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Published on: December 9, 2015
Younger age at multiple sclerosis onset is associated with worse outcomes at age 50
Gauruv Bose1,2, Brian C Healy1,2, Christian Barro1,2
1Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Objective:
Older age at multiple sclerosis (MS) onset has been associated with worse 10-year outcomes. However, disease duration often exceeds 10 years and age-related comorbidities may also contribute to disability. We investigated patients with>10 years disease duration to determine how age at MS onset is associated with clinical, MRI and occupational outcomes at age 50.
Methods:
We included patients enrolled in the Comprehensive Longitudinal Investigation of Multiple Sclerosis at the Brigham and Women's Hospital with disease duration>10 years. Outcomes at age 50 included the Expanded Disability Status Scale (EDSS), development of secondary-progressive multiple sclerosis (SPMS), brain T2-lesion volume (T2LV) and brain parenchymal fraction (BPF), and occupational status. We assessed how onset age was independently associated with each outcome when adjusting for the date of visit closest to age 50, sex, time to first treatment, number of treatments by age 50 and exposure to high-efficacy treatments by age 50.
Results:
We included 661 patients with median onset at 31.4 years. The outcomes at age 50 were worse the younger first symptoms developed: for every 5 years earlier, the EDSS was 0.22 points worse (95% CI: 0.04 to 0.40; p=0.015), odds of SPMS 1.33 times higher (95% CI: 1.08 to 1.64; p=0.008), T2LV 1.86 mL higher (95% CI: 1.02 to 2.70; p<0.001), BPF 0.97% worse (95% CI: 0.52 to 1.42; p<0.001) and odds of unemployment from MS 1.24 times higher (95% CI: 1.01 to 1.53; p=0.037).
Conclusions:
All outcomes at age 50 were worse in patients with younger age at onset. Decisions to provide high-efficacy treatments should consider younger age at onset, equating to a longer expected disease duration, as a poor prognostic factor.
Insights
Younger age at multiple sclerosis (MS) onset is linked to worse outcomes by age 50. Earlier onset indicates longer disease duration, suggesting a need for earlier, more aggressive treatment strategies.
Area of Science:
- Neurology
- Clinical Research
- Epidemiology
Background:
- Older age at multiple sclerosis (MS) onset is associated with poorer 10-year outcomes.
- Disease duration often exceeds 10 years, and age-related comorbidities can influence disability.
- Investigating long-term disease impact requires analysis beyond the initial decade.
Purpose of the Study:
- To determine the association between age at MS onset and clinical, MRI, and occupational outcomes at age 50.
- To analyze outcomes in patients with a disease duration exceeding 10 years.
- To identify early onset age as a prognostic factor for long-term MS progression.
Main Methods:
- Inclusion of 661 patients from the Comprehensive Longitudinal Investigation of Multiple Sclerosis with >10 years disease duration.
- Assessment of outcomes at age 50: Expanded Disability Status Scale (EDSS), secondary-progressive MS (SPMS) development, T2-lesion volume (T2LV), brain parenchymal fraction (BPF), and occupational status.
- Statistical adjustment for visit date, sex, treatment history, and high-efficacy treatment exposure.
Main Results:
- Earlier age at MS onset correlated with worse outcomes by age 50.
- For every 5-year decrease in onset age: EDSS worsened by 0.22 points, SPMS odds increased 1.33-fold, T2LV increased by 1.86 mL, BPF worsened by 0.97%, and unemployment odds increased 1.24-fold.
- All assessed outcomes demonstrated a significant association with younger age at onset.
Conclusions:
- Younger age at MS onset is a significant predictor of worse clinical, radiological, and occupational outcomes at age 50.
- Longer disease duration associated with early onset should be considered a poor prognostic factor.
- Treatment decisions, particularly for high-efficacy therapies, should incorporate age at onset as a key prognostic indicator.
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