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The Multiple Sclerosis Performance Test MSPT: An iPad-Based Disability Assessment Tool
Published on: June 30, 2014
Active and non-active secondary progressive multiple sclerosis patients exhibit similar disability progression:
Clara Grazia Chisari1,2, Maria Pia Amato3, Alessia Di Sapio4
1Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Multiple Sclerosis Center, University of Catania, Catania, Italy.
Abstract:
'Active' and 'non-active' secondary progressive MS (SPMS) have distinct pathophysiological mechanisms and clinical characteristics, but there is still no consensus regarding the frequency of these MS forms in the real-world setting. We aimed to evaluate the frequency of 'active' and 'non-active' SPMS in a large cohort of Italian MS patients and the differences in terms of clinical and MRI characteristics and disease progression. This multicenter study collected data about MS patients who have transitioned to the SP form in the period between 1st January 2014 and 31st December 2019 and followed by the MS centers contributing to the Italian MS Registry. Patients were divided into 'active SPMS' and 'non-active SPMS', based on both reported MRI data and relapse activity in the year before conversion to SPMS. Out of 68,621, 8,316 (12.1%) patients were diagnosed with SPMS. Out of them, 872 (10.5%) were classified into patients with either 'active' or 'non-active' SPMS. A total of 237 were classified into patients with 'active SPMS' (27.2%) and 635 as 'non-active SPMS' (72.8%). 'Non-active SPMS' patients were older, with a longer disease duration compared to those with 'active SPMS'. The percentages of patients showing progression independent of relapse activity (PIRA) at 24 months were similar between 'active' and 'non-active' SPMS patients (67 [27.4%] vs 188 [29.6%]; p = 0.60). In the 'active' group, 36 (15.2%) patients showed relapse-associated worsening (RAW). Comparison of the survival curves to EDSS 6 and 7 according to disease activity did not show significant differences (p = 0.68 and p = 0.71). 'Active' and 'non-active' SPMS patients had a similar risk of achieving disability milestones, suggesting that progression is primarily attributed to PIRA and only to a small extent to disease activity.
Insights
Most secondary progressive multiple sclerosis (SPMS) patients are non-active, with progression largely driven by factors independent of relapses. This suggests PIRA is a key driver of disability in SPMS, not active disease.
Area of Science:
- Neurology
- Immunology
- Clinical Research
Background:
- Secondary progressive multiple sclerosis (SPMS) is characterized by distinct active and non-active forms.
- Real-world data on the frequency and characteristics of active versus non-active SPMS is limited.
- Understanding these differences is crucial for disease management and treatment strategies.
Purpose of the Study:
- To determine the frequency of active and non-active SPMS in a large Italian cohort.
- To compare clinical and MRI characteristics between active and non-active SPMS.
- To analyze disease progression patterns, including progression independent of relapse activity (PIRA) and relapse-associated worsening (RAW).
Main Methods:
- A multicenter study of Italian MS patients who transitioned to SPMS between 2014 and 2019.
- Classification of SPMS into 'active' or 'non-active' based on MRI and relapse data in the preceding year.
- Analysis of clinical data, MRI characteristics, and disability progression (EDSS scores, PIRA, RAW).
Main Results:
- Out of 8,316 SPMS patients, 10.5% (872) were classified: 27.2% active SPMS and 72.8% non-active SPMS.
- Non-active SPMS patients were older with longer disease duration.
- PIRA rates were similar in both groups (27.4% active vs. 29.6% non-active). RAW occurred in 15.2% of active SPMS patients.
- No significant differences in survival to EDSS 6 or 7 between active and non-active SPMS groups.
Conclusions:
- The majority of SPMS patients in this cohort were classified as non-active.
- Disease progression in SPMS appears primarily driven by PIRA, irrespective of active disease status.
- Disease activity contributes minimally to overall disability progression in SPMS.
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