Abstract
Objective: To investigate patient reported outcomes predictive of conversion to SPMS in an aging sample of MS patients.
Background: The secondary progressive (SP) phase of multiple sclerosis (MS) is characterized by a progressive accumulation of neurological disability, preceded by a relapsing remitting (RR) disease course. Older age at disease onset, high frequency of relapses and male sex have frequently been found to be predictive of a higher risk of disease conversion.
Design/Methods: Subjects are part of the New York State Multiple Sclerosis Consortium (NYSMSC). Patients with an RRMS disease type at study enrollment, age 50 or over, with a disease duration of at least 15 years were selected for this study (n=155). Chi-squared tests and logistic regression modelling were used to investigate the predictive value of patient reported outcomes at study enrollment and conversion to SPMS at year 5.
Results: Five years after study enrollment (median disease duration=22 years), 47 (30.3%) RRMS subjects progressed to SPMS. Those who converted were older at study enrollment (54.8 vs 52.1, p=.01), and had a higher Kurtzke Expanded Disability Status Scale (EDSS) at both baseline (3.5 vs 2.6, p<.001), and at year 5 (5.6 vs 3.0, p<.001). Patients who progressed at year 5 were more likely to report lower limb problems at baseline (53.2% vs 21.5%, OR: 3.0, p<.001), and were more likely to report some degree of fatigue (91.5% vs 68.2%, OR: 4.2, p=.004), compared to those who did not progress, even after adjusting for age, disease duration and EDSS. Fatigue and lower limb problems were strongly correlated (p-value=0.001).
Conclusions: Fatigue and lower limb problems at baseline were predictive of a higher chance of conversion after 5 years of follow-up. Targeting patients with these symptoms may result in more successfully predicting patients at higher risk of disease conversion and subsequently tailoring therapeutic strategies.
Study Supported by: The study was supported by the National Multiple Sclerosis Society grant HC-1411-02004
Disclosure: Dr. Vaughn has nothing to disclose. Dr. Kavak has nothing to disclose. Dr. Bushra has nothing to disclose. Dr. Noyes has nothing to disclose. Dr. Edwards has received personal compensation for activities with Biogen and Sanofi Genzyme as a speaker and/or consultant. Dr. Edwards has received research support from Biogen, Genentech, Sanofi-Genzyme, and Hoffmann-La Roche. Dr. Goodman received personal compensation for activities with Abbvie, Acorda Therapeutics, Atara, Bayer HealthCare, Biogen, Novartis, Sanofi-Genzyme, and Teva. Dr. Goodman has received research support from Acorda, Avanir, Biogen, EMD-Serono, Novartis, Ono, Roche, Sanofi-Genzyme, Sun and Teva. Dr. Coyle has received personal compensation for activities with AbbVie, Accordant, Acorda, Bayer, Biogen Idec, Genentech/Roche, Genzyme/Sanofi, Mallinckrodt, Novartis, Serono, and Teva as a consultant. Dr. Krupp has received licensing and/or royalty fees from Johnson and Johnson, AbbVie, and Grifols. Dr. Jubelt received personal compensation for activities with EMD Serono, Novartis and Biogen. Dr. Gottesman has received personal compensation for activities with Biogen, Teva and Gemzyme as a consultant. Dr. Benedict has received personal compensation for activities with Actelion, Biogen Idec, Bayer, and Novartis as a consultant. Dr. Weinstock-Guttman has received personal compensation for activities with Biogen, Teva Pharmaceuticals, EMD Serono, Genzyme&Sanofi, Novartis and Genentech as a speaker and consultant. Dr. Weinstock-Guttman has received research support from Biogen, Teva Pharmaceuticals, EMD Serono, Genzyme & Sanofi, Novartis, Genentech.
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