Radiologically isolated syndrome: a 10-year follow-up study to identify factors predicting a clinical event
ECTRIMS Online Library. Lebrun C. 09/11/19; 279420; 97
Dr. Christine Lebrun
Dr. Christine Lebrun

Abstract: 97

Type: Scientific Session

Abstract Category: Clinical aspects of MS - Natural course

C. Lebrun-Frenay1, O. Kantarci2, A. Siva3, C. Cara-Dallière4, C. Louapre5, F. Durand-Dubief6, E. Thouvenot7, P. Vemersch8, M. Inglese9, N. De Stefano10, G. Mathey11, E. Le page12, U. Uygunoğlu3, M. Tintore13, D. Laplaud14, J. De Seze15, J. Ciron16, J. Pelletier17, B. Brochet18, E. Berger19, C. Bensa20, B. Bourre21, O. Casez22, L. Mondot23, B. Zeydan2, M. Cohen24, C. Azevedo25, N. Makhani26, M.P. Sormani27, D. Pelletier25, D. Okuda28, RISC, SFSEP, OFSEP

1Hôpital Pasteur2 | Neurology | MS Clinic, Nice Cote d'Azur University, Nice, France, 2Mayo Clinic, Rochester, MN, United States, 3Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey, 4Montpellier University Hospital, Montpellier, 5Pitié Salpetriere Hospital, Paris, 6Lyon University Hospital, Lyon, 7Nîmes University Hospital, Nîmes, 8Lille University Hospital, Lille, France, 9Mount Sinai Hospital, New York, NY, United States, 10Siena University, Siena, Italy, 11Nancy University Hospital, Nancy, 12Rennes University Hospital, Rennes, France, 13CEMCAT, Barcelona, Spain, 14Nantes University Hospital, Nantes, 15Strasbourg University, Hôpital Civil, Strasbourg, 16Toulouse University Hospital, Toulouse, 17Marseille University Hospital, Marseille, 18Bordeaux University Hospital, Bordeaux, 19Besancon Hospital, Besançon, 20Rothschild Foundation, Paris, 21Rouen University Hospital, Rouen, 22Grenoble University Hospital, Grenoble, 23Nice University Hospital, 24CRCSEP Côte d'Azur University, Nice, France, 25University of Southern California, Los Angeles, CA, 26Yale University, New Haven, CT, United States, 27Genoa University, Genoa, Italy, 28University of Texas Southwestern Medical Center, Dallas, TX, United States

Objectives: To investigate risk factors for the development of a seminal clinical event in RIS using a 10-year, multi-national, retrospectively-identified subject dataset.
Background: Our original observation published in 2014 identified male sex, age ≤37, and presence of spinal cord lesion involvement as factors increasing the 5-year risk of evolution from RIS to MS.
Methods: Retrospectively identified RIS subjects according to the RISConsortium criteria (Okuda, 2009) from a worldwide cohort included 22 databases from 5 countries. Subjects were prospectively followed up and underwent serial clinical and MRI studies. Sex, age, presence of at least one spinal cord lesion, presence of gadolinium enhanced (Gd+) lesions, dissemination in time on follow up MRI, positive CSF, on the risk of the first clinical event were analyzed. Time to first clinical event was compared across different groups by univariate and multivariate analyses using Cox regression models.
Results: Data were available in 451 RIS subjects (F: 358 (78.2%)). Mean age from RIS diagnosis was 37.1 years (y) (median: 37.0 y, range: 11-74 y) with mean clinical follow-up time of 5.9 y (median: 4.6 y, range: 0.01-22 y). Twelve subjects were under 18 years. Clinical events were identified in 53% (standard error=2.5%) of individuals within a 10-year period. Of those who developed symptoms, 5% fulfilled criteria for primary progressive MS. Age [hazard ratio (HR): 0.98 (95% CI: 0.96-0.99); p=0.02] and MRI lesions in the cervical or thoracic spinal cord [HR: 3.29 (2.22-4.94); p ≤ 0.001] were identified as significant predictors of a first clinical event. Positive CSF or gd+ were not predictive of a clinical event (HR=1.45 (95%CI 1.05-1.99) and HR= 0.99 (95%CI=0.69-1.44 respectively)). Reason for MRI, specifically headache, was not associated with an increased risk of evolution to a first event.
Conclusion: These data provide evidence that a majority of RIS subjects experience a first clinical event within 10 years. An age < 37 y and spinal cord involvement appear to be the most important independent predictors of symptom onset.
Disclosure: All authors have nothing to disclose regarding this work

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