RT Journal Article
T1 Highly active immunomodulatory therapy ameliorates accumulation of disability in moderately advanced and advanced multiple sclerosis.
A1 Lizak, Nathaniel
A1 Lugaresi, Alessandra
A1 Alroughani, Raed
A1 Lechner-Scott, Jeannette
A1 Slee, Mark
A1 Havrdova, Eva
A1 Horakova, Dana
A1 Trojano, Maria
A1 Izquierdo, Guillermo
A1 Duquette, Pierre
A1 Girard, Marc
A1 Prat, Alexandre
A1 Grammond, Pierre
A1 Hupperts, Raymond
A1 Grand'Maison, Francois
A1 Sola, Patrizia
A1 Pucci, Eugenio
A1 Bergamaschi, Roberto
A1 Oreja-Guevara, Celia
A1 Van Pesch, Vincent
A1 Ramo, Cristina
A1 Spitaleri, Daniele
A1 Iuliano, Gerardo
A1 Boz, Cavit
A1 Granella, Franco
A1 Olascoaga, Javier
A1 Verheul, Freek
A1 Rozsa, Csilla
A1 Cristiano, Edgardo
A1 Flechter, Shlomo
A1 Hodgkinson, Suzanne
A1 Amato, Maria Pia
A1 Deri, Norma
A1 Jokubaitis, Vilija
A1 Spelman, Tim
A1 Butzkueven, Helmut
A1 Kalincik, Tomas
A1 MSBase Study Group, 
AB To evaluate variability and predictability of disability trajectories in moderately advanced and advanced multiple sclerosis (MS), and their modifiability with immunomodulatory therapy. The epochs between Expanded Disability Status Scale (EDSS) steps 3-6, 4-6 and 6-6.5 were analysed. Patients with relapse-onset MS and having reached 6-month confirmed baseline EDSS step (3/4/6) were identified in MSBase, a global observational MS cohort study. We used multivariable survival models to examine the impact of disease-modifying therapy, clinical and demographic factors on progression to the outcome EDSS step (6/6.5). Sensitivity analyses with varying outcome definitions and inclusion criteria were conducted. For the EDSS 3-6, 4-6 and 6-6.5 epochs, 1560, 1504 and 1231 patients were identified, respectively. Disability trajectories showed large coefficients of variance prebaseline (0.92-1.11) and postbaseline (2.15-2.50), with no significant correlations. The probability of reaching the outcome step was not associated with prebaseline variables, but was increased by higher relapse rates during each epoch (HRs 1.58-3.07; p Disease progression during moderately advanced and advanced MS is highly variable and amnesic to prior disease activity. Lower relapse rates and greater time on higher efficacy immunomodulatory therapy after reaching EDSS steps 3, 4 and 6 are associated with a decreased risk of accumulating further disability. Highly effective immunomodulatory therapy ameliorates accumulation of disability in moderately advanced and advanced relapse-onset MS.
YR 2016
FD 2016-09-28
LK http://hdl.handle.net/10668/10485
UL http://hdl.handle.net/10668/10485
LA en
DS RISalud
RD Apr 8, 2025