Contributions
Abstract: 139
Type: Free Communications
Abstract Category: Clinical aspects of MS - Diagnosis and differential diagnosis
Background: The 2017 revisions to the McDonald criteria allow the use of symptomatic lesions to demonstrate dissemination in space (DIS) or time (DIT), of cortical lesions to demonstrate DIS or DIT, and the presence of IgG oligoclonal bands (OB) together with clinical or radiological DIS to diagnose multiple sclerosis (MS) (Brain 2018, Lancet Neurol 2018).
Objectives: To compare the proportion of patients diagnosed with MS at the time of the clinically isolated syndrome (CIS) using the 2010 and 2017 McDonald criteria, and to assess the proportion of patients fulfilling exclusively the 2017 criteria at baseline who present a second attack or fulfil 2010 McDonald on follow-up.
Methods: Study based on an ongoing CIS cohort. MRIs were obtained 3-5 months after the CIS, at one year and every five years. OB were determined by isoelectric focusing combined with immunoblotting. From this cohort, we selected 566 patients with OB determination and sufficient data on baseline brain MRI to assess DIS and DIT. We calculated the proportion of patients fulfilling each component of the 2010 and 2017 McDonald criteria at baseline (DIS, DIT, presence of OB) separately and in combination as appropriate. After selecting the patients who fulfilled exclusively the 2017 criteria at baseline, we assessed the proportion presenting a second attack or fulfilling the 2010 criteria on follow-up.
Results: The baseline characteristics were in line with those previously described in our cohort. 2010 DIS was fulfilled by 308 (54.5%) patients compared to 333 (58.8%) fulfilling 2017 DIS. DIT was fulfilled by 184 (32.5%) patients in both the 2010 and 2017 criteria. OB were positive in 336 (59.4%) cases. The proportion of patients fulfilling 2010 DIS plus DIT (n=159, 28.1%) and 2017 DIS plus DIT (n=168, 29.7%) at baseline was similar. Nevertheless, the DIS plus positive OB criterion was met by 263 (46.5%) patients, and when taking into consideration the 2017 DIS plus DIT or DIS plus positive OB complete criteria, 291 (51.4%) patients were diagnosed with MS. At baseline, 132 (23.3%) patients met exclusively the 2017 criteria. After a median (percentiles 25-75) follow-up of 6.9 (2.7-10.6) years during which 86 (65.2%) patients initiated disease-modifying treatments, 68 (51.5%) had a second attack and 97 (73.5%) fulfilled 2010 McDonald over time.
Conclusions: The 2017 revisions to the McDonald criteria increase the proportion of patients diagnosed with MS by nearly 25% at the time of the CIS.
Disclosure: G Arrambidehas received compensation for consulting services from Biogen-Idec, research support from Novartis, travel expenses for scientific meetings from Novartis, Roche, and Stendhal, and speaking honoraria from Sanofi-Aventis and Stendhal.
M Tintorehas received compensation for consulting services and speaking honoraria from Bayer Schering Pharma, Merck-Serono, Biogen-Idec, Teva Pharmaceuticals, Sanofi-Aventis, Novartis, Almirall, Genzyme, and Roche.
C Espejoreports no disclosures.
C Augerhas received speaking honoraria from Novartis, Biogen and Stendhal.
M Castilloreports no disclosures.
J Río has received speaking honoraria and personal compensation for participating on Advisory Boards from Almirall, Bayer-Schering Healthcare, Biogen-Idec, Genzyme, Merck-Serono, Novartis, Teva, and Sanofi-Aventis.
J Castillóreports no disclosures.
A Vidal-Jordanahas received speaking honoraria and consulting fees from Novartis, Roche, and Sanofi-Aventis.
I Galánreports no disclosures.
C Noshas received funding for travel from Biogen Idec and F. Hoffmann-La Roche, Ltd., and speaker honoraria from Novartis.
R Mitjanareports no disclosures.
P Mulero reports no disclosures.
A de Barrosreports no disclosures.
B Rodríguez-Acevedo reports no disclosures.
L Midaglia reports no disclosures.
J Sastre-Garriga has received compensation for participating on Advisory Boards, speaking honoraria and travel expenses for scientific meetings, consulting services or research support from Celgene, Novartis, Biogen, Teva, Merck, Almirall, and Genzyme.
A Roviraserves on scientific advisory boards for Biogen Idec, Bayer, Novartis, Genzyme, and OLEA Medical, and on the editorial board of the American Journal of Neuroradiology, Neuroradiology and European Radiology, has received speaker honoraria from Bayer, Genzyme, Sanofi-Aventis, Bracco, Merck-Serono, Teva Pharmaceutical Industries Ltd, OLEA Medical, Stendhal, Novartis and Biogen Idec, and has research agreements with Siemens AG.
M Comabella has received compensation for consulting services and speaking honoraria from Bayer Schering Pharma, Merk Serono, Biogen-Idec, Teva Pharmaceuticals, Sanofi-Aventis, and Novartis.
X Montalbanhas received speaking honoraria and travel expenses for participation in scientific meetings, has been a steering committee member of clinical trials or participated in advisory boards of clinical trials in the past with Actelion, Amirall, Bayer, Biogen, Celgene, Genzyme, Hoffmann-La Roche, Novartis, Oryzon Genomics, Sanofi-Genzyme and Teva Pharmaceutical.
Abstract: 139
Type: Free Communications
Abstract Category: Clinical aspects of MS - Diagnosis and differential diagnosis
Background: The 2017 revisions to the McDonald criteria allow the use of symptomatic lesions to demonstrate dissemination in space (DIS) or time (DIT), of cortical lesions to demonstrate DIS or DIT, and the presence of IgG oligoclonal bands (OB) together with clinical or radiological DIS to diagnose multiple sclerosis (MS) (Brain 2018, Lancet Neurol 2018).
Objectives: To compare the proportion of patients diagnosed with MS at the time of the clinically isolated syndrome (CIS) using the 2010 and 2017 McDonald criteria, and to assess the proportion of patients fulfilling exclusively the 2017 criteria at baseline who present a second attack or fulfil 2010 McDonald on follow-up.
Methods: Study based on an ongoing CIS cohort. MRIs were obtained 3-5 months after the CIS, at one year and every five years. OB were determined by isoelectric focusing combined with immunoblotting. From this cohort, we selected 566 patients with OB determination and sufficient data on baseline brain MRI to assess DIS and DIT. We calculated the proportion of patients fulfilling each component of the 2010 and 2017 McDonald criteria at baseline (DIS, DIT, presence of OB) separately and in combination as appropriate. After selecting the patients who fulfilled exclusively the 2017 criteria at baseline, we assessed the proportion presenting a second attack or fulfilling the 2010 criteria on follow-up.
Results: The baseline characteristics were in line with those previously described in our cohort. 2010 DIS was fulfilled by 308 (54.5%) patients compared to 333 (58.8%) fulfilling 2017 DIS. DIT was fulfilled by 184 (32.5%) patients in both the 2010 and 2017 criteria. OB were positive in 336 (59.4%) cases. The proportion of patients fulfilling 2010 DIS plus DIT (n=159, 28.1%) and 2017 DIS plus DIT (n=168, 29.7%) at baseline was similar. Nevertheless, the DIS plus positive OB criterion was met by 263 (46.5%) patients, and when taking into consideration the 2017 DIS plus DIT or DIS plus positive OB complete criteria, 291 (51.4%) patients were diagnosed with MS. At baseline, 132 (23.3%) patients met exclusively the 2017 criteria. After a median (percentiles 25-75) follow-up of 6.9 (2.7-10.6) years during which 86 (65.2%) patients initiated disease-modifying treatments, 68 (51.5%) had a second attack and 97 (73.5%) fulfilled 2010 McDonald over time.
Conclusions: The 2017 revisions to the McDonald criteria increase the proportion of patients diagnosed with MS by nearly 25% at the time of the CIS.
Disclosure: G Arrambidehas received compensation for consulting services from Biogen-Idec, research support from Novartis, travel expenses for scientific meetings from Novartis, Roche, and Stendhal, and speaking honoraria from Sanofi-Aventis and Stendhal.
M Tintorehas received compensation for consulting services and speaking honoraria from Bayer Schering Pharma, Merck-Serono, Biogen-Idec, Teva Pharmaceuticals, Sanofi-Aventis, Novartis, Almirall, Genzyme, and Roche.
C Espejoreports no disclosures.
C Augerhas received speaking honoraria from Novartis, Biogen and Stendhal.
M Castilloreports no disclosures.
J Río has received speaking honoraria and personal compensation for participating on Advisory Boards from Almirall, Bayer-Schering Healthcare, Biogen-Idec, Genzyme, Merck-Serono, Novartis, Teva, and Sanofi-Aventis.
J Castillóreports no disclosures.
A Vidal-Jordanahas received speaking honoraria and consulting fees from Novartis, Roche, and Sanofi-Aventis.
I Galánreports no disclosures.
C Noshas received funding for travel from Biogen Idec and F. Hoffmann-La Roche, Ltd., and speaker honoraria from Novartis.
R Mitjanareports no disclosures.
P Mulero reports no disclosures.
A de Barrosreports no disclosures.
B Rodríguez-Acevedo reports no disclosures.
L Midaglia reports no disclosures.
J Sastre-Garriga has received compensation for participating on Advisory Boards, speaking honoraria and travel expenses for scientific meetings, consulting services or research support from Celgene, Novartis, Biogen, Teva, Merck, Almirall, and Genzyme.
A Roviraserves on scientific advisory boards for Biogen Idec, Bayer, Novartis, Genzyme, and OLEA Medical, and on the editorial board of the American Journal of Neuroradiology, Neuroradiology and European Radiology, has received speaker honoraria from Bayer, Genzyme, Sanofi-Aventis, Bracco, Merck-Serono, Teva Pharmaceutical Industries Ltd, OLEA Medical, Stendhal, Novartis and Biogen Idec, and has research agreements with Siemens AG.
M Comabella has received compensation for consulting services and speaking honoraria from Bayer Schering Pharma, Merk Serono, Biogen-Idec, Teva Pharmaceuticals, Sanofi-Aventis, and Novartis.
X Montalbanhas received speaking honoraria and travel expenses for participation in scientific meetings, has been a steering committee member of clinical trials or participated in advisory boards of clinical trials in the past with Actelion, Amirall, Bayer, Biogen, Celgene, Genzyme, Hoffmann-La Roche, Novartis, Oryzon Genomics, Sanofi-Genzyme and Teva Pharmaceutical.