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Published on: December 9, 2015
Changes in prognosis of the Danish multiple sclerosis population over time
Melinda Magyari1, Hanna Joensen2, Tine Iskov Kopp2
1The Danish Multiple Sclerosis Registry, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark/Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Background:
The course of multiple sclerosis (MS) appears to be milder in recent decades.
Objective:
To investigate how time from onset to disability milestones and how demographic and clinical characteristics have changed through subsequent onset cohorts of patients with MS.
Methods:
In the nationwide Danish Multiple Sclerosis Registry, we have registered all 13,562 Danish patients with onset of MS or clinically isolated syndrome from 1996 through 2020. For the analyses of prognosis, we used all cases with relapsing onset (N = 11,669). After stratification into 5-year onset cohorts, we computed the hazard ratios for disability endpoints for all cohorts having at least 10 years of follow-up and the oldest 1996-2000 onset cohort as reference.
Results:
Patients in more recent MS onset cohorts have a shorter diagnostic delay and more of them start disease-modifying treatment within 1 year since diagnosis. The prognosis was better for later onset cohorts. For the 2001-2005 cohort, the hazard ratio for confirmed Expanded Disability Status Scale (EDSS) 4 was 0.85 (95% confidence interval (CI), 0.76-0.95) and for confirmed EDSS 6: 0.76 (95% CI, 0.65-0.88). For the more recent 2006-2010 cohort, the corresponding hazard ratios were 0.70 (95% CI, 0.62-0.79) and 0.60 (95% CI, 0.50-0.71).
Conclusion:
We observed a considerable improvement of the prognosis in recent onset cohorts of relapsing-onset MS.
Insights
Multiple sclerosis (MS) prognosis has significantly improved in recent years. Later onset cohorts show faster diagnosis and better outcomes, indicating a milder disease course for new patients.
Area of Science:
- Neurology
- Epidemiology
- Clinical Research
Background:
- The clinical course of multiple sclerosis (MS) appears to be milder in recent decades.
- Investigating changes in MS progression and patient characteristics over time is crucial.
Purpose of the Study:
- To examine how time to disability milestones and demographic/clinical factors have evolved in subsequent onset cohorts of MS patients.
- To assess changes in diagnostic delay and early treatment initiation in MS.
Main Methods:
- Utilized the nationwide Danish Multiple Sclerosis Registry, including 13,562 patients with MS or clinically isolated syndrome onset from 1996-2020.
- Analyzed 11,669 relapsing-onset MS cases, stratified into 5-year onset cohorts, comparing prognosis against the 1996-2000 reference cohort.
- Calculated hazard ratios for disability endpoints (e.g., Expanded Disability Status Scale 4 and 6) with at least 10 years of follow-up.
Main Results:
- More recent MS onset cohorts exhibit shorter diagnostic delays and increased initiation of disease-modifying treatments within one year of diagnosis.
- Prognosis for disability milestones has improved in later onset cohorts.
- Hazard ratios for EDSS 4 and EDSS 6 were significantly lower in the 2001-2005 and 2006-2010 cohorts compared to the reference.
Conclusions:
- A considerable improvement in the prognosis for recent onset cohorts of relapsing-onset MS has been observed.
- These findings suggest a trend towards a milder disease course and better management outcomes in contemporary MS patients.
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