Multiple sclerosis from onset to secondary progression: a 30-year Italian register study

Area of Science:

• Neurology
• Clinical Epidemiology

Background:

• Disease-modifying therapies (DMTs) have been available for three decades.
• Significant progress has been made in managing relapsing multiple sclerosis (MS), yet challenges remain in controlling disease progression.

Purpose of the Study:

• To analyze the long-term course of MS over 30 years.
• To investigate the transition from relapsing-remitting MS to secondary progressive MS (SP) across different treatment eras.

Main Methods:

• A cohort study utilizing prospectively collected data from the Italian MS Register.
• Analysis of 9958 patients, defining secondary progression (SP) using a data-driven algorithm over a 30-year follow-up period.
• Comparison of SP conversion rates across five distinct eras of disease onset.

Main Results:

• 1364 patients (13.7%) converted to SP after a mean of 8.5 years.
• Patients who never received DMTs had a higher rate of SP conversion (9.9%) compared to those treated (5.2%).
• SP incidence rates decreased over time, from 1.98 in the first era to 1.15 in the fifth era. Increased treatment coverage was associated with a reduced risk of SP.

Conclusions:

• SP conversion rates in MS have declined over 30 years.
• Improved therapeutic coverage with DMTs is a key factor in reducing SP.
• Future research should focus on comprehensive models for understanding and managing MS progression.