Late-onset multiple sclerosis: disability trajectories in relapsing-remitting patients of the Italian MS Registry
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Published on: December 9, 2015
Lorena Lorefice1, Ottavia Elena Ferraro2, Giuseppe Fenu3
1Department of Medical Sciences and Public Health, Multiple Sclerosis Center, Binaghi Hospital, University of Cagliari, ASL Cagliari, via Is Guadazzonis 2, PO Binaghi, 01916, Cagliari, Italy. lorena.lorefice@aslcagliari.it.
Background:
Generally infrequent, multiple sclerosis (MS) with late onset (LOMS) is characterized by an onset over the age of 50 and a mainly progressive course, while relapsing-remitting (RR) forms are less frequently observed and explored. This study aimed to characterize a large cohort of MS patients with RRMS at onset to assess the baseline factors related to the worst disability trajectories and explore the role of LOMS.
Methods:
The data were extracted from the Italian MS Register (IMSR). Disability trajectories, defined using at least two and up to twenty expanded disability status scale (EDSS) assessments annually performed, were implemented using group-based trajectory models (GBTMs) to identify different groups with the same trajectories over time. MS profiles were explored using multinomial logistic regression.
Results:
A total of 16,159 RR patients [1012 (6.26%) presented with LOMS] were analyzed. The GBTM identified four disability trajectories. The group with the most severe EDSS trend included 12.3% of the patients with a mean EDSS score > 4, which increased over time and exceeded 6 score. The group with medium severity EDSS trend comprised 21.9% of the patients and showed a change in EDSS > 3 scores over time. The largest group with 50.8% of patients reported a constant EDSS of 2 score. Finally, the benign group comprised 14.9% of the patients with a low and constant EDSS of 1 score over time. The probability of being in the worst groups increased if the patient was male; had LOMS or experienced brainstem, spinal, or supratentorial symptoms.
Conclusions:
Four MS severity profiles among RRMS patients in the IMSR have been reported, with LOMS being associated with a rapid worsening of EDSS scores. These findings have important implications for recognizing and managing how older age, aging, and age-related factors interact with MS and its evolution.
Insights
Late-onset multiple sclerosis (MS) in older adults is linked to faster disability progression. Identifying risk factors like male sex and specific symptoms can help manage MS evolution in aging populations.
Area of Science:
- Neurology
- Clinical Research
- Epidemiology
Background:
- Multiple sclerosis (MS) typically begins earlier in life, but late-onset MS (LOMS), starting after age 50, presents unique challenges.
- LOMS often follows a progressive course, with relapsing-remitting forms being less understood.
- This study investigates factors influencing disability trajectories in a large cohort of relapsing-remitting MS (RRMS) patients, focusing on the impact of LOMS.
Purpose of the Study:
- To characterize disability trajectories in a large cohort of RRMS patients.
- To identify baseline factors associated with severe disability progression.
- To explore the specific role of late-onset MS (LOMS) in disease progression.
Main Methods:
- Utilized data from the Italian MS Register (IMSR) for 16,159 RRMS patients.
- Employed group-based trajectory models (GBTMs) to define distinct disability progression patterns based on Expanded Disability Status Scale (EDSS) scores.
- Used multinomial logistic regression to analyze MS profiles and associated factors.
Main Results:
- Four distinct disability trajectories were identified among RRMS patients.
- 12.3% of patients experienced the most severe trajectory, with EDSS scores exceeding 6.
- Factors increasing the likelihood of severe disability included male sex, LOMS, and symptoms affecting the brainstem, spinal cord, or supratentorial regions.
Conclusions:
- Identified four distinct severity profiles within the RRMS population.
- Late-onset MS (LOMS) is significantly associated with a more rapid worsening of disability (EDSS scores).
- Findings highlight the importance of considering age-related factors in MS management and understanding disease evolution.
