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Onset of progressive phase is an age-dependent clinical milestone in multiple sclerosis

Melih Tutuncu1, Junger Tang, Nuhad Abou Zeid

  • 1Mayo Clinic Center for Multiple Sclerosis and CNS Demyelinating Diseases, Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.

Multiple Sclerosis (Houndmills, Basingstoke, England)
|June 28, 2012
PubMed
Abstract

Insights

Age, not disease duration, dictates the onset of progressive multiple sclerosis (MS). Not all relapsing-remitting MS patients develop progressive MS, with progression onset being age-dependent.

Area of Science:

  • Neurology
  • Immunology
  • Clinical Research

Background:

  • The natural history of multiple sclerosis (MS) progression is not fully understood.
  • It remains unclear if all patients with relapsing-remitting MS (RRMS) inevitably transition to a progressive disease course.
  • The onset of progressive MS appears to be more closely linked to patient age than disease duration.

Purpose of the Study:

  • To investigate whether the onset of progressive multiple sclerosis (MS) is primarily age-dependent rather than duration-dependent.
  • To compare the age of progression onset across different subtypes of progressive MS, including primary progressive MS (PPMS) and secondary progressive MS (SPMS).

Main Methods:

  • Comparative analysis of a population-based MS cohort and a clinic-based progressive MS cohort.
  • Classification of progressive MS into primary progressive MS (PPMS), single attack progressive MS (SAPMS), and secondary progressive MS (SPMS).
  • Statistical analysis of demographics, age at progression onset, and time to Expanded Disability Status Scale of 6 (EDSS6) using chi-squared tests, t-tests, and Kaplan-Meier analyses.

Main Results:

  • No significant differences were observed in sex ratio, age at progression onset, or time to EDSS6 between the population-based and clinic-based cohorts.
  • Progression to a defined disability level (EDSS6) occurred predominantly after the onset of the progressive disease course.
  • A substantial proportion (38%) of RRMS patients did not develop progression by age 75, indicating that not all RRMS cases convert to progressive MS.

Conclusions:

  • The development of progressive multiple sclerosis (MS) is more strongly associated with patient age than with the duration of the preceding relapsing-remitting phase.
  • Not all individuals with relapsing-remitting MS (RRMS) will inevitably progress to a secondary progressive form of the disease.
  • Significant disability accumulation in MS primarily occurs after the onset of a progressive disease course.

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