No sex-specific difference in disease trajectory in multiple sclerosis patients before and after age 50

作者：Bove Riley; Musallam Alexander; Healy Brian C; Houtchens Maria; Glanz Bonnie I; Khoury Samia; Guttmann Charles R; De Jager Philip L; Chitnis Tanuja^*

来源：BMC Neurology, 2013, 13(1): 73.

DOI：10.1186/1471-2377-13-73

• Demyelinating disease
• Multiple sclerosis
• Natural history studies
• MRI
• Disease progression
• Menopause
• Gender

Background: The disease course in multiple sclerosis (MS) is influenced by many factors, including age, sex, and sex hormones. Little is known about sex-specific changes in disease course around age 50, which may represent a key biological transition period for reproductive aging.
Methods: Male and female subjects with no prior chemotherapy exposure were selected from a prospective MS cohort to form groups representing the years before (38-46 years, N=351) and after (54-62 years, N=200) age 50. Primary analysis assessed for interaction between effects of sex and age on clinical (Expanded Disability Status Scale, EDSS; relapse rate) and radiologic (T2 lesion volume, T2LV; brain parenchymal fraction, BPF) outcomes. Secondarily, we explored patient-reported outcomes (PROs).
Results: As expected, there were age-and sex-related changes with male and older cohorts showing worse disease severity (EDSS), brain atrophy (BPF), and more progressive course. There was no interaction between age and sex on cross-sectional adjusted clinical (EDSS, relapse rate) or radiologic (BPF, T2LV) measures, or on 2-year trajectories of decline. There was a significant interaction between age and sex for a physical functioning PRO (SF-36): the older female cohort reported lower physical functioning than men (p=0.002). There were no differences in depression (Center for Epidemiological Study - Depression, CES-D) or fatigue (Modified Fatigue Impact Scale, MFIS) scores.
Conclusions: There was no interaction between age and sex suggestive of an effect of reproductive aging on clinical or radiologic progression. Prospective analyses across the menopausal transition are needed.

• 出版日期2013-7-3