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Comprehensive Autopsy Program for Individuals with Multiple Sclerosis
Published on: July 19, 2019
The Phenotypes of Multiple Sclerosis Differ Significantly in Relative and Excess Mortality
Melinda Magyari1,2,3, Frederik Elberling1, Nils Koch-Henriksen1,4
1The Danish Multiple Sclerosis Registry, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.
Background:
Patients With Multiple Sclerosis (MS) Have Higher Mortality Than Matched Background Populations. We Compare Relative and Excess Mortality in MS Over the Matched Background Populations Between Primary Progressive MS (PPMS), relapsing Onset MS (ROMS), and Secondary Progressive MS (SPMS).
Methods:
We included all patients from the nationwide and complete Danish MS Registry with onset 1994-2022 and compared the extra mortality of the MS phenotypes in terms of relative and excess mortality, with adjustment for sex, age at onset, disease-modifying treatment, and number of recorded relapses. We calculated the adjusted ratios of relative and excess mortalities between PPMS and ROMS and between PPMS and SPMS.
Results:
The initial course was unknown in 221, leaving 1412 cases with PPMS (which includes progressive relapsing MS) and 12,449 cases with ROMS. 627 had died during follow-up by the end of 2022. After adjustment, both ratios between PPMS and ROMS came close to unity, indicating that the excess mortality is equal for PPMS and ROMS in the long run. The adjusted relative and additive mortalities were factors 6.05 (95% CI 4.42-8.27) and 1.90 (95% CI 1.65-2.18) higher in SPMS than in PPMS.
Conclusions:
Compared with the matched population, the adjusted relative and excess mortalities are the same for PPMS and ROMS. However, SPMS had a higher relative and excess mortality than PPMS, probably in part owing to the burden of disease carried over from the pre-progressive phase. This underlines the need for effective treatment in this later stage of the disease and more attention to comorbidity.
Insights
Mortality rates for Primary Progressive Multiple Sclerosis (PPMS) and relapsing Onset MS (ROMS) are similar. Secondary Progressive MS (SPMS) shows significantly higher mortality than PPMS, emphasizing treatment needs.
Area of Science:
- Neurology
- Epidemiology
- Public Health
Background:
- Multiple Sclerosis (MS) is associated with increased mortality compared to the general population.
- Understanding mortality differences across MS subtypes is crucial for patient care and resource allocation.
Purpose of the Study:
- To compare relative and excess mortality between Primary Progressive MS (PPMS), relapsing Onset MS (ROMS), and Secondary Progressive MS (SPMS).
- To analyze mortality risks across different MS disease courses.
Main Methods:
- Utilized the Danish MS Registry (1994-2022) including 14,120 MS patients.
- Compared excess and relative mortality adjusting for sex, age, treatment, and relapses.
- Calculated adjusted mortality ratios between MS phenotypes.
Main Results:
- PPMS and ROMS exhibited similar long-term excess mortality.
- Secondary Progressive MS (SPMS) demonstrated significantly higher relative (6.05x) and excess (1.90x) mortality compared to PPMS.
- Data included 1412 PPMS, 12,449 ROMS cases, with 627 deaths.
Conclusions:
- PPMS and ROMS have comparable mortality risks.
- SPMS carries a substantially higher mortality burden, likely due to accumulated disease effects.
- Highlights the need for advanced treatment strategies and comorbidity management in later MS stages.
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