Contributions
Abstract: 197
Type: Oral
Abstract Category: Clinical aspects of MS - 4 Natural course
Background: multiple sclerosis (MS) treatment has widely evolved in the last two decades, but no definitive data are available in terms of extent and persistency of medium and long-term benefits.
Goals: To evaluate whether the introduction of therapies changed the MS prognosis, assessing the age at which patients diagnosed in different periods (pre- and post-therapies approval) reached EDSS milestones, with no comparisons of treated and untreated patients.
Methods: We retrospectively studied the dataset of MS outpatients evaluated at the MS Centre of Montichiari (Brescia, Italy), including patients with a diagnosis of MS between 1980-2015. Patients included had at least two follow-up visits, complete baseline information (age, sex, date of first symptom, date of diagnosis, baseline EDSS), MS diagnosis according to the MS diagnostic criteria evolving over time, an initial RRMS course and age at diagnosis 18-60 years. Age at which patients reached EDSS 6 was compared according to year of diagnosis (grouping patients diagnosed in 1980-1990, 1991-1995, 1996-2000, 2001-2005, 2006-2010, 2011-2015), by a Cox model adjusted for mean age at diagnosis and EDSS visits frequency.
Results: 1370 RRMS patients were included. The average age at onset was 32 years (SD= 9.4, range =12-59 years) and the average age at diagnosis was 35.7 years (SD= 9.4, 18-60 years). The age at diagnosis increased from 32 to 35 years (p< 0.001) in more recent years. Patients diagnosed in more recent periods reached EDSS=6 at higher age: taking patients diagnosed before 1990 as a reference, the probability to reach EDSS=6 was similar in patients diagnosed in the period 1991-1995 (HR=1.09), it was reduced by 17% in patients diagnosed in 1996-2000 (HR=0.83, p=0.37), by 38% in patients diagnosed in 2001-2005 (HR=0.62, p=0.05), by 40% in patients diagnosed in 2006-2010 (HR=0.60, p< 0.05), by 75%in patients diagnosed in 2011-2015 (HR=0.25, p< 0.0001). The proportion of patients diagnosed before 2000 who reached EDSS=6 at the age of 50 years was 29% and 10% after 2000 (p< 0.0001).
Conclusions: modification of MS course observed after 2000 is confirmed in the extended dataset analysis. Probability to reach EDSS 6 starts decreasing after introduction of first DMTs in Italy and further drops as the proportion of treated patients increases. A second leap coincides with the introduction of second-line treatments (natalizumab, fingolimod), as observed in our previous analysis.
Disclosure: Dr. Cordioli received consulting fees from Novartis, TEVA and Merk-Serono. Dr. De Rossi consulting fees from Biogen. Dr. Gallo received teaching fees from Novartis. Dr. Signori received teaching fees from Novartis. Dr. Capra received lecture fees from Novartis, Biogen, Teva and Sanofi. Dr. Sormani received consulting fees from Biogen Idec, Merck Serono, Teva, Genzyme, Roche, Novartis.Dr. Rasia and Dr. Mancinelli have nothing to disclose.
Abstract: 197
Type: Oral
Abstract Category: Clinical aspects of MS - 4 Natural course
Background: multiple sclerosis (MS) treatment has widely evolved in the last two decades, but no definitive data are available in terms of extent and persistency of medium and long-term benefits.
Goals: To evaluate whether the introduction of therapies changed the MS prognosis, assessing the age at which patients diagnosed in different periods (pre- and post-therapies approval) reached EDSS milestones, with no comparisons of treated and untreated patients.
Methods: We retrospectively studied the dataset of MS outpatients evaluated at the MS Centre of Montichiari (Brescia, Italy), including patients with a diagnosis of MS between 1980-2015. Patients included had at least two follow-up visits, complete baseline information (age, sex, date of first symptom, date of diagnosis, baseline EDSS), MS diagnosis according to the MS diagnostic criteria evolving over time, an initial RRMS course and age at diagnosis 18-60 years. Age at which patients reached EDSS 6 was compared according to year of diagnosis (grouping patients diagnosed in 1980-1990, 1991-1995, 1996-2000, 2001-2005, 2006-2010, 2011-2015), by a Cox model adjusted for mean age at diagnosis and EDSS visits frequency.
Results: 1370 RRMS patients were included. The average age at onset was 32 years (SD= 9.4, range =12-59 years) and the average age at diagnosis was 35.7 years (SD= 9.4, 18-60 years). The age at diagnosis increased from 32 to 35 years (p< 0.001) in more recent years. Patients diagnosed in more recent periods reached EDSS=6 at higher age: taking patients diagnosed before 1990 as a reference, the probability to reach EDSS=6 was similar in patients diagnosed in the period 1991-1995 (HR=1.09), it was reduced by 17% in patients diagnosed in 1996-2000 (HR=0.83, p=0.37), by 38% in patients diagnosed in 2001-2005 (HR=0.62, p=0.05), by 40% in patients diagnosed in 2006-2010 (HR=0.60, p< 0.05), by 75%in patients diagnosed in 2011-2015 (HR=0.25, p< 0.0001). The proportion of patients diagnosed before 2000 who reached EDSS=6 at the age of 50 years was 29% and 10% after 2000 (p< 0.0001).
Conclusions: modification of MS course observed after 2000 is confirmed in the extended dataset analysis. Probability to reach EDSS 6 starts decreasing after introduction of first DMTs in Italy and further drops as the proportion of treated patients increases. A second leap coincides with the introduction of second-line treatments (natalizumab, fingolimod), as observed in our previous analysis.
Disclosure: Dr. Cordioli received consulting fees from Novartis, TEVA and Merk-Serono. Dr. De Rossi consulting fees from Biogen. Dr. Gallo received teaching fees from Novartis. Dr. Signori received teaching fees from Novartis. Dr. Capra received lecture fees from Novartis, Biogen, Teva and Sanofi. Dr. Sormani received consulting fees from Biogen Idec, Merck Serono, Teva, Genzyme, Roche, Novartis.Dr. Rasia and Dr. Mancinelli have nothing to disclose.