Contributions
Abstract: P841
Type: Poster
Abstract Category: Clinical aspects of MS - Natural course
Introduction: Multiple sclerosis usually begins with a relapsing-remitting (RRMS) phase characterized by clinical relapses and inflammatory demyelination evident on magnetic resonance imaging (MRI). Disability in RRMS is thought to develop through incomplete recovery from relapses. Most patients eventually develop a secondary-progressive course characterized by a gradual increase in disability over time thought secondary to neurodegeneration. The possibility of a mild form of progression during early stages of the disease has been proposed. It is unclear if RRMS patients experience gradual worsening despite inflammatory stability.
Methods: The Knowledge Program (KP) is a patient and clinician reported outcomes database linked to the electronic medical record. Through KP query and chart review, we identified all RRMS patients seen between 1/1/2008 and 12/31/2014. We included patients who were ≤50 years old, had disease duration of ≤10 years, and developed no new or enlarging T2 lesions or gadolinium enhancing lesions from their first to last MRI. The Timed 25 Foot Walk (T25FW), 9 Hole Peg Test (9HPT), Performance Scales (PS), Patient Health Questionnaire-9 (PHQ9), and European Quality of Life 5-Dimensions (EQ5D) during the period of MRI stability were extracted. Mixed effects linear models were used to determine the trajectory of the outcomes. Age, gender, and time from first MRI were included as fixed effects and subject as a random effect.
Results: The initial cohort included 5735 patients. We identified 128 who met inclusion criteria with stable MRIs. The average time between first and last MRI was 4.2 years and the average number of MRIs was 4.1. A significant increase of 0.26 seconds per year was found for the T25FW (p =0.03). A non-significant increase of 0.20 seconds per year on the right (p=0.50) and 0.45 seconds per year on the left (p=0.23) was seen for the 9HPT. An increase of 0.07 points per year was seen for the PS but this was not significant (p=0.68). PHQ9 scores improved by 0.20 points per year, but this was also not significant (p=0.14). Finally, the EQ5D score worsened by 0.0021 points per year (p=0.682).
Conclusions: A subtle but significant increase was seen in the T25FW over time, but the other outcomes did not significantly change. Our findings support the notion that inflammatory pathology is primarily responsible for worsening during RRMS, however gradual worsening may be present from early stages of MS as well.
Disclosure: Dr. Conway has received personal compensation for consulting for Arena Pharmaceuticals.
Dr. Ontaneda has received research support paid to his institution from NIH, Genzyme, and Novartis. He has received personal compensation for consulting from Genentech, Novartis, and Biogen Idec.
Abstract: P841
Type: Poster
Abstract Category: Clinical aspects of MS - Natural course
Introduction: Multiple sclerosis usually begins with a relapsing-remitting (RRMS) phase characterized by clinical relapses and inflammatory demyelination evident on magnetic resonance imaging (MRI). Disability in RRMS is thought to develop through incomplete recovery from relapses. Most patients eventually develop a secondary-progressive course characterized by a gradual increase in disability over time thought secondary to neurodegeneration. The possibility of a mild form of progression during early stages of the disease has been proposed. It is unclear if RRMS patients experience gradual worsening despite inflammatory stability.
Methods: The Knowledge Program (KP) is a patient and clinician reported outcomes database linked to the electronic medical record. Through KP query and chart review, we identified all RRMS patients seen between 1/1/2008 and 12/31/2014. We included patients who were ≤50 years old, had disease duration of ≤10 years, and developed no new or enlarging T2 lesions or gadolinium enhancing lesions from their first to last MRI. The Timed 25 Foot Walk (T25FW), 9 Hole Peg Test (9HPT), Performance Scales (PS), Patient Health Questionnaire-9 (PHQ9), and European Quality of Life 5-Dimensions (EQ5D) during the period of MRI stability were extracted. Mixed effects linear models were used to determine the trajectory of the outcomes. Age, gender, and time from first MRI were included as fixed effects and subject as a random effect.
Results: The initial cohort included 5735 patients. We identified 128 who met inclusion criteria with stable MRIs. The average time between first and last MRI was 4.2 years and the average number of MRIs was 4.1. A significant increase of 0.26 seconds per year was found for the T25FW (p =0.03). A non-significant increase of 0.20 seconds per year on the right (p=0.50) and 0.45 seconds per year on the left (p=0.23) was seen for the 9HPT. An increase of 0.07 points per year was seen for the PS but this was not significant (p=0.68). PHQ9 scores improved by 0.20 points per year, but this was also not significant (p=0.14). Finally, the EQ5D score worsened by 0.0021 points per year (p=0.682).
Conclusions: A subtle but significant increase was seen in the T25FW over time, but the other outcomes did not significantly change. Our findings support the notion that inflammatory pathology is primarily responsible for worsening during RRMS, however gradual worsening may be present from early stages of MS as well.
Disclosure: Dr. Conway has received personal compensation for consulting for Arena Pharmaceuticals.
Dr. Ontaneda has received research support paid to his institution from NIH, Genzyme, and Novartis. He has received personal compensation for consulting from Genentech, Novartis, and Biogen Idec.