Contributions
Abstract: EP1327
Type: ePoster
Abstract Category: Clinical aspects of MS - 4 Natural course
Background: Paroxysmal (PS) and unusual symptoms (US) account for approximately 1.6% of initial manifestations of multiple sclerosis (MS) and have comparable conversion rates to clinically definite MS (CDMS) as classical bout onset symptoms (CS). However, long-term prognosis and clinical outcome of patients experiencing PS or US as first clinical manifestation are unclear.
Methods: Clinical, MRI and cerebrospinal fluid data were obtained retrospectively and patients presenting with PS or US were compared to patients with CS presentation.
Results: In a cohort of 532 relapsing onset MS patients followed for a mean period of 11.4 years (SD 3.6), 10 (1.9%) patients initially presented with PS/US. PS/US patients received disease modifying treatment (DMT) in a significantly smaller proportion immediately after the first clinical symptom (30% vs. 61.7%; p=0.021) and during the observation period (60% vs. 83.5%; p=0.033). In multivariate models correcting for sex, age at initial symptoms, complete remission of initial symptoms, total number of T2 and contrast-enhancing lesions, presence of oligoclonal bands and DMT exposure, PS/US were not associated with lower annualized relapse rate or lower EDSS over time.
Conclusion: In addition to a similar conversion rate to CDMS, patients presenting with PS/US at disease onset display very similar relapse and disability rates as patients with CS onset. Consequently, initial presentation with PS/US does not indicate benign or atypical MS, but requires DMT initiation based on the same criteria as in CS patients.
Disclosure:
GB has has participated in meetings sponsored by Biogen, Merck Serono, Novartis, Genzyme and Teva Ratiopharm.
RE has participated in meetings sponsored by and received honoraria (lectures and consultations) from Biogen, Merck Serono and Teva Ratiopharm, has received grants for educational purposes from Biogen, Böhringer Ingelheim, Merck Serono, Novartis Pharma GmbH, Ottobock and Teva Ratiopharm, and has received honoraria for acting as consultant for Teva Pharmaceuticals Europe.
LMW has participated in meetings sopnsored by Bayer and Stryker.
HH has participated in meetings sponsored by, received speaker honoraria or travel funding from Bayer Schering, Biogen, Merck Serono and Novartis, and received honoraria for acting as consultant for Teva Pharmaceuticals Europe.
MA received speaker honoraria from Novartis.
SW has participated in meetings sponsored by, received honoraria or travel funding from Biogen, Merck Serono, Novartis, Sanofi Genzyme, Teva Ratiopharm, Allergan, Ipsen Pharma and Roche.
FDP has received speaking honoraria from Biogen-Idec and Sanofi-Aventis Austria.
MW reports no conflict of interest.
MR reports no conflict of interest.
FD has participated in meetings sponsored by or received honoraria for acting as an advisor/speaker for Bayer Healthcare, Biogen, Genzyme-Sanofi, Merck, Novartis Pharma, Roche and TEVA.
TB has participated in meetings sponsored by and received honoraria (lectures, advisory boards, consultations) from pharmaceutical companies marketing treatments for MS: Bayer, Biogen, Genzyme, Merck, Novartis, Octapharma, Ratiopharm, Roche, Sanofi Aventis, TEVA. His institution has received financial support in the past 12 months by unrestricted research grants (Biogen, Bayer, Merck, Novartis, Ratiopharm, Sanofi Aventis) and for participation in clinical trials in multiple sclerosis sponsored by Alexion, Bayer, Biogen, Merck, Novartis, Octapharma, Roche, Sanofi Aventis, TEVA.
Abstract: EP1327
Type: ePoster
Abstract Category: Clinical aspects of MS - 4 Natural course
Background: Paroxysmal (PS) and unusual symptoms (US) account for approximately 1.6% of initial manifestations of multiple sclerosis (MS) and have comparable conversion rates to clinically definite MS (CDMS) as classical bout onset symptoms (CS). However, long-term prognosis and clinical outcome of patients experiencing PS or US as first clinical manifestation are unclear.
Methods: Clinical, MRI and cerebrospinal fluid data were obtained retrospectively and patients presenting with PS or US were compared to patients with CS presentation.
Results: In a cohort of 532 relapsing onset MS patients followed for a mean period of 11.4 years (SD 3.6), 10 (1.9%) patients initially presented with PS/US. PS/US patients received disease modifying treatment (DMT) in a significantly smaller proportion immediately after the first clinical symptom (30% vs. 61.7%; p=0.021) and during the observation period (60% vs. 83.5%; p=0.033). In multivariate models correcting for sex, age at initial symptoms, complete remission of initial symptoms, total number of T2 and contrast-enhancing lesions, presence of oligoclonal bands and DMT exposure, PS/US were not associated with lower annualized relapse rate or lower EDSS over time.
Conclusion: In addition to a similar conversion rate to CDMS, patients presenting with PS/US at disease onset display very similar relapse and disability rates as patients with CS onset. Consequently, initial presentation with PS/US does not indicate benign or atypical MS, but requires DMT initiation based on the same criteria as in CS patients.
Disclosure:
GB has has participated in meetings sponsored by Biogen, Merck Serono, Novartis, Genzyme and Teva Ratiopharm.
RE has participated in meetings sponsored by and received honoraria (lectures and consultations) from Biogen, Merck Serono and Teva Ratiopharm, has received grants for educational purposes from Biogen, Böhringer Ingelheim, Merck Serono, Novartis Pharma GmbH, Ottobock and Teva Ratiopharm, and has received honoraria for acting as consultant for Teva Pharmaceuticals Europe.
LMW has participated in meetings sopnsored by Bayer and Stryker.
HH has participated in meetings sponsored by, received speaker honoraria or travel funding from Bayer Schering, Biogen, Merck Serono and Novartis, and received honoraria for acting as consultant for Teva Pharmaceuticals Europe.
MA received speaker honoraria from Novartis.
SW has participated in meetings sponsored by, received honoraria or travel funding from Biogen, Merck Serono, Novartis, Sanofi Genzyme, Teva Ratiopharm, Allergan, Ipsen Pharma and Roche.
FDP has received speaking honoraria from Biogen-Idec and Sanofi-Aventis Austria.
MW reports no conflict of interest.
MR reports no conflict of interest.
FD has participated in meetings sponsored by or received honoraria for acting as an advisor/speaker for Bayer Healthcare, Biogen, Genzyme-Sanofi, Merck, Novartis Pharma, Roche and TEVA.
TB has participated in meetings sponsored by and received honoraria (lectures, advisory boards, consultations) from pharmaceutical companies marketing treatments for MS: Bayer, Biogen, Genzyme, Merck, Novartis, Octapharma, Ratiopharm, Roche, Sanofi Aventis, TEVA. His institution has received financial support in the past 12 months by unrestricted research grants (Biogen, Bayer, Merck, Novartis, Ratiopharm, Sanofi Aventis) and for participation in clinical trials in multiple sclerosis sponsored by Alexion, Bayer, Biogen, Merck, Novartis, Octapharma, Roche, Sanofi Aventis, TEVA.