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Abstract
Objective: To compare multiple sclerosis (MS) disability progression among North Africans (NAs) living in France (NAF) and in Tunisia (NAT) and Caucasian patients born and living in France (CF).
Methods: Patients with MS admitted to the day hospital in the Neurology Department at Pitié-Salpêtrière Hospital (France) and Razi Hospital (Tunisia) were questioned on their place of birth and the place of birth of their parents. To compare delay to outcomes, log-rank tests were used. Univariate and multivariate Cox models were used to determine factors influencing time to Expanded Disability Status Scale (EDSS) 6.
Results: We consecutively included 462 patients: 171 CF, 151 NAT, and 140 NAF. Sex ratio, disease forms, and delay from disease onset to diagnosis were similar between the groups. NAF differed from other groups, with a shorter median time to reach EDSS 3, 4, and 6, and a more frequent incomplete recovery after first relapse (p < 0.0001). Furthermore, the NA second-generation group showed the youngest median age at onset (26.5 ± 8.8 years, p = 0.001), the shortest median time to EDSS 6 in relapsing-remitting patients, and an increased mean number of relapses during the first 5 years of the disease (6.1 ± 3.7, p = 0.01) compared to CF. The Cox proportional hazard models demonstrate that (1) NA ethnicity is a significant predictor of fast progression even when adjusting for major covariates and (2) treatment did not influence the models.
Conclusion: Our study further supports severity of MS in NAs and unravels the particular severity in NAs living in France, mainly for the second generation.
GLOSSARY
- AQP4-IgG=
- aquaporin-4 immunoglobulin G antibodies;
- CF=
- Caucasian living in France;
- DMT=
- disease-modifying therapy;
- EDMUS=
- European Database for Multiple Sclerosis;
- EDSS=
- Expanded Disability Status Scale;
- MS=
- multiple sclerosis;
- MSSS=
- Multiple Sclerosis Severity Scale;
- NA=
- North African;
- NAF=
- North African patients living in France;
- NAF1=
- first generation of North African patients living in France;
- NAF2=
- second generation of North African patients living in France;
- NAT=
- North African patients living in Tunisia;
- NMOSD=
- neuromyelitis optica spectrum disorders;
- OCB=
- oligoclonal immunoglobulin G bands;
- PPMS=
- primary progressive multiple sclerosis;
- RRMS=
- relapsing-remitting multiple sclerosis
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Editorial, page 1214
- Received June 27, 2016.
- Accepted in final form December 29, 2016.
- © 2017 American Academy of Neurology
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