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Published on: December 9, 2015
Multiple sclerosis from onset to secondary progression: a 30-year Italian register study
Aurora Zanghì1, Massimiliano Copetti2, Carlo Avolio1
1Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
Background:
Three decades have passed since the initial approval of disease-modifying therapies (DMTs). Ongoing discussion is focused on fundamental aspects of the disease, highlighting a growing division between successes in managing relapsing multiple sclerosis (MS) and the persistent challenges posed by disease progression.
Methods:
A cohort study on prospectively acquired data from the Italian MS register. The primary outcome was to describe the MS disease course from onset to secondary progression (SP) defined according to a data-driven algorithm over 30 years follow-up and according to five different eras of disease onset.
Results:
A total cohort of 9958 patients was analysed; 1364 converted to SP after a mean of 8.5 (SD 5.5) years. A higher rate of patients converting to SP had never been exposed to DMTs (135, 9.9% vs 424, 5.2%) than non-converting ones. The treatment coverage was also lower in patients converting to SP than non-converting ones 58.4 (SD 31.5) vs 73.6 (SD 27.6).The SP incidence rate was 1.26 (95% CI 1.19 to 1.32) overall. The rates showed a downward trend among the different eras: from 1st era 1.98 (95% CI 1.73 to 2.27) to 5th era 1.15 (95% CI 0.97 to 1.35).In the multivariable Cox model, 10% increase of treatment coverage was associated to 19% lower risk to convert to SP (10%, HR 0.89, 95% CI 0.87 to 0.90).
Conclusions:
This 30-year analysis suggests that SP conversion rates have decreased over time, partially explained by improvements in therapeutic coverage. Future research should adopt a multifaceted approach to develop more comprehensive models of disease progression.
Insights
Disease-modifying therapies (DMTs) have improved multiple sclerosis (MS) management. Over 30 years, DMT use reduced the risk of secondary progression (SP) in MS patients, indicating better disease control.
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.
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