Is benign MS ‚benign'?
ECTRIMS Online Library. Ellenberger D. Sep 12, 2019; 279086; P726
David Ellenberger
David Ellenberger
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Abstract

Abstract: P726

Type: Poster Sessions

Abstract Category: Clinical aspects of MS - MS Variants

D. Ellenberger1, P. Flachenecker2, K. Eichstädt1, J. Haas3,4, C. Kleinschnitz5, D. Pöhlau4,6, O. Rienhoff7, P.S. Rommer8,9, U.K. Zettl9, A. Stahmann1, on behalf of the German MS Register by the German MS Society

1German MS-Register by DMSG, MS Forschungs- und Projektentwicklungs-gGmbH, Hannover, 2Neurological Rehabilitation Center Quellenhof, Bad Wildbad, 3MS Center, Jewish Hospital, Berlin, 4German MS Society, Hannover, 5Department of Neurology, University Hospital Essen, Essen, 6German Red Cross Camillus Clinic, Asbach, 7Department of Medical Informatics, University Medical Center Göttingen, Georg-August-University, Göttingen, Germany, 8Department of Neurology, University Hospital Vienna, Vienna, Austria, 9Neurological Clinic, Section Neuro-Immunology, University Rostock, Rostock, Germany

Introduction: Benign MS (BMS) was defined as patients that are fully functional in all neurologic systems after 15 years after onset (DD) (Lublin and Reingold, 1996). Amato described the most commonly used definition of patients (PwMS) not exceeding an EDSS of 3.0 after 15 years. The definition and existence of BMS is still a matter of debate. In the age of earliest possible MS diagnosis, individual prognosis and initiation of DMT - the clinical relevance of a 'benign' disease course is a pressing question.
Aims: This study aims to provide quantitative and qualitative analysis on BMS in Germany.
Methods: Data from the German MS-Register was analysed. Only PwMS with a DD of ≥15 y were included. These were divided into 'benign' with EDSS≤3 and 'non-benign' with EDSS>3. Descriptive analyses were performed using R and group comparisons were done using Chi²-Tests, considering p-values< 1% statistically significant. Survival time analyses beyond the 15 years disease duration were performed using Kaplan-Meier.
Results: We identified 8,794 PwMS with a DD≥15 years. 3,794 patients (43.1%) fulfilled the criteria of EDSS≤ 3.0. Mean age at last visit was 53.3 (±9.9) years.
78.0% of the benign-PwMS compared to 71.7% were females. Mean age at onset for benign-PwMS was 28.7 (±8.5) years and mean time from onset to diagnosis was 4.5 (±6.5) years compared to 30.6(+-9.4) and 4.2(+-6.6) years. Within the benign group 92% were RRMS, 6.0% SPMS, 1.6% PPMS. The levels of SPMS and PPMS were higher (45.7%, 9.7%) in the non-benign group. Levels of employment (70%) were higher than in non-benign patients (34%). We analysed the benign-subgroup for survival (defined as EDSS≤3), showing, that only about 55% of the benign-PwMS stayed benign for further 10 years, with males having lesser chances.
Conclusions:

  • With 43% a high number of the patients did fulfil the internationally most commonly used definition of BMS.
  • In contrast, the low number of benign-PwMS with DD of 25 years shows, that the time to measure 'true benignity' of a MS might not be at DD of 15 years
  • In contrast to the low EDSS a high number (30%) of 'benign' patients is unemployed (already after 15 years).
  • The focus on the EDSS in today´s definition of BMS, which disregards 'soft/hidden' symptoms like fatigue, cognition and emotions, could be a possible explanation.
  • A revision of the definition for 'benign'-MS is due.

Disclosure: DE, KE, OR: nothing to disclose
PF has received speaker's fees and honoraria for advisory boards from Almirall, Bayer, Biogen, Genzyme, Merck-Serono, Novartis, Roche and Teva. He has participated in pharmaceutical company sponsored trials by Almirall, Biogen Idec and Novartis. None resulted in a conflict of interest.
JH has received compensation from Almirall, Allergan, Biogen, Bayer, HOFFMANN La Roche, Merck, Novartis, Octapharma and Teva. None resulted in a conflict of interest.
CK has received speaker's fees and honoraria for advisory boards from Biogen, Merck Serono, Bayer, Teva, Novartis, Medday, Mylan, Genzyme, Almirall und Roche; None resulted in a conflict of interest. RP received honorary for lectures and consultancy from Biogen, Daiichi-Sankyo, Merck, Novartis, Roche, Sanofi-Genzyme, Shire, Teva. He received research grants from Biogen, Merck, Roche. None resulted in a conflict of interest.
UKZ has received speaking fees, travel support and /or financial support for research activities from Almirall, Bayer, Biogen, Merck Serono, Novartis, Roche, Sanofi Genzyme, Teva as well as EU, BMBF, BMWi and DFG. None related to this work.
AS has received institutional research grants from Merck and Novartis. None resulted in a conflict of interest.

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