Disability progression in aggressive multiple sclerosis

作者：Menon Suresh; Zhu Feng; Shirani Afsaneh; Oger Joel; Freedman Mark S; Tremlett Helen^*

来源：Multiple Sclerosis, 2017, 23(3): 456-463.

DOI：10.1177/1352458516653273

• Multiple sclerosis
• neuroepidemiology
• epidemiology

Objective: To examine disease progression in aggressive' multiple sclerosis (MS), British Columbia, Canada (1980-2009).
Methods: Aggressive (or malignant') MS was defined as Expanded Disability Status Scale (EDSS) 6 within 5years from onset. The first EDSS 6 was termed baseline'. Within 2, 3 and 5years post-baseline, patients were categorized as follows: worsened' or improved', relative to baseline EDSS (the remainder exhibited no change or had no new scores). The associations between patient characteristics (sex, relapsing onset/primary progressive, onset age, onset symptoms, disease duration, cumulative prior relapses and baseline EDSS) and worsening in disability were examined longitudinally using logistic regression.
Results: Of the 225/4341 (5.2%) aggressive/malignant MS patients, 134 (59.6%) were female, 167 (74.2%) were relapsing onset, 94 (41.8%) had received disease-modifying drugs at some point and the mean follow-up was 8.7years. The proportion of patients who worsened' increased from 40.4% to 57.8%, while those who improved' varied little (range, 8.9%-10.2%). The odds of worsening increased with disease duration (adjusted odds ratio (AOR)=1.36; 95% confidence interval (CI)=1.22-1.52) and the presence of primary progressive (vs relapsing-onset) MS (AOR=1.85; 95% CI=1.01-3.38).
Conclusion: Apart from disease duration and a primary progressive course, no clinically useful associations of subsequent disease worsening in patients with aggressive/malignant MS were identified.

• 出版日期2017-3