The outcome spectrum of multiple sclerosis: disability, mortality, and a cluster of predictors from onset
Journal article, 2015

Interest in the long-term natural history of multiple sclerosis (MS) is being revived, as disability endpoints become increasingly important with the advent of highly efficacious long range but potentially harmful drugs. MS had an increasingly benign course, probably due to better assessment and changing diagnostic criteria. Incidence cohorts reduce inclusion bias, capturing both extreme benign and severe cases. We conducted a 50-year follow-up of an incidence cohort of Gothenburg residents with MS onset in 1950-1964 (n = 254; 212 with an initial relapsing-remitting course and 42 with a monophasic course, diagnostic criteria according to Poser). Patients were followed longitudinally until censoring, death, or study termination in 2012 and evaluated using Kaplan-Meier estimates and Cox regression analysis. Median time to secondary progression was 15 years. Median time to EDSS6 and EDSS7 was 26 and 48 years (n = 254), respectively. The cumulative risk of reaching EDSS6 was 50 % at 55 years of age and 80 % at 80 years of age (n = 212). A score based on a cluster of clinical features at onset predicted secondary progression, EDSS6, EDSS7, and EDSS10 (hazard ratio 1.6-2.3 per score unit for women, 0.99-1.49 for men). This score predicted the disease course during five decades indirectly, by predicting time to secondary progression. Age at onset predicted the course in men, with 3-6 % yearly increase in the risk of reaching disability milestones. The present incidence cohort provided hard outcome data in untreated patients over several decades.

Natural history

Prognosis

Prediction

Multiple sclerosis

Age

Gender

Author

Helen Tedeholm

University of Gothenburg

Bengt Skoog

University of Gothenburg

Vera Lisovskaja

University of Gothenburg

Chalmers, Mathematical Sciences, Mathematical Statistics

Björn Runmarker

University of Gothenburg

Olle Nerman

University of Gothenburg

Chalmers, Mathematical Sciences, Mathematical Statistics

Oluf Andersen

University of Gothenburg

Journal of Neurology

0340-5354 (ISSN)

Vol. 262 5 1148-1163

Subject Categories

Neurosciences

DOI

10.1007/s00415-015-7674-y

More information

Created

10/7/2017