Contributions
Abstract: P853
Type: Poster
Abstract Category: Clinical aspects of MS - Epidemiology
Background: Accurately describing the clinical phenotype in multiple sclerosis (MS) is important for communication between clinicians, choice of therapy and study design. In 2014, Lublin et al. published a revision of the existing definition, adding two modifiers: disease activity and disease progression.
Goals: Apply the revised clinical course definition in a number of patients from the Swedish multiple sclerosis register (SMSreg) and describe their new phenotypes.
Methods: SMSreg was used and patients who have been treated with natalizumab were chosen, because of their frequent evaluations. Data used were the clinical visits (recent relapses and EDSS) and radiological evaluations (brain MRI with intravenous gadolinium contrast medium). Data span was from the beginning of therapy until the most recent evaluation. Every clinical evaluation was paired with the chronologically nearest radiological evaluation counting as one follow up. A definition of the phenotype according to the revised clinical course definition was made in each follow up.
Results: 150 patients were chosen from the SMSreg and were followed from the treatment initiation. 109 (72.7%) were female. The mean age at onset of disease was 32.8 years, at the time of diagnosis 37,2 years, and at the time of the first follow up (fo0) in the beginning of the treatment 46.1 years. 119 patients (79.3%) had relapsing remitting MS (RRMS), 24 (16%) had secondary progressive MS (SPMS), 6 (4%) had progressive relapsing MS (PRMS) and 1 (0.7%) had primary progressive MS (PPMS). When the revised definitions were applied at fo0, 98 (65.4%) were RRMS with activity (RRMS-A), 18 (12%) were RRMS without activity (RRMS-NA), 4 (2.7%) were RRMS with indeterminate activity (RRMS-IA), 4 (2.7%) were SPMS without activity but also 19 (12.7%) were SPMS with activity (SPMS-A-IP). At the next follow up (fo1), 48 (49%) of the RRMS-A were defined as RRMS-NA, 37 (37,9%) remained as RRMS-A and the rest converted to SPMS. 90 RRMS-A patients had one more follow up, where there were more patients, 60 (66,6%) who showed no activity comparing to fo0.
Conclusions: Applying the revised criteria for the clinical course definition of MS gives a more dynamic description of the patient"s phenotype over time. Describing the presence or absence of activity enables a more accurate definition, which can be changed in every clinical and radiological evaluation. This may contribute to changing the medical decision, e.g. the current treatment.
Disclosure: Eleni Mentesidou: nothing to disclose
Dr. Ali Manouchehrinia: nothing to disclose.
Dr. Katharia Fink: Received an unrestricted research grant from Biogen
Prof. Jan Hillert: Received honoraria for serving on advisory boards for Biogen and Novartis and speaker´s fees from BiogenIdec, Merck-Serono, Bayer-Schering, Teva and Sanofi-Genzyme. He has served as P.I. for projects, or received unrestricted research support from, Biogen, Sanofi-Genzyme, Merck-Serono and Novartis.
Authors report no conflict of interest
Abstract: P853
Type: Poster
Abstract Category: Clinical aspects of MS - Epidemiology
Background: Accurately describing the clinical phenotype in multiple sclerosis (MS) is important for communication between clinicians, choice of therapy and study design. In 2014, Lublin et al. published a revision of the existing definition, adding two modifiers: disease activity and disease progression.
Goals: Apply the revised clinical course definition in a number of patients from the Swedish multiple sclerosis register (SMSreg) and describe their new phenotypes.
Methods: SMSreg was used and patients who have been treated with natalizumab were chosen, because of their frequent evaluations. Data used were the clinical visits (recent relapses and EDSS) and radiological evaluations (brain MRI with intravenous gadolinium contrast medium). Data span was from the beginning of therapy until the most recent evaluation. Every clinical evaluation was paired with the chronologically nearest radiological evaluation counting as one follow up. A definition of the phenotype according to the revised clinical course definition was made in each follow up.
Results: 150 patients were chosen from the SMSreg and were followed from the treatment initiation. 109 (72.7%) were female. The mean age at onset of disease was 32.8 years, at the time of diagnosis 37,2 years, and at the time of the first follow up (fo0) in the beginning of the treatment 46.1 years. 119 patients (79.3%) had relapsing remitting MS (RRMS), 24 (16%) had secondary progressive MS (SPMS), 6 (4%) had progressive relapsing MS (PRMS) and 1 (0.7%) had primary progressive MS (PPMS). When the revised definitions were applied at fo0, 98 (65.4%) were RRMS with activity (RRMS-A), 18 (12%) were RRMS without activity (RRMS-NA), 4 (2.7%) were RRMS with indeterminate activity (RRMS-IA), 4 (2.7%) were SPMS without activity but also 19 (12.7%) were SPMS with activity (SPMS-A-IP). At the next follow up (fo1), 48 (49%) of the RRMS-A were defined as RRMS-NA, 37 (37,9%) remained as RRMS-A and the rest converted to SPMS. 90 RRMS-A patients had one more follow up, where there were more patients, 60 (66,6%) who showed no activity comparing to fo0.
Conclusions: Applying the revised criteria for the clinical course definition of MS gives a more dynamic description of the patient"s phenotype over time. Describing the presence or absence of activity enables a more accurate definition, which can be changed in every clinical and radiological evaluation. This may contribute to changing the medical decision, e.g. the current treatment.
Disclosure: Eleni Mentesidou: nothing to disclose
Dr. Ali Manouchehrinia: nothing to disclose.
Dr. Katharia Fink: Received an unrestricted research grant from Biogen
Prof. Jan Hillert: Received honoraria for serving on advisory boards for Biogen and Novartis and speaker´s fees from BiogenIdec, Merck-Serono, Bayer-Schering, Teva and Sanofi-Genzyme. He has served as P.I. for projects, or received unrestricted research support from, Biogen, Sanofi-Genzyme, Merck-Serono and Novartis.
Authors report no conflict of interest