Contributions
Abstract: P352
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - Natural course
Introduction: Cerebellar symptoms are a common feature in multiple sclerosis (MS). A proportion of patients present with these symptoms at or early after their first clinical presentation. Whether early cerebellar symptoms have any prognostic value in MS is unclear.
Objectives/Aims: The aim of this study was to investigate long-term disability outcomes in patients presenting with early cerebellar symptoms.
Design/Setting: This retrospective cohort study used prospectively collected data from the MSBase registry, a large international observational cohort of MS patients. The studied outcomes were cumulative hazard of relapses and disability worsening events, confirmed over 6 months with Expanded Disability Status Scale (EDSS) scores.
Methods: Inclusion criteria consisted of: diagnosis of relapsing MS with ≥1 relapse recorded, first EDSS assessment within 2 years of patients' first MS symptom, ≥3 recorded EDSS scores and EDSS frequency ≥1/year. Patients with a relapse with cerebellar symptoms or an EDSS score with cerebellar functional score ≥2 were identified as having early cerebellar presentation. Cox proportional hazards models were used to describe and compare the probability of remaining free from (i) relapse and (ii) disability worsening between patients who presented with early cerebellar symptoms and those who did not. Andersen-Gill models were used to estimate the cumulative hazard of (i) relapse incidences and (ii) disability worsening events. The models were adjusted for demographic and clinical factors.
Results: The study cohort consisted of 10,929 eligible MS patients, including 2,723 patients with early cerebellar symptoms. Shorter median times to first relapse (0.6 vs 1.1 years respectively, hazard ratio HR=1.09, P< 0.001) and to first confirmed disability worsening event (14.1 vs 17.5 years respectively, HR=1.44, P< 10-13) were observed for patients with early cerebellar symptoms. Patients with early cerebellar symptoms also had a greater cumulative hazard of relapses (HR=1.15, P< 10-7) and of disability worsening events (HR=1.37, P< 10-11).
Conclusions: The presence of early cerebellar symptoms in MS is associated with poorer prognosis. Therefore, early cerebellar symptoms could potentially be used as an early indicator of the need for more aggressive therapeutic approach.
Disclosure: Minh Vy Hoang Le: nothing to disclose.
Charles Malpas: nothing to disclose.
Sifat Sharmin: nothing to disclose.
Dana Horakova received speaker honoraria and consulting fees from Biogen, Merck , Teva and Novartis, as well as support for research activities from Biogen and research grants from Charles University in Prague [PRVOUK-P26/LF1/4], Czech Minsitry of Education [PROGRES Q27/LF1] and Czech Ministry of Health [NT13237-4/2012].
Eva Kubala Havrdova received speaker honoraria and consultant fees from Actelion, Biogen, Celgene, Merck, Novartis, Roche, Sanofi and Teva, and support for research activities from Czech Ministry of Education [project Progres Q27/LF1].
Maria Trojano received speaker honoraria from Biogen-Idec, Bayer-Schering, Sanofi Aventis, Merck, Teva , Novartis and Almirall; has received research grants for her Institution from Biogen-Idec, Merck, and Novartis.
Guillermo Izquierdo received speaking honoraria from Biogen, Novartis, Sanofi, Merck, Roche, Almirall and Teva.
Sara Eichau did not declare any competing interests.
Serkan Ozakbas did not declare any competing interests.
Alessandra Lugaresi is a Bayer, Biogen, Genzyme, Merck Advisory Board Member. She received travel grants and honoraria from Roche, Bayer, Biogen, Merck, Novartis, Sanofi, Teva and Fondazione Italiana Sclerosi Multipla (FISM). Her institution received research grants from Bayer, Biogen, Merck, Novartis, Sanofi , Teva and Fondazione Italiana Sclerosi Multipla (FISM).
Alexandre Prat did not declare any competing interests.
Marc Girard received consulting fees from Teva Canada Innovation, Biogen, Novartis and Genzyme Sanofi; lecture payments from Teva Canada Innovation, Novartis and EMD . He has also received a research grant from Canadian Institutes of Health Research.
Pierre Duquette served on editorial boards and has been supported to attend meetings by EMD, Biogen, Novartis, Genzyme, and TEVA Neuroscience. He holds grants from the CIHR and the MS Society of Canada and has received funding for investigator-initiated trials from Biogen, Novartis, and Genzyme.
Raed Alroughani received honoraria as a speaker and for serving on scientific advisory boards from Bayer, Biogen, GSK, Merck, Novartis, Roche and Sanofi-Genzyme.
Roberto Bergamaschi received speaker honoraria from Bayer Schering, Biogen, Genzyme, Merck , Novartis, Sanofi-Aventis, Teva; research grants from Bayer Schering, Biogen, Merck , Novartis, Sanofi-Aventis, Teva; congress and travel/accommodation expense compensations by Almirall, Bayer Schering, Biogen, Genzyme, Merck , Novartis, Sanofi-Aventis, Teva.
Patrizia Sola served on scientific advisory boards for Biogen Idec and TEVA, she has received funding for travel and speaker honoraria from Biogen Idec, Merck , Teva, Sanofi Genzyme, Novartis and Bayer and research grants for her Institution from Bayer, Biogen, Merck , Novartis, Sanofi, Teva.
Diana Ferraro received travel grants and/or speaker honoraria from Merck, TEVA, Novartis, Biogen and Sanofi-Genzyme.
Pierre Grammond is a Merck, Novartis, Teva-neuroscience, Biogen and Genzyme advisory board member, consultant for Merck , received payments for lectures by Merck , Teva-Neuroscience and Canadian Multiple sclerosis society, and received grants for travel from Teva-Neuroscience and Novartis.
Francois Grand´Maison received honoraria or research funding from Biogen, Genzyme, Novartis, Teva Neurosciences, Mitsubishi and ONO Pharmaceuticals.
Murat Terzi received travel grants from Novartis, Bayer-Schering, Merck and Teva; has participated in clinical trials by Sanofi Aventis, Roche and Novartis.
Cavit Boz received conference travel support from Biogen, Novartis, Bayer-Schering, Merck and Teva; has participated in clinical trials by Sanofi Aventis, Roche and Novartis.
Raymond Hupperts received honoraria as consultant on scientific advisory boards from Merck, Biogen, Genzyme-Sanofi and Teva, research funding from Merck and Biogen, and speaker honoraria from Sanofi-Genzyme and Novartis.
Helmut Butzkueven served on scientific advisory boards for Biogen, Novartis and Sanofi-Aventis and has received conference travel support from Novartis, Biogen and Sanofi Aventis. He serves on steering committees for trials conducted by Biogen and Novartis, and has received research support from Merck , Novartis and Biogen.
Anneke van der Walt served on scientific advisory boards for Biogen, Novartis and Sanofi-Aventis and has received conference travel support from Novartis, Biogen and Sanofi Aventis. She serves on steering committees for trials conducted by Biogen and Novartis, and has received research support from Merck , Novartis and Biogen.
Eugenio Pucci served on scientific advisory boards for Merck, Genzyme and Biogen; he has received honoraria and travel grants from Sanofi Aventis, Novartis, Biogen, Merck, Genzyme and Teva; he has received travel grants and equipment from "Associazione Marchigiana Sclerosi Multipla e altre malattie neurologiche".
Franco Granella received research grant from Biogen, served on scientific advisory boards for Biogen, Novartis, Merck, and Sanofi-Aventis and received funding for travel and speaker honoraria from Biogen, Merck, Sanofi-Aventis, and Almirall.
Vincent Van Pesch received travel grants from Biogen, Bayer Schering, Genzyme, Merck, Teva and Novartis Pharma. His institution receives honoraria for consultancy and lectures from Biogen, Bayer Schering, Genzyme, Merck, Roche, Teva and Novartis Pharma as well as research grants from Novartis Pharma and Bayer Schering.
Aysun Soysal did not declare any competing interests.
Bassem Yamout did not declare any competing interests.
Jeannette Lechner-Scott accepted travel compensation from Novartis, Biogen and Merck. Her institution receives the honoraria for talks and advisory board commitment from Bayer Health Care, Biogen, Genzyme Sanofi, Merck, Novartis and Teva, has been involved in clinical trials with Biogen, Novartis and Teva.
Daniele Spitaleri received honoraria as a consultant on scientific advisory boards by Bayer-Schering, Novartis and Sanofi-Aventis and compensation for travel from Novartis, Biogen, Sanofi Aventis, Teva and Merck.
Radek Ampapa received conference travel support from Novartis, Teva, Biogen, Bayer and Merck and has participated in a clinical trials by Biogen, Novartis, Teva and Actelion.
Recai Turkoglu did not declare any competing interests.
Gerardo Iuliano had travel/accommodations/meeting expenses funded by Bayer Schering, Biogen, Merck , Novartis, Sanofi Aventis, and Teva.
Cristina Ramo-Tello received research funding, compensation for travel or speaker honoraria from Biogen, Novartis, Genzyme and Almirall.
Jose Luis Sanchez-Menoyo accepted travel compensation from Novartis and Biogen, speaking honoraria from Biogen, Novartis, Sanofi, Merck , Almirall, Bayer and Teva and has participated in a clinical trial by Biogen.
Youssef Sidhom did not declare any competing interests.
Riadh Gouider did not declare any competing interests.
Vahid Shaygannejad did not declare any competing interests.
Julie Prevost accepted travel compensation from Novartis, Biogen, Genzyme, Teva, and speaking honoraria from Biogen, Novartis, Genzyme and Teva.
Ayse Altintas received personal fees and speaker honoraria from Teva, Merck, Biogen - Gen Pharma, Roche, Novartis, Bayer, Sanofi-Genzyme; received travel and registration grants from Merck, Biogen - Gen Pharma, Roche, Sanofi-Genzyme and Bayer.
Yara Fragoso received honoraria as a consultant on scientific advisory boards by Novartis, Teva, Roche and Sanofi-Aventis and compensation for travel from Novartis, Biogen, Sanofi Aventis, Teva, Roche and Merck.
Pamela McCombe did not declare any competing interests.
Abstract: P352
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - Natural course
Introduction: Cerebellar symptoms are a common feature in multiple sclerosis (MS). A proportion of patients present with these symptoms at or early after their first clinical presentation. Whether early cerebellar symptoms have any prognostic value in MS is unclear.
Objectives/Aims: The aim of this study was to investigate long-term disability outcomes in patients presenting with early cerebellar symptoms.
Design/Setting: This retrospective cohort study used prospectively collected data from the MSBase registry, a large international observational cohort of MS patients. The studied outcomes were cumulative hazard of relapses and disability worsening events, confirmed over 6 months with Expanded Disability Status Scale (EDSS) scores.
Methods: Inclusion criteria consisted of: diagnosis of relapsing MS with ≥1 relapse recorded, first EDSS assessment within 2 years of patients' first MS symptom, ≥3 recorded EDSS scores and EDSS frequency ≥1/year. Patients with a relapse with cerebellar symptoms or an EDSS score with cerebellar functional score ≥2 were identified as having early cerebellar presentation. Cox proportional hazards models were used to describe and compare the probability of remaining free from (i) relapse and (ii) disability worsening between patients who presented with early cerebellar symptoms and those who did not. Andersen-Gill models were used to estimate the cumulative hazard of (i) relapse incidences and (ii) disability worsening events. The models were adjusted for demographic and clinical factors.
Results: The study cohort consisted of 10,929 eligible MS patients, including 2,723 patients with early cerebellar symptoms. Shorter median times to first relapse (0.6 vs 1.1 years respectively, hazard ratio HR=1.09, P< 0.001) and to first confirmed disability worsening event (14.1 vs 17.5 years respectively, HR=1.44, P< 10-13) were observed for patients with early cerebellar symptoms. Patients with early cerebellar symptoms also had a greater cumulative hazard of relapses (HR=1.15, P< 10-7) and of disability worsening events (HR=1.37, P< 10-11).
Conclusions: The presence of early cerebellar symptoms in MS is associated with poorer prognosis. Therefore, early cerebellar symptoms could potentially be used as an early indicator of the need for more aggressive therapeutic approach.
Disclosure: Minh Vy Hoang Le: nothing to disclose.
Charles Malpas: nothing to disclose.
Sifat Sharmin: nothing to disclose.
Dana Horakova received speaker honoraria and consulting fees from Biogen, Merck , Teva and Novartis, as well as support for research activities from Biogen and research grants from Charles University in Prague [PRVOUK-P26/LF1/4], Czech Minsitry of Education [PROGRES Q27/LF1] and Czech Ministry of Health [NT13237-4/2012].
Eva Kubala Havrdova received speaker honoraria and consultant fees from Actelion, Biogen, Celgene, Merck, Novartis, Roche, Sanofi and Teva, and support for research activities from Czech Ministry of Education [project Progres Q27/LF1].
Maria Trojano received speaker honoraria from Biogen-Idec, Bayer-Schering, Sanofi Aventis, Merck, Teva , Novartis and Almirall; has received research grants for her Institution from Biogen-Idec, Merck, and Novartis.
Guillermo Izquierdo received speaking honoraria from Biogen, Novartis, Sanofi, Merck, Roche, Almirall and Teva.
Sara Eichau did not declare any competing interests.
Serkan Ozakbas did not declare any competing interests.
Alessandra Lugaresi is a Bayer, Biogen, Genzyme, Merck Advisory Board Member. She received travel grants and honoraria from Roche, Bayer, Biogen, Merck, Novartis, Sanofi, Teva and Fondazione Italiana Sclerosi Multipla (FISM). Her institution received research grants from Bayer, Biogen, Merck, Novartis, Sanofi , Teva and Fondazione Italiana Sclerosi Multipla (FISM).
Alexandre Prat did not declare any competing interests.
Marc Girard received consulting fees from Teva Canada Innovation, Biogen, Novartis and Genzyme Sanofi; lecture payments from Teva Canada Innovation, Novartis and EMD . He has also received a research grant from Canadian Institutes of Health Research.
Pierre Duquette served on editorial boards and has been supported to attend meetings by EMD, Biogen, Novartis, Genzyme, and TEVA Neuroscience. He holds grants from the CIHR and the MS Society of Canada and has received funding for investigator-initiated trials from Biogen, Novartis, and Genzyme.
Raed Alroughani received honoraria as a speaker and for serving on scientific advisory boards from Bayer, Biogen, GSK, Merck, Novartis, Roche and Sanofi-Genzyme.
Roberto Bergamaschi received speaker honoraria from Bayer Schering, Biogen, Genzyme, Merck , Novartis, Sanofi-Aventis, Teva; research grants from Bayer Schering, Biogen, Merck , Novartis, Sanofi-Aventis, Teva; congress and travel/accommodation expense compensations by Almirall, Bayer Schering, Biogen, Genzyme, Merck , Novartis, Sanofi-Aventis, Teva.
Patrizia Sola served on scientific advisory boards for Biogen Idec and TEVA, she has received funding for travel and speaker honoraria from Biogen Idec, Merck , Teva, Sanofi Genzyme, Novartis and Bayer and research grants for her Institution from Bayer, Biogen, Merck , Novartis, Sanofi, Teva.
Diana Ferraro received travel grants and/or speaker honoraria from Merck, TEVA, Novartis, Biogen and Sanofi-Genzyme.
Pierre Grammond is a Merck, Novartis, Teva-neuroscience, Biogen and Genzyme advisory board member, consultant for Merck , received payments for lectures by Merck , Teva-Neuroscience and Canadian Multiple sclerosis society, and received grants for travel from Teva-Neuroscience and Novartis.
Francois Grand´Maison received honoraria or research funding from Biogen, Genzyme, Novartis, Teva Neurosciences, Mitsubishi and ONO Pharmaceuticals.
Murat Terzi received travel grants from Novartis, Bayer-Schering, Merck and Teva; has participated in clinical trials by Sanofi Aventis, Roche and Novartis.
Cavit Boz received conference travel support from Biogen, Novartis, Bayer-Schering, Merck and Teva; has participated in clinical trials by Sanofi Aventis, Roche and Novartis.
Raymond Hupperts received honoraria as consultant on scientific advisory boards from Merck, Biogen, Genzyme-Sanofi and Teva, research funding from Merck and Biogen, and speaker honoraria from Sanofi-Genzyme and Novartis.
Helmut Butzkueven served on scientific advisory boards for Biogen, Novartis and Sanofi-Aventis and has received conference travel support from Novartis, Biogen and Sanofi Aventis. He serves on steering committees for trials conducted by Biogen and Novartis, and has received research support from Merck , Novartis and Biogen.
Anneke van der Walt served on scientific advisory boards for Biogen, Novartis and Sanofi-Aventis and has received conference travel support from Novartis, Biogen and Sanofi Aventis. She serves on steering committees for trials conducted by Biogen and Novartis, and has received research support from Merck , Novartis and Biogen.
Eugenio Pucci served on scientific advisory boards for Merck, Genzyme and Biogen; he has received honoraria and travel grants from Sanofi Aventis, Novartis, Biogen, Merck, Genzyme and Teva; he has received travel grants and equipment from "Associazione Marchigiana Sclerosi Multipla e altre malattie neurologiche".
Franco Granella received research grant from Biogen, served on scientific advisory boards for Biogen, Novartis, Merck, and Sanofi-Aventis and received funding for travel and speaker honoraria from Biogen, Merck, Sanofi-Aventis, and Almirall.
Vincent Van Pesch received travel grants from Biogen, Bayer Schering, Genzyme, Merck, Teva and Novartis Pharma. His institution receives honoraria for consultancy and lectures from Biogen, Bayer Schering, Genzyme, Merck, Roche, Teva and Novartis Pharma as well as research grants from Novartis Pharma and Bayer Schering.
Aysun Soysal did not declare any competing interests.
Bassem Yamout did not declare any competing interests.
Jeannette Lechner-Scott accepted travel compensation from Novartis, Biogen and Merck. Her institution receives the honoraria for talks and advisory board commitment from Bayer Health Care, Biogen, Genzyme Sanofi, Merck, Novartis and Teva, has been involved in clinical trials with Biogen, Novartis and Teva.
Daniele Spitaleri received honoraria as a consultant on scientific advisory boards by Bayer-Schering, Novartis and Sanofi-Aventis and compensation for travel from Novartis, Biogen, Sanofi Aventis, Teva and Merck.
Radek Ampapa received conference travel support from Novartis, Teva, Biogen, Bayer and Merck and has participated in a clinical trials by Biogen, Novartis, Teva and Actelion.
Recai Turkoglu did not declare any competing interests.
Gerardo Iuliano had travel/accommodations/meeting expenses funded by Bayer Schering, Biogen, Merck , Novartis, Sanofi Aventis, and Teva.
Cristina Ramo-Tello received research funding, compensation for travel or speaker honoraria from Biogen, Novartis, Genzyme and Almirall.
Jose Luis Sanchez-Menoyo accepted travel compensation from Novartis and Biogen, speaking honoraria from Biogen, Novartis, Sanofi, Merck , Almirall, Bayer and Teva and has participated in a clinical trial by Biogen.
Youssef Sidhom did not declare any competing interests.
Riadh Gouider did not declare any competing interests.
Vahid Shaygannejad did not declare any competing interests.
Julie Prevost accepted travel compensation from Novartis, Biogen, Genzyme, Teva, and speaking honoraria from Biogen, Novartis, Genzyme and Teva.
Ayse Altintas received personal fees and speaker honoraria from Teva, Merck, Biogen - Gen Pharma, Roche, Novartis, Bayer, Sanofi-Genzyme; received travel and registration grants from Merck, Biogen - Gen Pharma, Roche, Sanofi-Genzyme and Bayer.
Yara Fragoso received honoraria as a consultant on scientific advisory boards by Novartis, Teva, Roche and Sanofi-Aventis and compensation for travel from Novartis, Biogen, Sanofi Aventis, Teva, Roche and Merck.
Pamela McCombe did not declare any competing interests.