. These studies supported the protective role of female in the permeability of brain barriers [ 19 ].…”

Section: Discussionsupporting

confidence: 74%

Evaluation of CSF albumin quotient in neuronal surface antibody-associated autoimmune encephalitis

Lai

Cai

Zheng

et al. 2022

Fluids Barriers CNS

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Background and Objectives Disruption of brain barriers is considered to be involved in the pathogenesis of neuronal surface antibody-associated autoimmune encephalitis (NSAE), but few studies have focused on their relationship. We aimed to explore the association between the integrity of brain barriers and clinical and paraclinical characteristics in patients with NSAE. Methods This retrospective study consecutively recruited patients with NSAE. The cerebrospinal fluid (CSF) / serum albumin quotient (Qalb) was used to evaluate the function of brain barriers. The data on demographic information, clinical manifestations, magnetic resonance imaging (MRI), CSF findings and prognosis were collected and analyzed. Results Of the 93 patients included, 33 (35.5%) patients were assigned to the elevated Qalb group and 60 (64.5%) patients to the normal Qalb group. Males and prodromal symptoms were more common in elevated Qalb group (both P < 0.05). The CSF white blood cell, protein, immunoglobulin G and albumin were significantly higher in elevated Qalb group (all P < 0.05). Patients with elevated Qalb were more likely to have brain lesions on MRI (60.6% versus 33.3%, P = 0.011). The modified Rankin Scale (mRS) scores at discharge and at last follow-up were significantly higher in patients with elevated Qalb than those with normal Qalb (both P < 0.05). After univariate and multivariate analyses, Qalb elevation (adjusted odds ratio = 3.96, 95% confidence interval = 1.15–13.59, P = 0.029) was demonstrated as the only independent risk factor for a poor prognosis. Discussion Males, prodromal symptoms, brain lesions on MRI, CSF pleocytosis, and elevated CSF protein were more common in NSAE patients with increased Qalb. Qalb elevation was an independent prognostic indicator for a poor prognosis in NSAE.

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Section: Discussionsupporting

confidence: 74%

Evaluation of CSF albumin quotient in neuronal surface antibody-associated autoimmune encephalitis

Lai

Cai

Zheng

et al. 2022

Fluids Barriers CNS

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“…It may also be of interest for future studies to examine whether prodromal features are related in any way to the timing of a MS diagnosis, or diagnostic delay. However, a recent study from Denmark found that whilst the time from onset to diagnosis had changed over time (decreased) since the 1950s, it did not differ by sex ( 42 ).…”

Section: Discussionmentioning

confidence: 98%

Sex and age differences in the Multiple Sclerosis prodrome

Yusuf

Wijnands²,

Karim³

et al. 2022

Front. Neurol.

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Background and objectivesLittle is known of the potential sex and age differences in the MS prodrome. We investigated sex and age differences in healthcare utilization during the MS prodrome.MethodsThis was a population-based matched cohort study linking administrative and clinical data from British Columbia, Canada (population = 5 million). MS cases in the 5 years preceding a first demyelinating event (“administrative cohort;” n = 6,863) or MS symptom onset (“clinical cohort;” n = 966) were compared to age-, sex- and geographically-matched controls (n = 31,865/4,534). Negative binomial and modified Poisson models were used to compare the rates of physician visits and hospitalizations per international classification of diseases chapter, and prescriptions filled per drug class, between MS cases and controls across sex and age-groups (< 30, 30–49, ≥50 years).ResultsIn the administrative cohort, males with MS had a higher relative rate for genitourinary-related visits (males: adjusted Rate Ratio (aRR) = 1.65, females: aRR = 1.19, likelihood ratio test P = 0.02) and antivertigo prescriptions (males: aRR = 4.72, females: aRR = 3.01 P < 0.01). Injury and infection-related hospitalizations were relatively more frequent for ≥50-year-olds (injuries < 30/30–49/≥50: aRR = 1.16/1.39/2.12, P < 0.01; infections 30–49/≥50: aRR = 1.43/2.72, P = 0.03), while sensory-related visits and cardiovascular prescriptions were relatively more common in younger persons (sensory 30–49/≥50: aRR = 1.67/1.45, P = 0.03; cardiovascular < 30/30–49/≥50: aRR = 1.56/1.39/1.18, P < 0.01). General practitioner visits were relatively more frequent in males (males: aRR = 1.63, females: aRR = 1.40, P < 0.01) and ≥50-year-olds (< 30/≥50: aRR = 1.32/1.55, P = 0.02), while differences in ophthalmologist visits were disproportionally larger among younger persons, < 50-years-old (< 30/30–49/≥50: aRR = 2.25/2.20/1.55, P < 0.01). None of the sex and age-related differences in the smaller clinical cohort reached significance (P ≥ 0.05).DiscussionSex and age-specific differences in healthcare use were observed in the 5 years before MS onset. Findings demonstrate fundamental heterogeneity in the MS prodromal presentation.

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“…13 However, a registry study found that in persons with disease onset after the age of 50 years, the risk of reaching EDSS 6 at any given age is lower than in patients with onset earlier in life, which is due to a shorter disease duration with shorter time to accumulate disability in the late-onset group, 14 and in our recently published study using the same registry data, we found that the annualised increase in EDSS was twice as high in patients with onset at age 50 or more than in all patients together. 15 This observation is supported by a smaller study conducted on the British Columbia database, 16 underlying the fact that outcomes deriving from a population-based cohort may not be totally generalisable to different age- or course-defined subgroups of patients with MS.…”

Section: Discussionmentioning

confidence: 92%

Changes in prognosis of the Danish multiple sclerosis population over time

et al. 2022

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Background: The course of multiple sclerosis (MS) appears to be milder in recent decades. Objective: To investigate how time from onset to disability milestones and how demographic and clinical characteristics have changed through subsequent onset cohorts of patients with MS. Methods: In the nationwide Danish Multiple Sclerosis Registry, we have registered all 13,562 Danish patients with onset of MS or clinically isolated syndrome from 1996 through 2020. For the analyses of prognosis, we used all cases with relapsing onset ( N = 11,669). After stratification into 5-year onset cohorts, we computed the hazard ratios for disability endpoints for all cohorts having at least 10 years of follow-up and the oldest 1996–2000 onset cohort as reference. Results: Patients in more recent MS onset cohorts have a shorter diagnostic delay and more of them start disease-modifying treatment within 1 year since diagnosis. The prognosis was better for later onset cohorts. For the 2001–2005 cohort, the hazard ratio for confirmed Expanded Disability Status Scale (EDSS) 4 was 0.85 (95% confidence interval (CI), 0.76–0.95) and for confirmed EDSS 6: 0.76 (95% CI, 0.65–0.88). For the more recent 2006–2010 cohort, the corresponding hazard ratios were 0.70 (95% CI, 0.62–0.79) and 0.60 (95% CI, 0.50–0.71). Conclusion: We observed a considerable improvement of the prognosis in recent onset cohorts of relapsing-onset MS.

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Quantitative effect of sex on disease activity and disability accumulation in multiple sclerosis

Cited by 33 publications

References 32 publications

Evaluation of CSF albumin quotient in neuronal surface antibody-associated autoimmune encephalitis

Evaluation of CSF albumin quotient in neuronal surface antibody-associated autoimmune encephalitis

Sex and age differences in the Multiple Sclerosis prodrome

Changes in prognosis of the Danish multiple sclerosis population over time

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