Clinical and Instrumental Findings and Disability Progression in Primary Progressive and Progressive Relapsing Multiple Sclerosis: A Comparison Study of a Sicilian Group of Patients (P04.139)

Abstract

OBJECTIVE: 1) To compare clinical and instrumental findings in Primary-Progressive Multiple Sclerosis (PPMS) and Progressive-Relapsing Multiple Sclerosis (PRMS). 2) To investigate progression rate differences in PPMS/PRMS.

BACKGROUND: Relapsing-Remitting MS and PPMS have different prognosis. Immunomodulators and Immunosuppressors Disease Modifiymg Drugs (IMDMD/ISDMD) act on relapses but not on progression. Scanty studies indicate a similar progression rate in PPMS/PRMS.

DESIGN/METHODS: PPMS and PRMS patients were identified in an MS database established in 1990. End of follow-up was September 30, 2012. Continuous variables were compared by “Student t test”, categorical variables with “chi square test”, survival analyses by Kaplan-Meier estimates, and Cox regression models.

RESULTS: In a database including 1300 MS patients, we identified 134 affected by PPMS/PRMS. Thirty-four were excluded. Of the remaining 100 patients, 60 were females. Median age at onset was 38 years (range 7-62); median follow-up time 15 years (range 3-38). MS onset was monosymptomatic in 75% of patients; in 74% the pyramidal system was involved at onset. Six subjects died before we planned the study. Comparisons between the 55 PPMS and the 45 PRMS patients showed significant differences for median age at onset (40 yrs PPMS; 35 yrs PRMS; p = 0.02) and presence of infratentorial lesions at brain MRI (80% PPMS; 51% PRMS; p = 0.008). Time to reach EDSS 6.0 (median 8 years) or EDSS 7,0 (median 18 years) were similar for PPMS and PRMS also when we stratified by sex, type of onset, location of brain lesions at MRI, therapy for at least six months with IMDMD/ISDMD. Younger age at onset was associated with a longer time to reach EDSS 6.0 in PRMS group (14 vs. 8 yrs; p = 0.03).

CONCLUSIONS: MS progression was similar in PPMS/PRMS and was unmodified by treatments. Younger age at onset was associated with slower progression in PRMS.

Disclosure: Dr. Salemi has received research support from Teva Pharmaceutical for a research project on oxidative stress factors and multiple sclerosis. Dr. Ragonese has received personal compensation for activities with Cesare Serono Foundation as a consultant. Dr. Realmuto has nothing to disclose. Dr. Cammilleri has nothing to disclose. Dr. Lo Re has nothing to disclose. Dr. Mazzola has nothing to disclose. Dr. Lo Re has nothing to disclose. Dr. Savettieri has received personal compensation for activities with Cesare Serono Foundation for the epidemiological project: MS mortality.