USF-LVHN SELECT
Long-term evolution of multiple sclerosis disability in the treatment era.
Publication/Presentation Date
10-1-2016
Abstract
OBJECTIVE: To characterize the accrual of long-term disability in a cohort of actively treated multiple sclerosis (MS) patients and to assess whether clinical and magnetic resonance imaging (MRI) data used in clinical trials have long-term prognostic value.
METHODS: This is a prospective study of 517 actively managed MS patients enrolled at a single center.
RESULTS: More than 91% of patients were retained, with data ascertained up to 10 years after the baseline visit. At this last assessment, neurologic disability as measured by the Expanded Disability Status Scale (EDSS) was stable or improved compared to baseline in 41% of patients. Subjects with no evidence of disease activity (NEDA) by clinical and MRI criteria during the first 2 years had long-term outcomes that were no different from those of the cohort as a whole. 25-OH vitamin D serum levels were inversely associated with short-term MS disease activity; however, these levels had no association with long-term disability. At a median time of 16.8 years after disease onset, 10.7% (95% confidence interval [CI] = 7.2-14%) of patients reached an EDSS ≥ 6, and 18.1% (95% CI = 13.5-22.5%) evolved from relapsing MS to secondary progressive MS (SPMS).
INTERPRETATION: Rates of worsening and evolution to SPMS were substantially lower when compared to earlier natural history studies. Notably, the NEDA 2-year endpoint was not a predictor of long-term stability. Finally, the data call into question the utility of annual MRI assessments as a treat-to-target approach for MS care. Ann Neurol 2016;80:499-510.
Volume
80
Issue
4
First Page
499
Last Page
510
ISSN
1531-8249
Published In/Presented At
University of California, San Francisco MS-EPIC Team:, Cree, B. A., Gourraud, P. A., Oksenberg, J. R., Bevan, C., Crabtree-Hartman, E., Gelfand, J. M., Goodin, D. S., Graves, J., Green, A. J., Mowry, E., Okuda, D. T., Pelletier, D., von Büdingen, H. C., Zamvil, S. S., Agrawal, A., Caillier, S., Ciocca, C., Gomez, R., Kanner, R., … Hauser, S. L. (2016). Long-term evolution of multiple sclerosis disability in the treatment era. Annals of neurology, 80(4), 499–510. https://doi.org/10.1002/ana.24747
Disciplines
Medical Education | Medicine and Health Sciences
PubMedID
27464262
Department(s)
USF-LVHN SELECT Program, USF-LVHN SELECT Program Students
Document Type
Article