Contributions
Abstract: P827
Type: Poster
Abstract Category: Clinical aspects of MS - Paediatric MS
Objectives: To characterize clinical, demographic and long term outcomes of Paediatric Onset Multiple Sclerosis (POMS) patients, and to compare them to those with adult onset (AOMS) analyzing two hospital-based cohorts.
Methods: Cohort A included 666 patients followed prospectively since the adult age; 39 of them (6%) had the clinical onset < 18 years (POMS), and 627 (94%) ≥18 years (AOMS). Time to second attack, and long-term disability, measured as the time to reach an Expanded Disability Status Scale (EDSS) of 4.0, were analyzed by stepwise Cox regression models including clinical and demographic variables as predictors. Annualized incidence relapse rate (AIRR) was calculated by a Cox regression model for multiple events. Due to possible recall bias for relapses during the first years of the disease in POMS patients, we compared the analysis of time to second attack of cohort A with a cohort of clinically isolated syndrome (CIS) patients (cohort B, paediatric onset CIS n=46 [4%], adult onset CIS n=1109 [96%]), followed prospectively since disease onset.
Results: In both cohorts patients had similar baseline characteristics regardless age at onset, including female predominance (cohort A: 67 vs 69%; cohort B: 65 vs 67%) and presenting symptoms at onset, except for oligoclonal bands positivity (cohort A: 90 vs 82%; cohort B: 38 vs 58%, p=0.014). In cohort A, the median (interquartile range) disease duration was 19 years (13-33) and 12 years (6-19) respectively, whereas in cohort B follow-up from onset was similar (7.0 [2-12] years vs 7.4 [2-14] years). In cohort A, the overall AIRR for both groups was similar (0.45 vs 0.43 relapse/person risk/year), but the median time to second attack was longer for POMS (34 vs 17 months, p=0.01). In cohort B, the proportion of patients experiencing a second attack (41.3 vs 40.8%), and the median time to second attack was similar between groups (19 vs 18 months, p=0.855). In cohort A, the median time to reach an EDSS of 4.0 was longer in POMS than in AOMS patients (34 vs 23 years; p=0.0001), but they reached this disability at a significantly younger age than AOMS patients (median age 48 vs 61 year old; p=0.0001).
Conclusion: Our results confirm that patients with POMS take more time to reach a similar disability score, but do so 10 years younger than patients with AOMS. The study emphasizes the importance of taking into account the existence of a recall bias for relapses at the time of analyzing prognostic outcomes.
Disclosure: contributed equally (shared first authorship)
shared last (senior) authorship
This work has been supported in part by Fundació Marató-TV3 (20141830, TA, GA, CA, MS, AR, FG, AS, MT); Instituto Carlos III, Madrid, Spain (CM14/00081 TA); Dodot Procter & Gamble research grant sponsored by Asociación Española de Pediatría (AEP) (DN040579, TA)
T Armangue reports no disclosures.
G Arrambide has received compensation for consulting services from Biogen-Idec and research support from Novartis.
Y Blanco reports no disclosures
P Mulero reports no disclosures.
M Sepúlveda reports no disclosures.
C Auger reports no disclosures.
N Sola-Valls reports no disclosures
A Rovira serves on scientific advisory boards for NeuroTEC and on the editorial board of the American Journal of Neuroradiology and Neuroradiology, has received speaker honoraria from Bayer Schering Pharma, Sanofi-Aventis, Bracco, Merck Serono, Teva Pharmaceutical Industries Ltd., and Biogen-Idec, receives research support from Bayer Schering Pharma, and serves as a consultant for Novartis.
F Graus reports no disclosures.
X Montalban has received speaking honoraria and travel expenses for scientific meetings, has been a steering committee member of clinical trials or participated in advisory boards of clinical trials in the past with Amirall, Bayer, Biogen, Genzyme, Merck, Novartis, Receptos, Roche, Sanofi-Genzyme and Teva Pharmaceutical.
A Saiz has received compensation for consulting services and speaker honoraria from Bayer-Schering, Merck-Serono, Biogen-Idec, Sanofi-Aventis, Teva Pharmaceutical Industries Ltd and Novartis.
M Tintore has received compensation for consulting services and speaking honoraria from Bayer Schering Pharma, Merck-Serono, Biogen-Idec, Teva Pharmaceuticals, Sanofi-Aventis, Novartis, Almirall, Genzyme, and Roche.
Abstract: P827
Type: Poster
Abstract Category: Clinical aspects of MS - Paediatric MS
Objectives: To characterize clinical, demographic and long term outcomes of Paediatric Onset Multiple Sclerosis (POMS) patients, and to compare them to those with adult onset (AOMS) analyzing two hospital-based cohorts.
Methods: Cohort A included 666 patients followed prospectively since the adult age; 39 of them (6%) had the clinical onset < 18 years (POMS), and 627 (94%) ≥18 years (AOMS). Time to second attack, and long-term disability, measured as the time to reach an Expanded Disability Status Scale (EDSS) of 4.0, were analyzed by stepwise Cox regression models including clinical and demographic variables as predictors. Annualized incidence relapse rate (AIRR) was calculated by a Cox regression model for multiple events. Due to possible recall bias for relapses during the first years of the disease in POMS patients, we compared the analysis of time to second attack of cohort A with a cohort of clinically isolated syndrome (CIS) patients (cohort B, paediatric onset CIS n=46 [4%], adult onset CIS n=1109 [96%]), followed prospectively since disease onset.
Results: In both cohorts patients had similar baseline characteristics regardless age at onset, including female predominance (cohort A: 67 vs 69%; cohort B: 65 vs 67%) and presenting symptoms at onset, except for oligoclonal bands positivity (cohort A: 90 vs 82%; cohort B: 38 vs 58%, p=0.014). In cohort A, the median (interquartile range) disease duration was 19 years (13-33) and 12 years (6-19) respectively, whereas in cohort B follow-up from onset was similar (7.0 [2-12] years vs 7.4 [2-14] years). In cohort A, the overall AIRR for both groups was similar (0.45 vs 0.43 relapse/person risk/year), but the median time to second attack was longer for POMS (34 vs 17 months, p=0.01). In cohort B, the proportion of patients experiencing a second attack (41.3 vs 40.8%), and the median time to second attack was similar between groups (19 vs 18 months, p=0.855). In cohort A, the median time to reach an EDSS of 4.0 was longer in POMS than in AOMS patients (34 vs 23 years; p=0.0001), but they reached this disability at a significantly younger age than AOMS patients (median age 48 vs 61 year old; p=0.0001).
Conclusion: Our results confirm that patients with POMS take more time to reach a similar disability score, but do so 10 years younger than patients with AOMS. The study emphasizes the importance of taking into account the existence of a recall bias for relapses at the time of analyzing prognostic outcomes.
Disclosure: contributed equally (shared first authorship)
shared last (senior) authorship
This work has been supported in part by Fundació Marató-TV3 (20141830, TA, GA, CA, MS, AR, FG, AS, MT); Instituto Carlos III, Madrid, Spain (CM14/00081 TA); Dodot Procter & Gamble research grant sponsored by Asociación Española de Pediatría (AEP) (DN040579, TA)
T Armangue reports no disclosures.
G Arrambide has received compensation for consulting services from Biogen-Idec and research support from Novartis.
Y Blanco reports no disclosures
P Mulero reports no disclosures.
M Sepúlveda reports no disclosures.
C Auger reports no disclosures.
N Sola-Valls reports no disclosures
A Rovira serves on scientific advisory boards for NeuroTEC and on the editorial board of the American Journal of Neuroradiology and Neuroradiology, has received speaker honoraria from Bayer Schering Pharma, Sanofi-Aventis, Bracco, Merck Serono, Teva Pharmaceutical Industries Ltd., and Biogen-Idec, receives research support from Bayer Schering Pharma, and serves as a consultant for Novartis.
F Graus reports no disclosures.
X Montalban has received speaking honoraria and travel expenses for scientific meetings, has been a steering committee member of clinical trials or participated in advisory boards of clinical trials in the past with Amirall, Bayer, Biogen, Genzyme, Merck, Novartis, Receptos, Roche, Sanofi-Genzyme and Teva Pharmaceutical.
A Saiz has received compensation for consulting services and speaker honoraria from Bayer-Schering, Merck-Serono, Biogen-Idec, Sanofi-Aventis, Teva Pharmaceutical Industries Ltd and Novartis.
M Tintore has received compensation for consulting services and speaking honoraria from Bayer Schering Pharma, Merck-Serono, Biogen-Idec, Teva Pharmaceuticals, Sanofi-Aventis, Novartis, Almirall, Genzyme, and Roche.