Is it possible to predict benign multiple sclerosis?
Author(s): ,
A. Sartori
Affiliations:
Department of Medical, Surgical, and Health Sciences, University of Trieste, Trieste, Italy
,
M. Abdoli
Affiliations:
University of Ottawa and Ottawa Hospital Research Institute, Ottawa, ON, Canada
M.S. Freedman
Affiliations:
University of Ottawa and Ottawa Hospital Research Institute, Ottawa, ON, Canada
ECTRIMS Online Library. Sartori A. 10/09/15; 115603; 730
Arianna Sartori
Arianna Sartori
Contributions
Abstract
Abstract: P770

Type: Poster

Abstract Category: Natural course

Background: Benign Multiple Sclerosis (MS) has prognostic and therapeutic implications. Most definitions are retrospective, involving a period of observation of 5-10 years from onset of symptoms with prevalence reported ranging from 6-64%. However, many patients presumed 'benign' at 10 years actually progress with time and are no longer benign (NLB).

Objectives: To compare clinical and paraclinical characteristics of benign MS patients defined as EDSS score ≤3, 10 years from disease onset with those who still fulfilled that definition vs. being NLB at 20 years from disease onset.

Methods and patients: A retrospective study of patients at the Ottawa Hospital MS Clinic was performed, looking for patients with the following inclusion criteria: clinically definite MS (not CIS); EDSS score ≤3 at 10 years from onset of first symptoms; disease onset from December 1983 - December 1993; clinical assessments performed at 10±1 and 20±1 years from onset of MS symptoms.

Results: We found 175 patients fulfilling the inclusion criteria. 20 years from disease onset, 66.3% of patients still remained benign. Considering patients with EDSS score ≤2 or ≤1 at 10 years, the percentage remaining benign at 20 years increased to 71.9% and 81.6%, respectively. In a univariate analysis, female sex, EDSS score ≤1 at 10 years and a pure sensory onset represented the most favourable prognostic factors; EDSS score >2 and a pure motor symptom at onset were associated with the greatest chance of being NLB at 20 years. There were significantly more patients (p=0.033) treated with disease modifying drugs (DMD) in the NLB group. In a logistic regression analysis EDSS ≤1 at 10 years was able to predict a benign course at 20 years with better than 80% specificity.

Discussion and conclusions: We found a higher percentage of benign patients at 20 years compared to previous studies, possibly due to a higher percentage of patients treated with DMD in our population. A multivariate analysis did not find any early clinical variable that could predict a benign course at 20 years. However, EDSS ≤2 at 10 years had a better predictive value than EDSS score ≤3 at 10 years, which was neither sensitive nor specific for predicting continuing to be benign at 20 years. Most patients acquiring early disability (>2) before 10 years are very unlikely to remain benign. We propose that a better definition of benign use stricter EDSS cut-offs (≤2 or even ≤1) at 10 years, in order to enhance the specificity.

Disclosure:

Arianna Sartori: Receipt of honoraria or consultation fees: Merk Serono, Novartis. Mohammad Abdoli: Receipt of honoraria or consultation fees: EMD Canada, Genzyme Canada, Consortium of Multiple Sclerosis Centers.

Mark S. Freedman: Receipt of honoraria or consultation fees: BayerHealthcare, BiogenIdec, Chugai, EMD Canada, Genzyme, Merck Serono, Novartis, Hoffman La-Roche, Sanofi-Aventis, Teva Canada Innovation; member of a company advisory board, board of directors or other similar group: Actelion, BayerHealthcare, BiogenIdec, Hoffman La-Roche, Merck Serono, Novartis, Opexa, Sanofi-Aventis; participation in a company sponsored speaker's bureau: Genzyme.

Abstract: P770

Type: Poster

Abstract Category: Natural course

Background: Benign Multiple Sclerosis (MS) has prognostic and therapeutic implications. Most definitions are retrospective, involving a period of observation of 5-10 years from onset of symptoms with prevalence reported ranging from 6-64%. However, many patients presumed 'benign' at 10 years actually progress with time and are no longer benign (NLB).

Objectives: To compare clinical and paraclinical characteristics of benign MS patients defined as EDSS score ≤3, 10 years from disease onset with those who still fulfilled that definition vs. being NLB at 20 years from disease onset.

Methods and patients: A retrospective study of patients at the Ottawa Hospital MS Clinic was performed, looking for patients with the following inclusion criteria: clinically definite MS (not CIS); EDSS score ≤3 at 10 years from onset of first symptoms; disease onset from December 1983 - December 1993; clinical assessments performed at 10±1 and 20±1 years from onset of MS symptoms.

Results: We found 175 patients fulfilling the inclusion criteria. 20 years from disease onset, 66.3% of patients still remained benign. Considering patients with EDSS score ≤2 or ≤1 at 10 years, the percentage remaining benign at 20 years increased to 71.9% and 81.6%, respectively. In a univariate analysis, female sex, EDSS score ≤1 at 10 years and a pure sensory onset represented the most favourable prognostic factors; EDSS score >2 and a pure motor symptom at onset were associated with the greatest chance of being NLB at 20 years. There were significantly more patients (p=0.033) treated with disease modifying drugs (DMD) in the NLB group. In a logistic regression analysis EDSS ≤1 at 10 years was able to predict a benign course at 20 years with better than 80% specificity.

Discussion and conclusions: We found a higher percentage of benign patients at 20 years compared to previous studies, possibly due to a higher percentage of patients treated with DMD in our population. A multivariate analysis did not find any early clinical variable that could predict a benign course at 20 years. However, EDSS ≤2 at 10 years had a better predictive value than EDSS score ≤3 at 10 years, which was neither sensitive nor specific for predicting continuing to be benign at 20 years. Most patients acquiring early disability (>2) before 10 years are very unlikely to remain benign. We propose that a better definition of benign use stricter EDSS cut-offs (≤2 or even ≤1) at 10 years, in order to enhance the specificity.

Disclosure:

Arianna Sartori: Receipt of honoraria or consultation fees: Merk Serono, Novartis. Mohammad Abdoli: Receipt of honoraria or consultation fees: EMD Canada, Genzyme Canada, Consortium of Multiple Sclerosis Centers.

Mark S. Freedman: Receipt of honoraria or consultation fees: BayerHealthcare, BiogenIdec, Chugai, EMD Canada, Genzyme, Merck Serono, Novartis, Hoffman La-Roche, Sanofi-Aventis, Teva Canada Innovation; member of a company advisory board, board of directors or other similar group: Actelion, BayerHealthcare, BiogenIdec, Hoffman La-Roche, Merck Serono, Novartis, Opexa, Sanofi-Aventis; participation in a company sponsored speaker's bureau: Genzyme.

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