1
|
Sharmin S, Bovis F, Malpas C, Horakova D, Havrdova EK, Izquierdo G, Eichau S, Trojano M, Prat A, Girard M, Duquette P, Onofrj M, Lugaresi A, Grand'Maison F, Grammond P, Sola P, Ferraro D, Terzi M, Gerlach O, Alroughani R, Boz C, Shaygannejad V, van Pesch V, Cartechini E, Kappos L, Lechner-Scott J, Bergamaschi R, Turkoglu R, Solaro C, Iuliano G, Granella F, Van Wijmeersch B, Spitaleri D, Slee M, McCombe P, Prevost J, Ampapa R, Ozakbas S, Sanchez-Menoyo JL, Soysal A, Vucic S, Petersen T, de Gans K, Butler E, Hodgkinson S, Sidhom Y, Gouider R, Cristiano E, Castillo-Triviño T, Saladino ML, Barnett M, Moore F, Rozsa C, Yamout B, Skibina O, van der Walt A, Buzzard K, Gray O, Hughes S, Perez Sempere A, Singhal B, Fragoso Y, Shaw C, Kermode A, Taylor B, Simo M, Shuey N, Al-Harbi T, Macdonell R, Dominguez JA, Csepany T, Sirbu CA, Sormani MP, Butzkueven H, Kalincik T. Confirmed disability progression as a marker of permanent disability in multiple sclerosis. Eur J Neurol 2022; 29:2321-2334. [PMID: 35582938 PMCID: PMC9539581 DOI: 10.1111/ene.15406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/05/2022] [Indexed: 11/30/2022]
Abstract
Background and purpose The prevention of disability over the long term is the main treatment goal in multiple sclerosis (MS); however, randomized clinical trials evaluate only short‐term treatment effects on disability. This study aimed to define criteria for 6‐month confirmed disability progression events of MS with a high probability of resulting in sustained long‐term disability worsening. Methods In total, 14,802 6‐month confirmed disability progression events were identified in 8741 patients from the global MSBase registry. For each 6‐month confirmed progression event (13,321 in the development and 1481 in the validation cohort), a sustained progression score was calculated based on the demographic and clinical characteristics at the time of progression that were predictive of long‐term disability worsening. The score was externally validated in the Cladribine Tablets Treating Multiple Sclerosis Orally (CLARITY) trial. Results The score was based on age, sex, MS phenotype, relapse activity, disability score and its change from baseline, number of affected functional system domains and worsening in six of the domains. In the internal validation cohort, a 61% lower chance of improvement was estimated with each unit increase in the score (hazard ratio 0.39, 95% confidence interval 0.29–0.52; discriminatory index 0.89). The proportions of progression events sustained at 5 years stratified by the score were 1: 72%; 2: 88%; 3: 94%; 4: 100%. The results of the CLARITY trial were confirmed for reduction of disability progression that was >88% likely to be sustained (events with score ˃1.5). Conclusions Clinicodemographic characteristics of 6‐month confirmed disability progression events identify those at high risk of sustained long‐term disability. This knowledge will allow future trials to better assess the effect of therapy on long‐term disability accrual.
Collapse
Affiliation(s)
- Sifat Sharmin
- CORe, Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Francesca Bovis
- Department of Health Sciences (DISSAL), University of Genoa, Italy
| | - Charles Malpas
- CORe, Department of Medicine, University of Melbourne, Melbourne, Australia.,Melbourne MS Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Eva Kubala Havrdova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | | | - Sara Eichau
- Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Maria Trojano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | - Alexandre Prat
- Hopital Notre Dame, Montreal, Canada; CHUM and Universite de Montreal, Montreal, Canada
| | - Marc Girard
- Hopital Notre Dame, Montreal, Canada; CHUM and Universite de Montreal, Montreal, Canada
| | - Pierre Duquette
- Hopital Notre Dame, Montreal, Canada; CHUM and Universite de Montreal, Montreal, Canada
| | - Marco Onofrj
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio, Chieti, Italy
| | - Alessandra Lugaresi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italia; Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italia
| | | | | | - Patrizia Sola
- Department of Neuroscience, Azienda Ospedaliera Universitaria, Modena, Italy
| | - Diana Ferraro
- Department of Neuroscience, Azienda Ospedaliera Universitaria, Modena, Italy
| | - Murat Terzi
- Medical Faculty, 19 Mayis University, Samsun, Turkey
| | - Oliver Gerlach
- Department of Neurology, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - Raed Alroughani
- Division of Neurology, Department of Medicine, Amiri Hospital, Sharq, Kuwait
| | - Cavit Boz
- KTU Medical Faculty Farabi Hospital, Trabzon, Turkey
| | | | - Vincent van Pesch
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | | | - Ludwig Kappos
- Neurologic Clinic and Policlinic, Departments of Medicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
| | - Jeannette Lechner-Scott
- School of Medicine and Public Health, University Newcastle, Newcastle, Australia; Department of Neurology, John Hunter Hospital, Hunter New England Health, Newcastle, Australia
| | | | - Recai Turkoglu
- Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Claudio Solaro
- Department of Rehabilitaiton, ML Novarese Hospital Moncrivello, Italy
| | | | - Franco Granella
- Department of Medicine and Surgery, University of Parma, Parma, Italy; Department of General Medicine, Parma University Hospital, Parma, Italy
| | - Bart Van Wijmeersch
- Rehabilitation and MS-Centre Overpelt and Hasselt University, Hasselt, Belgium
| | - Daniele Spitaleri
- Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati Avellino, Avellino, Italy
| | - Mark Slee
- Flinders University, Adelaide, Australia
| | - Pamela McCombe
- University of Queensland, Brisbane, Australia; Royal Brisbane and Women's Hospital, Brisbane, Australia
| | | | | | | | | | - Aysun Soysal
- Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey
| | | | | | | | | | | | - Youssef Sidhom
- Department of Neurology, Razi Hospital, Manouba, Tunisia
| | - Riadh Gouider
- Department of Neurology, Razi Hospital, Manouba, Tunisia
| | | | - Tamara Castillo-Triviño
- Instituto de Investigación Sanitaria Biodonostia, Department of Neurology, Hospital Universitario Donostia, San Sebastián, Spain
| | | | | | | | - Csilla Rozsa
- Jahn Ferenc Teaching Hospital, Budapest, Hungary
| | - Bassem Yamout
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
| | - Olga Skibina
- Central Clinical School, Monash University, Melbourne, Australia; Department of Neurology, The Alfred Hospital, Melbourne, Australia
| | - Anneke van der Walt
- Central Clinical School, Monash University, Melbourne, Australia; Department of Neurology, The Alfred Hospital, Melbourne, Australia
| | - Katherine Buzzard
- Central Clinical School, Monash University, Melbourne, Australia; Department of Neurology, The Alfred Hospital, Melbourne, Australia
| | - Orla Gray
- South East Trust, Belfast, United Kingdom
| | | | | | - Bhim Singhal
- Bombay Hospital Institute of Medical Sciences, Mumbai, India
| | - Yara Fragoso
- Universidade Metropolitana de Santos, Santos, Brazil
| | | | - Allan Kermode
- Perron Institute, University of Western Australia, Nedlands, Australia; Institute of Immunology and Infectious Diseases, Murdoch University, Sir Charles Gairdner Hospital, Perth, Australia
| | | | | | - Neil Shuey
- St Vincents Hospital, Fitzroy, Melbourne, Australia
| | - Talal Al-Harbi
- Neurology Department, King Fahad Specialist Hospital-, Dammam, Saudi Arabia
| | | | | | - Tunde Csepany
- Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Carmen Adella Sirbu
- Titu Maiorescu University, Central Military Emergency University Hospital, Bucharest, Romania
| | | | - Helmut Butzkueven
- Central Clinical School, Monash University, Melbourne, Australia; Department of Neurology, The Alfred Hospital, Melbourne, Australia
| | - Tomas Kalincik
- CORe, Department of Medicine, University of Melbourne, Melbourne, Australia.,Melbourne MS Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia
| |
Collapse
|