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Published on: June 30, 2014
Early predictors of conversion to secondary progressive multiple sclerosis
Mahdi Barzegar1, Soroush Najdaghi1, Alireza Afshari-Safavi2
1Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of neurology, Isfahan University of Medical Sciences, Isfahan, Iran.
Background:
We conducted this study to estimated the time of conversion from relapsing-remitting MS (RRMS) to SPMS and its early predictor factors.
Methods:
In this retrospective study, demographic, clinical, and imaging data from MS patients at diagnosis were extracted. Cox proportional hazards model was used to assess the association between various baseline characteristics and conversion to SPMS. We also assessed the association brtween escalation and early intensive therapy approaches with transition to progressive phase.
Results:
Out of 1903 patients with RRMS at baseline, 293 (15.4%) patients progressed to SPMS during follow-up. The estimated number of patients converted to SPMS was 10% at 10-years, 50% at 20-years, and 93% at 30-years. On multivariate Cox regression analysis older age at onset (HR: 1.067, 95%CI: 1.048-1.085, p < 0.001), smoking (HR: 2.120, 95%CI: 1.203-3.736, p = 0.009), higher EDSS at onset (HR: 1.199, 95%CI: 1.109-1.295, p < 0.001), motor dysfunction (HR: 2.470, 95%CI: 1.605-3.800, p < 0.001), cerebellar dysfunction (HR: 3.096, 95%CI: 1.840-5.211, p < 0.001), and presence of lesions in spinal cord (HR: 0.573, 95%CI: 0.297-0.989, p = 0.042) increased the risk of conversion from RRMS to SPMS. No significant difference between escalation and EIT groups in the risk of transition to progressive phase (weighted HR = 1.438; 95% CI: 0.963, 2.147; p = 0.076) was found.
Conclusion:
Our data support previous observations that smoking is a modifiable risk factor for secondary progressive MS and confirms that spinal cord involvement, age, and more severe disease at onset are prognostic factors for converting to secondary progressive MS.
Insights
Predictors for conversion to secondary progressive multiple sclerosis (SPMS) were identified in this study. Smoking, older age at onset, and higher disability scores increase the risk of SPMS progression.
Area of Science:
- Neurology
- Immunology
- Clinical Research
Background:
- Relapsing-remitting multiple sclerosis (RRMS) can progress to secondary progressive multiple sclerosis (SPMS).
- Identifying early predictors of SPMS conversion is crucial for patient management.
- Understanding the timeline of RRMS to SPMS conversion is essential for prognosis.
Purpose of the Study:
- To estimate the time of conversion from RRMS to SPMS.
- To identify early predictor factors for this conversion.
Main Methods:
- Retrospective study analyzing demographic, clinical, and imaging data at diagnosis.
- Cox proportional hazards model used to assess baseline characteristics associated with SPMS conversion.
- Evaluation of escalation and early intensive therapy (EIT) approaches on transition to the progressive phase.
Main Results:
- 15.4% of 1903 RRMS patients progressed to SPMS.
- Estimated conversion rates: 10% at 10 years, 50% at 20 years, 93% at 30 years.
- Significant predictors for SPMS conversion included older age at onset, smoking, higher baseline EDSS, motor and cerebellar dysfunction, and spinal cord lesions.
Conclusions:
- Smoking is a modifiable risk factor for SPMS.
- Spinal cord involvement, age at onset, and disease severity at onset are prognostic factors for SPMS conversion.
- No significant difference in transition risk was found between escalation and EIT groups.
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