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Harding-Forrester S, Roos I, Nguyen AL, Malpas CB, Diouf I, Moradi N, Sharmin S, Izquierdo G, Eichau S, Patti F, Horakova D, Kubala Havrdova E, Prat A, Girard M, Duquette P, Grand'Maison F, Onofrj M, Lugaresi A, Grammond P, Ozakbas S, Amato MP, Gerlach O, Sola P, Ferraro D, Buzzard K, Skibina O, Lechner-Scott J, Alroughani R, Boz C, Van Pesch V, Cartechini E, Terzi M, Maimone D, Ramo-Tello C, Yamout B, Khoury SJ, La Spitaleri D, Sa MJ, Blanco Y, Granella F, Slee M, Butler E, Sidhom Y, Gouider R, Bergamaschi R, Karabudak R, Ampapa R, Sánchez-Menoyo JL, Prevost J, Castillo-Trivino T, McCombe PA, Macdonell R, Laureys G, Van Hijfte L, Oh J, Altintas A, de Gans K, Turkoglu R, van der Walt A, Butzkueven H, Vucic S, Barnett M, Cristiano E, Hodgkinson S, Iuliano G, Kappos L, Kuhle J, Shaygannejad V, Soysal A, Weinstock-Guttman B, Van Wijmeersch B, Kalincik T. Disability accrual in primary and secondary progressive multiple sclerosis. J Neurol Neurosurg Psychiatry 2023; 94:707-717. [PMID: 37068931 DOI: 10.1136/jnnp-2022-330726] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/29/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Some studies comparing primary and secondary progressive multiple sclerosis (PPMS, SPMS) report similar ages at onset of the progressive phase and similar rates of subsequent disability accrual. Others report later onset and/or faster accrual in SPMS. Comparisons have been complicated by regional cohort effects, phenotypic differences in sex ratio and management and variable diagnostic criteria for SPMS. METHODS We compared disability accrual in PPMS and operationally diagnosed SPMS in the international, clinic-based MSBase cohort. Inclusion required PPMS or SPMS with onset at age ≥18 years since 1995. We estimated Andersen-Gill hazard ratios for disability accrual on the Expanded Disability Status Scale (EDSS), adjusted for sex, age, baseline disability, EDSS score frequency and drug therapies, with centre and patient as random effects. We also estimated ages at onset of the progressive phase (Kaplan-Meier) and at EDSS milestones (Turnbull). Analyses were replicated with physician-diagnosed SPMS. RESULTS Included patients comprised 1872 with PPMS (47% men; 50% with activity) and 2575 with SPMS (32% men; 40% with activity). Relative to PPMS, SPMS had older age at onset of the progressive phase (median 46.7 years (95% CI 46.2-47.3) vs 43.9 (43.3-44.4); p<0.001), greater baseline disability, slower disability accrual (HR 0.86 (0.78-0.94); p<0.001) and similar age at wheelchair dependence. CONCLUSIONS We demonstrate later onset of the progressive phase and slower disability accrual in SPMS versus PPMS. This may balance greater baseline disability in SPMS, yielding convergent disability trajectories across phenotypes. The different rates of disability accrual should be considered before amalgamating PPMS and SPMS in clinical trials.
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Affiliation(s)
- Sam Harding-Forrester
- CORe, Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Izanne Roos
- CORe, Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Neuroimmunology Centre, Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Ai-Lan Nguyen
- CORe, Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Neuroimmunology Centre, Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Charles B Malpas
- CORe, Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Neuroimmunology Centre, Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Ibrahima Diouf
- CORe, Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Neuroimmunology Centre, Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Nahid Moradi
- CORe, Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Neuroimmunology Centre, Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Sifat Sharmin
- CORe, Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Neuroimmunology Centre, Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Guillermo Izquierdo
- Multiple Sclerosis Unit, Hospital Universitario Virgen Macarena, Sevilla, Andalucía, Spain
| | - Sara Eichau
- Multiple Sclerosis Unit, Hospital Universitario Virgen Macarena, Sevilla, Andalucía, Spain
| | - Francesco Patti
- Neuroscience, Department of Surgical and Medical Sciences and Advanced Technologies 'G.F. Ingrassia', University of Catania, Catania, Italy
| | - Dana Horakova
- Department of Neurology and Centre of Clinical Neuroscience, Charles University First Faculty of Medicine, Praha, Czech Republic
| | - Eva Kubala Havrdova
- Department of Neurology and Centre of Clinical Neuroscience, Charles University First Faculty of Medicine, Praha, Czech Republic
| | - Alexandre Prat
- Centre Hospitalier, Université de Montréal, Montreal, Québec, Canada
- Department of Neuroscience, Université de Montréal, Montreal, Québec, Canada
| | - Marc Girard
- Centre Hospitalier, Université de Montréal, Montreal, Québec, Canada
- Faculté de Médecine, Université de Montréal, Montreal, Québec, Canada
| | - Pierre Duquette
- Centre Hospitalier, Université de Montréal, Montreal, Québec, Canada
- Faculté de Médecine, Université de Montréal, Montreal, Québec, Canada
| | | | - Marco Onofrj
- Department of Neurosciences, Imaging and Clinical Sciences, Gabriele d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Alessandra Lugaresi
- UOSI Riabilitazione Sclerosi Multipla, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Pierre Grammond
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches du Québec Centre de Recherche, Levis, Québec, Canada
| | - Serkan Ozakbas
- Department of Neurology, Dokuz Eylul University, İzmir, Turkey
| | - Maria Pia Amato
- Department of Neurological Siences, University of Florence, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Oliver Gerlach
- Department of Neurology, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | - Patrizia Sola
- Neurology Unit, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Diana Ferraro
- Department of Neuroscience, Azienda Ospedaliero-Universitaria di Modena, Modena, Emilia-Romagna, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Katherine Buzzard
- Department of Neurology, Box Hill Hospital, Box Hill, Victoria, Australia
| | - Olga Skibina
- Department of Neurology, Box Hill Hospital, Box Hill, Victoria, Australia
| | - Jeannette Lechner-Scott
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Department of Neurology, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Raed Alroughani
- Department of Medicine, Al-Amiri Hospital, Kuwait City, Kuwait
| | - Cavit Boz
- Department of Neurology, Karadeniz Technical University, Trabzon, Turkey
| | - Vincent Van Pesch
- Department of Neurology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | | | | | | | - Cristina Ramo-Tello
- Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Bassem Yamout
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
- Department of Neurology, American University of Beirut, Beirut, Lebanon
| | - Samia Joseph Khoury
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
- American University of Beirut, Beirut, Lebanon
| | | | - Maria Jose Sa
- Department of Neurology, Centro Hospitalar de São João, Porto, Portugal
- Health Sciences Faculty, Fernando Pessoa University, Porto, Portugal
| | - Yolanda Blanco
- Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
| | - Franco Granella
- Multiple Sclerosis Centre, Neurosciences, University of Parma, Parma, Italy
| | - Mark Slee
- Department of Neurology, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Ernest Butler
- Department of Neurology, Monash Medical Centre Clayton, Clayton, Victoria, Australia
| | - Youssef Sidhom
- Department of Neurology, Hopital Razi, La Manouba, Tunisia
| | - Riadh Gouider
- Department of Neurology, Razi Hospital, Rasht, Gilan, Iran
| | | | - Rana Karabudak
- Department of Neurology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Radek Ampapa
- Department of Neurology, Nemocnice Jihlava, Jihlava, Czech Republic
| | | | - Julie Prevost
- Centre integre de sante et de services sociaux des Laurentides point de service de Saint-Jerome, Saint-Jerome, Quebec, Canada
| | | | - Pamela A McCombe
- UQCCR, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Richard Macdonell
- Department of Neurology, Austin Health, Heidelberg, Victoria, Australia
| | - Guy Laureys
- Department of Neurology, University Hospital Ghent, Gent, Oost-Vlaanderen, Belgium
| | - Liesbeth Van Hijfte
- Department of Neurology, University Hospital Ghent, Gent, Oost-Vlaanderen, Belgium
| | - Jiwon Oh
- Division of Neurology, Department of Medicine, St Michael's Hospital, Toronto, Ontario, Canada
| | - Ayse Altintas
- Department of Neurology, Koc Universitesi, Istanbul, Turkey
- Koç University Research Center for Translational Medicine (KUTTAM), Koç University, Istanbul, Turkey
| | - Koen de Gans
- Department of Neurology, Groene Hart Ziekenhuis, Gouda, Zuid-Holland, The Netherlands
| | - Recai Turkoglu
- Department of Neurology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Anneke van der Walt
- Multiple Sclerosis and Neuroimmunology Unit, Monash University Central Clinical School, Melbourne, Victoria, Australia
| | - Helmut Butzkueven
- Department of Neuroscience, Monash University Central Clinical School, Melbourne, Victoria, Australia
- Department of Neurology, The Alfred, Melbourne, Victoria, Australia
| | - Steve Vucic
- Department of Neurology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Michael Barnett
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Edgardo Cristiano
- Centro de Esclerosis Múltiple de Buenos Aires, Hospital Italiano de Buenos Aires, Buenos Aires, Federal District, Argentina
| | - Suzanne Hodgkinson
- Department of Neurology, Liverpool Hospital, Liverpool, New South Wales, Australia
| | | | - Ludwig Kappos
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine, and Clinical Research, University Hospital Basel, Basel, Switzerland
- Research Centre for Clinical Neuroimmunology and Neuroscience, University Hospital Basel, Basel, Switzerland
| | - Jens Kuhle
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine, and Clinical Research, University Hospital Basel, Basel, Switzerland
- Research Centre for Clinical Neuroimmunology and Neuroscience, University Hospital Basel, Basel, Switzerland
| | - Vahid Shaygannejad
- Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Aysun Soysal
- Department of Neurology, Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Bianca Weinstock-Guttman
- Department of Neurology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Bart Van Wijmeersch
- Universitair MS Centrum, Hasselt University, Hasselt-Pelt, Belgium
- Rehabilitation & MS Centre, Pelt, Belgium
| | - Tomas Kalincik
- CORe, Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Neuroimmunology Centre, Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
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