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Related Experiment Videos

Changes in the ascertainment of multiple sclerosis.

R A Marrie1, G Cutter, T Tyry

  • 1Department of Neurology, Cleveland Clinic Foundation, Cleveland, OH 44195, USA. marrier@ccf.org

Neurology
|October 12, 2005
PubMed
Summary

The time to diagnose multiple sclerosis (MS) is decreasing, with more patients diagnosed at an earlier, milder disease stage. This trend impacts how treatment effectiveness is compared across studies.

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Area of Science:

  • Neurology
  • Epidemiology
  • Clinical Research

Background:

  • Diagnostic criteria for multiple sclerosis (MS) have evolved, MRI availability has increased, and therapeutic options are more widely known.
  • These factors may influence temporal trends in MS incidence and prevalence, potentially leading to earlier diagnosis and a higher proportion of mildly affected individuals being identified.

Purpose of the Study:

  • To assess temporal trends in the delay from symptom onset to diagnosis (DONDX) in multiple sclerosis (MS).
  • To determine if the degree of disability at diagnosis differs based on the year of symptom onset (YONSET).

Main Methods:

  • Analysis of data from 16,581 US participants in the NARCOMS Registry with symptom onset between 1980 and age 60.
  • Comparison of DONDX across 5-year YONSET groups using multivariate Cox regression.

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  • Assessment of disability (mild, moderate, severe) at diagnosis for 5,548 participants using Patient Determined Disease Steps and polytomous logistic regression.

    • Main Results:

    • A significant decrease in DONDX was observed with later YONSET (r = -0.43, p < 0.0001), persisting after demographic adjustment.
    • Later YONSET was associated with a higher likelihood of being diagnosed with mild disability compared to severe disability (OR = 1.10 per year).

    Conclusions:

    • The delay from symptom onset to diagnosis in MS is progressively shortening.
    • An increasing proportion of MS patients are diagnosed with mild disability, even after accounting for confounding factors.
    • These findings have implications for comparing treatment effects in contemporary clinical trials with historical data, given the influence of disease duration on therapy effectiveness.