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Relapsing and progressive MS: the sex-specific perspective.

Paulus Stefan Rommer1, David Ellenberger2, Kerstin Hellwig3

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Summary

Multiple sclerosis predominantly affects females, with higher rates of cognitive impairment, depression, and pain. While disease progression is similar, women with relapsing-onset MS retire earlier.

Keywords:
age of onsetmultiple sclerosisprogressive MSrelapsing MSsex ratio

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Area of Science:

  • Neurology
  • Immunology
  • Epidemiology

Background:

  • Multiple sclerosis (MS) is an inflammatory and neurodegenerative disease with an unknown etiology.
  • The disease predominantly affects females, with a 2:1 to 3:1 female-to-male ratio, though this ratio approaches 1:1 in primary progressive MS.
  • The higher age of onset in progressive MS suggests age may influence the observed sex ratio.

Purpose of the Study:

  • To investigate the influence of disease course and age at onset on the sex ratio in multiple sclerosis.
  • To compare clinical and demographic data between females and males across different MS disease courses.

Main Methods:

  • Analysis of clinical and demographic data from 18,728 patients in the German MS Register.
  • Inclusion criteria required complete mandatory data and a follow-up visit after January 1, 2018.
  • Comparison of sex ratios, age at diagnosis, and prevalence of symptoms (cognitive impairment, depression, pain, fatigue) between relapsing-onset MS (ROMS) and primary progressive MS (POMS) patients.

Main Results:

  • The overall female-to-male ratio was 2.6:1 (2.7:1 for ROMS, 1.3:1 for POMS).
  • Patients with POMS had a higher age at diagnosis (females: 43.3 years, males: 42.3 years) compared to ROMS (females: 32.1 years, males: 33.2 years).
  • Females consistently reported higher rates of cognitive impairment, depression, and pain. Fatigue was more prevalent in females with ROMS. Females with ROMS retired earlier and to a greater extent than males. Disease progression was similar between sexes.

Conclusions:

  • Clinical and demographic differences are more pronounced between MS disease courses than between sexes.
  • Female sex is a significant factor for increased prevalence of pain, depression, and cognitive impairment.
  • Further research is needed to determine if these factors contribute to earlier retirement in females with ROMS, highlighting the need for optimized symptomatic treatment and employment support.