Umberto Aguglia (Italy)
Magna Graecia University of Catanzaro, Regional Epilepsy Unit Medical and Surgical SciencesAuthor Of 1 Presentation
PROGRESSION INDEPENDENT OF RELAPSE ACTIVITY IN EARLY MULTIPLE SCLEROSIS PATIENTS
- Emilio Portaccio (Italy)
Abstract
Background and Aims:
Disability accrual in multiple sclerosis (MS) may occur as relapse-associated worsening (RAW) or progression independent of relapse activity (PIRA). We investigated the contribution of RAW and PIRA to confirmed disability accumulation (CDA) in patients with clinically isolated syndrome (CIS) and early relapsing-remitting (RR) MS.
Methods:
Relapsing-onset MS patients assessed within one year from onset and with follow-up >/= 5 years (n=5,340) were extracted from the Italian MS Registry. CDA was defined by an increase in Expanded Disability Status Scale (EDSS) score confirmed at 6 months, and classified per temporal association with relapses. Predictors of PIRA and RAW were assessed using multivariable Cox regression models.
Results:
PIRA occurred in 1472 (27.6%) and RAW in 240 (17.6%) patients. Predictors of PIRA were older age (HR=1.02;95%CI 1.02-1.03,p<0.001), RR course (HR=1.46;95%CI 1.30-1.64,p<0.001), longer disease duration (HR=1.49;95%CI 1.22-1.82,p<0.001), lower EDSS (HR=0.89;95%CI 0.85-0.93,p<0.001), lower number of relapses before the event (HR=0.93;95%CI 0.91-0.95,p<0.001). RAW was associated with younger age (HR=0.99;95%CI 0.98-0.99,p<0.001), RR course (HR=1.56; 95%CI 1.35-1.80,p<0.001), lower EDSS (HR=0.92;95%CI 0.87-0.97,p=0.002), higher number of relapses before the event (HR=1.07;95%CI 1.05-1.09,p<0.001). Longer exposure to disease modifying drugs (DMD) reduced the risk of both PIRA and RAW (p<0.001).
Conclusions:
in this early relapsing-onset MS cohort, PIRA was an important contributor to CDA. Our findings indicate that insidious progression appears even in the earliest phases of the disease, suggesting that inflammation and neurodegeneration can represent a single disease continuum. The analysis on progression independent of relapse and radiological activity is ongoing.
Moderator of 1 Session
- Umberto Aguglia (Italy)