Age at disease onset and clinical outcomes in patients with multiple sclerosis on immunomodulatory treatment
ECTRIMS Online Library. von Wyl V. 09/13/19; 279561; 302
Viktor von Wyl
Viktor von Wyl

Abstract: 302

Type: Scientific Session

Abstract Category: Clinical aspects of MS - Natural course

V. von Wyl1, B. Décard2, P. Benkert3, J. Lorscheider2, P. Hänni4, C. Lienert5, J. Kuhle2, T. Derfuss2, L. Kappos2, Ö. Yaldizli2

1Department of Epidemiology, Institute for Epidemiologie, Biostatistics und Prevention, University of Zurich, 2Neurologic Clinic and Policlinic, Departments of Medicine, University Hospital Basel and University of Basel, 3Department of Clinical Research, Clinical Trial Unit, University Hospital Basel, Basel, 4Swiss Association for Joint Tasks of Health Insurers, Solothurn, 5Department of Neurology, Rheinburg Clinic, Walzenhausen, Switzerland

Introduction: Pediatric-onset multiple sclerosis patients have higher relapse rates than adult-onset patients and an initially slower disability progression rate. However, less is known about the relation of age at disease onset and clinical outcomes across the full disease trajectory from childhood to older ages in MS patients on DMT.
Methods: We made use of the Swiss association for joint tasks of health insurers database which contains data from 14718 MS patients who initiated their first DMT between 1995 and 2017 (69% women; 85% relapsing-remitting (RR)MS; mean age 39±11.5 years; disease duration 6±8 years; 80% interferon-beta or glatiramer acetate). Patients were eligible for this analysis when they had a CIS or RRMS, were on DMT for at least one year between 1995 and 2017 and had a MS diagnosis on or after the January 1, 1993. Disability was assessed by the Expanded Disability Status Scale (EDSS) score. Age at disease onset was transformed into cubic splines to illustrate age-related event risks. The influence of age at disease onset on future relapses and disability progression was explored by multivariable Cox proportional hazard regression models.
Results: Data from 9705 MS patients were eligible for this analysis. The association between age at disease onset and EDSS progression had a sigmoid shape: EDSS progression hazards remained stable in patients with disease onset from early childhood to about 32 years, then increased sharply around the age of 45 years there off remaining stable at a relatively high level. In contrast, the association between age at disease onset and relapses was almost linear: The risk for relapses was highest at younger ages and decreased continuously from childhood to around 35 years of age: A 20 years old patient with first symptoms of MS had a 1.5fold higher risk for a relapse on DMT than a 38 years old fellow adjusted for gender, relapse activity before DMT initiation, EDSS, pyramidal functional system score and the MS severity score. The hazard for relapses remained constant for a decade and then continuously decreased from age 45 on.
Conclusions: Age is an important factor affecting clinical outcomes in MS. The age of 35 seems to be critical with regard to the compensation of CNS damage caused by MS. Patients with disease onset later 40 years have a higher risk for disability progression independent of other disease characteristics. This should be considered when designing clinical trials or choosing DMT.
- Viktor von Wyl has nothing to disclose.
- Bernhard Décard has nothing to disclose
- Pascal Benkert has nothing to disclose.
- Johannes Lorscheider has received research support from Biogen and served on advisory boards for Roche and Teva.
- Peter Hänni is employee of the Swiss association for joint tasks of health insurers, Solothurn, Switzerland.
- Carmen Lienert has nothing to disclose.
- Jens Kuhle´s institution received research support from Swiss MS Society, Biogen, Novartis, Roche, Genzyme, and Merck Serono; he received research support from Bayer AG, Celgene, Genzyme, Novartis, Roche Pharma (Schweiz) AG, Swiss National Research Foundation, ECTRIMS, University of Basel, and Swiss MS Society.
- Tobias Derfuss received speaker fees, research support, travel support, and/or served on Advisory Boards or Steering Committees of Novartis Pharma, Merck, Biogen, Teva, Bayer-Schering, GeNeuro, Mitsubishi Pharma, MedDay, Roche, and Genzyme; he received research support from Biogen, Novartis, Swiss National Research Foundation, University of Basel, and Swiss MS Society.
- Ludwig Kappos' Institution (University Hospital Basel) received in the last 3 years and used exclusively for research support at the Department: steering committee, advisory board and consultancy fees from Actelion, Almirall, Bayer, Biogen, Celgene/Receptos, df-mp, Excemed, Genzyme, Japan Tobacco, Merck, Minoryx, Mitsubishi Pharma, Novartis, Roche, sanofi-aventis, Santhera, Teva, Vianex and royalties for Neurostatus-UHB products. For educational activities the institution received payments and honoraria from Allergan, Almirall, Baxalta, Bayer, Biogen, CSL-Behring, Desitin, Excemed, Genzyme, Merck, Novartis, Pfizer, Roche, Sanofi-Aventis, Teva. L. Kappos has served in the last 24 months as international or local principal investigator for the following drug studies BOLD EXT., EXPAND (Siponimod, Novartis), DECIDE, DECIDE EXT. (Daclizumab HYP, Biogen), ENDORSE (DMF, Biogen), FINGORETT, FTY-UMBRELLA, INFORMS, INFORMS EXT LONGTERMS. (Fingolimod, Novartis), MOMENTUM (Amiselimod, Mitsubishi) OCRELIZUMAB PHASE II EXT., OPERA, ORATORIO and extensions (Ocrelizumab, Roche), REFLEXION (IFN β-1a, Merck), STRATA EXT, TOP (Natalizumab, Biogen), TERIFLUNOMIDE EXT, TERRIKIDS (Teriflunomide, Sanofi-Aventis) and ASCLEPIOS I/II (Ofatumumab, Novartis). The Research of the MS Center in Basel has been supported by grants from Bayer, Biogen, Novartis, the Swiss MS Society, the Swiss National Research Foundation, the European Union. In the last 24 months the institution also received grants for patient services from Bayer, Merck and CSL-Behring. L. Kappos is a member in the Editorial Boards of the following journals: 'Journal of Neurology'

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