Contributions
Abstract: 200
Type: Oral
Abstract Category: Clinical aspects of MS - 4 Natural course
Background: Benign multiple sclerosis (BMS) is often defined by the Expanded Disability Status Scale (EDSS) score of ≤3.0 after ≥15 years from the disease onset. As former research has shown, the clinical relevance of this classification remains unclear as patients initially classified as having BMS may have high cognitive impairments and advance towards higher disability and progressive MS course.
Goals: To investigate the difference in long-term progression of physical disability and decline of cognitive function between BMS and non-BMS patients.
Methods: The Swedish MS register was used to identify BMS cases adopting the BMS classification criteria of EDSS ≤3.0 and disease duration ≥15 years. The demographic and clinical characteristics of BMS and non-BMS patients at baseline were compared with a focus on investigating the long-term trajectory of EDSS and single digit modalities test (SDMT) scores beyond the first 15 years of disease using multilevel growth models.
Results: At baseline, at 15 years of disease duration, BMS patients were more often female (75% vs. 69%, P< 0.001), had a younger onset age (28.4 vs. 33.7 years, P< 0.001) and were less likely to have been exposed to 1st- and 2nd-line disease-modifying treatments (DMTs) (53% vs. 65%, P< 0.001 and 14% and 42%, P< 0.001, respectively) during the first 15 years of MS. Starting from year 15 to the latest clinical examination and when accounting for disease duration, sex, onset age and duration of DMTs exposure (n=4,724 patients; 23,465 EDSS scores), non-BMS patients had an average of 3.76 (95%CI: 3.68-3.84) EDSS score higher than BMS patients with clinically similar rate of progression. Non-BMS patients scored on average 8.9 (95%CI: 7.5 to 10.3) points lower for SDMT than BMS patients and showed a decline of -0.7 (95%CI: -0.87 to -0.52) SDMT points per year (n=1,422 patients; 6,944 SDMT scores).
Conclusions: The difference in terms of physical disability between BMS and non-BMS patients is already shaped early in the course of disease as the rate of progression between two groups was similar after 15 years of disease duration. BMS patients showed a significantly better cognitive performance than non-BMS patients and the overall cognitive decline was at a much lower rate. Although a retrospective diagnosis and limited in clinical usefulness, BMS may provide a valuable patient group for studying factors associated with progression of disability.
Disclosure:
Loes Crielaard: nothing to disclose
Andrius Kavaliunas: nothing to disclose
Ryan Ramanujam: nothing to disclose
Tomas Olsson: has received honoraria for lectures and advisory boards from Biogen, Novartis, Genzyme, Merck and TEVA. Unrestricted research grants from Biogen, Novartis and Genzyme.
Jan Hillert: has received honoraria for serving on advisory boards for Biogen, Sanofi-Genzyme and Novartis and speaker's fees from Biogen, Novartis, Merck-Serono, Bayer-Schering, Teva and Sanofi-Genzyme. He has served as P.I. for projects, or received unrestricted research support from, BiogenIdec, Merck-Serono, TEVA, Sanofi-Genzyme and Bayer-Schering. His MS research is funded by the Swedish Research Council and the Swedish Brain foundation.
Ali Manouchehrinia: nothing to disclose
Abstract: 200
Type: Oral
Abstract Category: Clinical aspects of MS - 4 Natural course
Background: Benign multiple sclerosis (BMS) is often defined by the Expanded Disability Status Scale (EDSS) score of ≤3.0 after ≥15 years from the disease onset. As former research has shown, the clinical relevance of this classification remains unclear as patients initially classified as having BMS may have high cognitive impairments and advance towards higher disability and progressive MS course.
Goals: To investigate the difference in long-term progression of physical disability and decline of cognitive function between BMS and non-BMS patients.
Methods: The Swedish MS register was used to identify BMS cases adopting the BMS classification criteria of EDSS ≤3.0 and disease duration ≥15 years. The demographic and clinical characteristics of BMS and non-BMS patients at baseline were compared with a focus on investigating the long-term trajectory of EDSS and single digit modalities test (SDMT) scores beyond the first 15 years of disease using multilevel growth models.
Results: At baseline, at 15 years of disease duration, BMS patients were more often female (75% vs. 69%, P< 0.001), had a younger onset age (28.4 vs. 33.7 years, P< 0.001) and were less likely to have been exposed to 1st- and 2nd-line disease-modifying treatments (DMTs) (53% vs. 65%, P< 0.001 and 14% and 42%, P< 0.001, respectively) during the first 15 years of MS. Starting from year 15 to the latest clinical examination and when accounting for disease duration, sex, onset age and duration of DMTs exposure (n=4,724 patients; 23,465 EDSS scores), non-BMS patients had an average of 3.76 (95%CI: 3.68-3.84) EDSS score higher than BMS patients with clinically similar rate of progression. Non-BMS patients scored on average 8.9 (95%CI: 7.5 to 10.3) points lower for SDMT than BMS patients and showed a decline of -0.7 (95%CI: -0.87 to -0.52) SDMT points per year (n=1,422 patients; 6,944 SDMT scores).
Conclusions: The difference in terms of physical disability between BMS and non-BMS patients is already shaped early in the course of disease as the rate of progression between two groups was similar after 15 years of disease duration. BMS patients showed a significantly better cognitive performance than non-BMS patients and the overall cognitive decline was at a much lower rate. Although a retrospective diagnosis and limited in clinical usefulness, BMS may provide a valuable patient group for studying factors associated with progression of disability.
Disclosure:
Loes Crielaard: nothing to disclose
Andrius Kavaliunas: nothing to disclose
Ryan Ramanujam: nothing to disclose
Tomas Olsson: has received honoraria for lectures and advisory boards from Biogen, Novartis, Genzyme, Merck and TEVA. Unrestricted research grants from Biogen, Novartis and Genzyme.
Jan Hillert: has received honoraria for serving on advisory boards for Biogen, Sanofi-Genzyme and Novartis and speaker's fees from Biogen, Novartis, Merck-Serono, Bayer-Schering, Teva and Sanofi-Genzyme. He has served as P.I. for projects, or received unrestricted research support from, BiogenIdec, Merck-Serono, TEVA, Sanofi-Genzyme and Bayer-Schering. His MS research is funded by the Swedish Research Council and the Swedish Brain foundation.
Ali Manouchehrinia: nothing to disclose