Factors associated with time to disability progression in patients with multiple sclerosis

Authors

DOI:

https://doi.org/10.17843/rpmesp.2022.394.11433

Keywords:

multiple sclerosis, Multivariate Analysis, disability evaluations

Abstract

Objectives. To determine the sociodemographic, clinical and radiological factors associated with time to disability progression in patients with multiple sclerosis (MS). Materials and methods. Cross-sectional descriptive study with an analytical component, based on clinical records of patients at the Neurological Institute of Colombia, between 2013 and 2021. Progression to disability in MS patients was defined as the time to an increase of at least 0.5 points in the EDSS (Expanded Disability Status Scale) score, sustained
for at least six months. A Cox regression model was used to estimate the survival function and Hazard Ratios (HR) with their 95% confidence intervals (95% CI). Results. We included 216 patients, of whom 25% progressed to disability, median survival was 78 months (95% CI: 70-83), active lesions (HR = 1.94; 95% CI: 1.10-3.44), cerebellar complications (HR = 2.03; 95% CI: 0. 99-4.16), being male (HR = 2.5; 95% CI: 1.32-4.73), and having neurological diseases (HR = 2.18; 95% CI: 1.03-4.61) were associated as risk factors. While relapsing remitting MS (HR = 0.63; 95% CI: 0.31-1.26) and age at diagnosis less than 40
years (HR = 0.96; 95% CI: 0.53-1.76) were associated as protective factors. Conclusions. Progression is affected by many factors, and there is no single independent factor.

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References

Federación Internacional de Esclerosis Múltiple. Atlas de Esclerosis Multiple tercera edicion. 3ra ed. España; 2020.

Debouverie M, Pittion−Vouyovitch S, Louis S, Guillemin F, LORSEP Group. Natural history of multiple sclerosis in a population−based cohort. Eur J Neurol. 2008;15(9):916−21. doi: 10.1111/j.1468-1331.2008.02241.x.

Filippi M, Bar−Or A, Piehl F, Preziosa P, Solari A, Vukusic S, et al. Multiple sclerosis. Nat Rev Dis Primer. 2018;4(1):43. doi: 10.1038/s41572-018-0041-4.

Dendrou CA, Fugger L, Friese MA. Immunopathology of multiple sclerosis. Nat Rev Immunol. 2015;15(9):545−58. doi: 10.1038/nri3871.

Katz Sand I. Classification, diagnosis, and differential diagnosis of multiple sclerosis. Curr Opin Neurol. 2015;28(3):193−205. doi: 10.1097/WCO.0000000000000206.

Files DK, Jausurawong T, Katrajian R, Danoff R. Multiple Sclerosis. Prim Care Clin Off Pract. 2015;42(2):159−75. doi: 10.1016/j.pop.2015.01.007.

Przybek J, Gniatkowska I, Mirowska−Guzel D, Członkowska A. Evolution of diagnostic criteria for multiple sclerosis. Neurol Neurochir Pol. 2015;49(5):313−21. doi: 10.1016/j.pjnns.2015.07.006.

Izquierdo G. Ruiz-Peña JL. Evaluación clínica de la esclerosis múltiple: cuantificación mediante la utilización de escalas. Rev Neurol. 2003; 36(2):145-152. doi: 10.33588/rn.3602.2002350.

Kurtzke JF. Rating neurologic impairment in multiple sclerosis: An expanded disability status scale (EDSS). Neurology. 1983;33(11):1444−1444. doi: 10.1212/wnl.33.11.1444.

Dekker I, Leurs CE, Hagens MHJ, van Kempen ZLE, Kleerekooper I, Lissenberg−Witte BI, et al. Long−term disease activity and disability progression in relapsing−remitting multiple sclerosis patients on natalizumab. Mult Scler Relat Disord. 2019;33:82−7. doi: 10.1016/j.msard.2019.05.017.

Hernández Posada A. Las personas con discapacidad: Su calidad de vida. Aquichan. 2004;4(1).

Confavreux C, Aimard G, Devic M. Course and prognosis of multiple sclerosis assessed by the computerized data processing of 349 patients. Brain J Neurol. 1980;103(2):281−300. doi: 10.1093/brain/103.2.281.

Saccà F, Costabile T, Carotenuto A, Lanzillo R, Moccia M, Pane C, et al. The EDSS integration with the Brief International Cognitive Assessment for Multiple Sclerosis and orientation tests. Mult Scler Houndmills Basingstoke Engl. 2017;23(9):1289−96. doi: 10.1177/1352458516677592.

Brownlee WJ, Hardy TA, Fazekas F, Miller DH. Diagnosis of multiple sclerosis: progress and challenges. The Lancet. 2017;389(10076):1336−46. doi: 10.1016/S0140-6736(16)30959-X.

World Health Organization, editor. Clasificación estadística internacional de enfermedades y problemas relacionados con la salud. Décima revisión. [10a rev.]. Washington, D.C: OPS, Oficina Sanitaria Panamericana, Oficina Regional de la Organización Mundial de la Salud; 1995. 3 p.

Tremlett H, Paty D, Devonshire V. Disability progression in multiple sclerosis is slower than previously reported. Neurology. 2006;66(2):172−7. doi: 10.1212/01.wnl.0000194259.90286.fe.

Jelinek GA, De Livera AM, Marck CH, Brown CR, Neate SL, Taylor KL, et al. Associations of Lifestyle, Medication, and Socio−Demographic Factors with Disability in People with Multiple Sclerosis: An International Cross−Sectional Study. Reindl M, editor. PLOS ONE. 2016;11(8):e0161701. doi: 10.1371/journal.pone.0161701.

Ribbons KA, McElduff P, Boz C, Trojano M, Izquierdo G, Duquette P, et al. Male Sex Is Independently Associated with Faster Disability Accumulation in Relapse−Onset MS but Not in Primary Progressive MS. Aktas O, editor. PLOS ONE. 2015;10(6):e0122686. https://doi.org/10.1371/journal.pone.0122686.

Scheuner MT, Sieverding P, Shekelle PG. Delivery of Genomic Medicine for Common Chronic Adult Diseases: A Systematic Review. JAMA. 2008;299(11):1320. doi: 10.1001/jama.299.11.1320.

Saldívar−Uribe C, Portilla-Villanueva MA, Esau-Mendoza-Garcia A. Comparar la actividad de las lesiones de esclerosis múltiple (EM) al minuto y a los 20 minutos de la aplicación de gadolinio en la resonancia magnética (RM) de cerebro. Gac Med Mexico. 2017;153:88−91.

Harrison DM, Roy S, Oh J, Izbudak I, Pham D, Courtney S, et al. Association of Cortical Lesion Burden on 7−T Magnetic Resonance Imaging With Cognition and Disability in Multiple Sclerosis. JAMA Neurol. 2015;72(9):1004. doi: 10.1001/jamaneurol.2015.1241.

Eshaghi A, Prados F, Brownlee WJ, Altmann DR, Tur C, Cardoso MJ, et al. Deep gray matter volume loss drives disability worsening in multiple sclerosis: Deep Gray Matter Volume Loss. Ann Neurol. febrero de 2018;83(2):210−22. doi: 10.1002/ana.25145.

Riise T, Grønning M, Fernández O, Lauer K, Midgard R, Minderhoud JM, et al. Early prognostic factors for disability in multiple sclerosis, a European multicenter study. Acta Neurol Scand. 1992;85(3):212−8. doi: 10.1111/j.1600-0404.1992.tb04031.x.

Gilmore CP, Donaldson I, Bö L, Owens T, Lowe J, Evangelou N. Regional variations in the extent and pattern of grey matter demyelination in multiple sclerosis: a comparison between the cerebral cortex, cerebellar cortex, deep grey matter nuclei and the spinal cord. J Neurol Neurosurg Psychiatry. 2009;80(2):182−7. doi: 10.1136/jnnp.2008.148767.

Kutzelnigg A, Faber−Rod JC, Bauer J, Lucchinetti CF, Sorensen PS, Laursen H, et al. Widespread Demyelination in the Cerebellar Cortex in Multiple Sclerosis. Brain Pathol. enero de 2007;17(1):38−44. doi: 10.1111/j.1750-3639.2006.00041.x.

Le M, Malpas C, Sharmin S, Horáková D, Havrdova E, Trojano M, et al. Disability outcomes of early cerebellar and brainstem symptoms in multiple sclerosis. Mult Scler J. 2021;27(5):755−66. doi: 10.1177/1352458520926955.

Ciampi E, Uribe−San−Martin R, Soler B, Molnar K, Reyes D, Keller K, et al. Prevalence of comorbidities in Multiple Sclerosis and impact on physical disability according to disease phenotypes. Mult Scler Relat Disord. noviembre de 2020;46:102565. doi: 10.1016/j.msard.2020.102565.

Marrie RA, Cohen J, Stuve O, Trojano M, Sørensen PS, Reingold S, et al. A systematic review of the incidence and prevalence of comorbidity in multiple sclerosis: Overview. Mult Scler J. marzo de 2015;21(3):263−81. doi: 10.1177/1352458514564491.

Scalfari A, Neuhaus A, Daumer M, Ebers GC, Muraro PA. Age and disability accumulation in multiple sclerosis. Neurology. 2011;77(13):1246−52. doi: 10.1212/WNL.0b013e318230a17d.

Stewart T, Spelman T, Havrdova E, Horakova D, Trojano M, Izquierdo G, et al. Contribution of different relapse phenotypes to disability in multiple sclerosis. Mult Scler J. 2017;23(2):266−76.

Published

2022-12-26

Issue

Section

Original Article

How to Cite

1.
Arteaga-Noriega A, Castro-Álvarez JF, Benjumea-Bedoya D, Gutiérrez-Vargas J, Segura-Cardona A, González-Gómez D, et al. Factors associated with time to disability progression in patients with multiple sclerosis. Rev Peru Med Exp Salud Publica [Internet]. 2022 Dec. 26 [cited 2024 May 29];39(4):442-49. Available from: https://rpmesp.ins.gob.pe/index.php/rpmesp/article/view/11433

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