Natural History Studies

This is a retrospective study using the MS Registry in Kuwait. They took a cohort of patients and looked at certain variables to see if they were predictive of MS progression.

The study is not revolutionary in its findings – it shows that a late age of onset, male gender and relapse frequency are all poor prognostic markers and increase the risk of progression to secondary-progressive MS. Furthermore, spinal cord relapses are worse than optic neuritis. 

I suppose the main take-home message from this study is that when deciding on treatments it is worthwhile trying to think about where your risk lies on the MS spectrum – one may be more inclined to go for a stronger drug earlier on if  you know that you have a number of poor prognostic indicators and vice versa. 

Prof G posted last year on the epidemic of MS in Kuwait and stated he felt this was likely due to women spending less time outdoors – this is a similar picture to Iran.

Clinical predictors of disease progression in multiple sclerosis patients with relapsing onset in a nation-wide cohort

Alroughani RA, Akhtar S, Ahmed SF, Al-Hashel JY.
Int J Neurosci. 2014 20:1-17. [Epub ahead of print]

Background: Predicting disease progression over time is challenging despite the available literature data.

Aim: To assess whether baseline clinical variables of MS patients would predict the conversion to progressive phase of the disease. Materials & methods: Utilizing the national MS registry, patients who had relapsing onsets and had confirmed EDSS score at baseline and follow-up visits were included. Primary progressive MS and CIS patients were excluded. Clinical variables (gender, age at onset, disease duration, number of relapses, EDSS score) were collected. The end point was conversion to secondary progressive MS. Chi Square and multivariable logistic regression were used to determine the influence of clinical variables on disease progression. Results: Data of 803 MS patients with relapsing onset were analyzed. Eighty five (10.6%) patients reached the end point. The risk of disease progression was significantly higher is men (P = 0.015), in patients who developed MS ≥ 40 years of age (P = 0.041) and who had ≥ 3 relapses during their disease course (P < 0.001). Spinal cord presentation at onset was predictive of progression (aOR = 2.01; P = 0.06) while optic neuritis at onset was associated with lower risk of progression (aOR = 0.30; P = 0.03). EDSS score at first visit did not influence disease progression when tested at 2 different cutoffs (EDSS < 4 vs. ≥ 4 and EDSS < 6 vs. ≥ 6) using multivariable logistic regression analysis (P = 0.960 and P = 0.866) respectively.

Conclusion: Men and patients who presented at age 40 yeas or beyond had increased risk of MS progression. Spinal cord symptoms at onset and 3 or more relapses were predictive of progression

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Arie Gafson

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