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Rojas JI, Patrucco L, Trojano M, Lugaresi A, Izquierdo G, Butzkueven H, Jokubaitis V, Duquette P, Girard M, Grand'Maison F, Grammond P, Oreja-Guevara C, Hupperts R, Boz C, Petersen T, Bergamaschi R, Giuliani G, Lechner-Scott J, Barnett M, Rio ME, Van Pesch V, Amato MP, Iuliano G, Fiol M, Slee M, Verheul F, Fernandez-Bolanos R, Poehlau D, Saladino ML, Braber-Moerland LD, Deri N, Oleschko-Arruda W, Cabrera-Gomez JA, Paine M, Vella N, Kister I, Skromne E, Savino A, Shaw C, Moore F, Vucic S, Petkovska-Boskova T, Bacile EAB, Santiago V, Cristiano E. Multiple sclerosis in Latin America: A different disease course severity? A collaborative study from the MSBase Registry. Mult Scler J Exp Transl Clin 2015; 1:2055217315600193. [PMID: 28607702 PMCID: PMC5408755 DOI: 10.1177/2055217315600193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 07/19/2015] [Indexed: 11/17/2022] Open
Abstract
Limited data suggest that multiple sclerosis (MS) in Latin America (LA) could be less severe than in the rest of the world. The objective was to compare the course of MS between LA and other regions.
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Affiliation(s)
| | | | - Maria Trojano
- Department of Basic Medical Sciences, Neuroscience, and Sense Organs, University of Bari, Italy
| | - Alessandra Lugaresi
- MS Center, Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio, Italy
| | | | | | - Vilija Jokubaitis
- Department of Neurology, Royal Melbourne Hospital, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia; Department of Neurology, Box Hill Hospital, Monash University, Australia
| | | | - Marc Girard
- Department of Neurology, Hôpital Notre Dame, Canada
| | | | | | | | | | - Cavit Boz
- Karadeniz Technical University, Turkey
| | | | | | | | - Jeannette Lechner-Scott
- Department of Medicine, John Hunter Hospital, Australia; Hunter Medical Research Institute, University of Newcastle, Australia
| | | | | | - Vincent Van Pesch
- Department of Neurology, Cliniques Universitaires Saint-Luc, Belgium
| | - Maria Pia Amato
- Department NEUROFARBA, Section of Neurosciences, University of Florence, Italy
| | | | | | - Mark Slee
- Flinders University and Medical Centre, Australia
| | - Freek Verheul
- Neurology Unit, Groen Hart Ziekenhuis, The Netherlands
| | | | | | | | | | | | | | | | | | | | - Ilya Kister
- New York University Langone Medical Center, USA
| | - Eli Skromne
- Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Mexico
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Ribbons KA, McElduff P, Boz C, Trojano M, Izquierdo G, Duquette P, Girard M, Grand’Maison F, Hupperts R, Grammond P, Oreja-Guevara C, Petersen T, Bergamaschi R, Giuliani G, Barnett M, van Pesch V, Amato MP, Iuliano G, Fiol M, Slee M, Verheul F, Cristiano E, Fernandez-Bolanos R, Saladino ML, Rio ME, Cabrera-Gomez J, Butzkueven H, van Munster E, Den Braber-Moerland L, La Spitaleri D, Lugaresi A, Shaygannejad V, Gray O, Deri N, Alroughani R, Lechner-Scott J. Male Sex Is Independently Associated with Faster Disability Accumulation in Relapse-Onset MS but Not in Primary Progressive MS. PLoS One 2015; 10:e0122686. [PMID: 26046348 PMCID: PMC4457630 DOI: 10.1371/journal.pone.0122686] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 02/26/2015] [Indexed: 11/22/2022] Open
Abstract
Background Multiple Sclerosis is more common in women than men and females have more relapses than men. In a large international cohort we have evaluated the effect of gender on disability accumulation and disease progression to determine if male MS patients have a worse clinical outcome than females. Methods Using the MSBase Registry, data from 15,826 MS patients from 25 countries was analysed. Changes in the severity of MS (EDSS) were compared between sexes using a repeated measures analysis in generalised linear mixed models. Kaplan-Meier analysis was used to test for sex difference in the time to reach EDSS milestones 3 and 6 and the secondary progressive MS. Results In relapse onset MS patients (n = 14,453), males progressed significantly faster in their EDSS than females (0.133 vs 0.112 per year, P<0.001,). Females had a reduced risk of secondary progressive MS (HR (95% CI) = 0.77 (0.67 to 0.90) P = 0.001). In primary progressive MS (n = 1,373), there was a significant increase in EDSS over time in males and females (P<0.001) but there was no significant sex effect on the annualized rate of EDSS change. Conclusion Among registrants of MSBase, male relapse-onset patients accumulate disability faster than female patients. In contrast, the rate of disability accumulation between male and female patients with primary progressive MS is similar.
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Affiliation(s)
| | | | - Cavit Boz
- Karadeniz Technical University, Trabzon, Turkey
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Maria-Pia Amato
- Department of Neurology, University of Florence, Florence, Italy
| | | | | | - Mark Slee
- Flinders Medical Centre, Adelaide, Australia
| | | | | | | | | | | | - Jose Cabrera-Gomez
- Multiple Sclerosis Clinic, International Center of Neurological Restoration, Havana, Cuba
| | | | | | | | | | | | - Vahid Shaygannejad
- Al-Zahara Hopsital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Orla Gray
- Craigavon Area Hospital, Armagh, Northern Ireland
| | - Norma Deri
- Hospital Fernandez, Capital Federal, Argentina
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Spelman T, Gray O, Trojano M, Petersen T, Izquierdo G, Lugaresi A, Hupperts R, Bergamaschi R, Duquette P, Grammond P, Giuliani G, Boz C, Verheul F, Oreja-Guevara C, Barnett M, Grand'Maison F, Edite Rio M, Lechner-Scott J, Van Pesch V, Fernandez Bolanos R, Flechter S, Den Braber-Moerland L, Iuliano G, Amato MP, Slee M, Cristiano E, Saladino ML, Paine M, Vella N, Kasa K, Deri N, Herbert J, Moore F, Petkovska-Boskova T, Alroughani R, Savino A, Shaw C, Vucic S, Santiago V, Bacile EA, Skromne E, Poehlau D, Cabrera-Gomez JA, Lucas R, Butzkueven H. Seasonal variation of relapse rate in multiple sclerosis is latitude dependent. Ann Neurol 2014; 76:880-90. [DOI: 10.1002/ana.24287] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 09/14/2014] [Accepted: 09/22/2014] [Indexed: 12/15/2022]
Affiliation(s)
- Tim Spelman
- Department of Neurology; Royal Melbourne Hospital; Parkville Australia
| | - Orla Gray
- Craigavon Area Hospital; Portadown Northern Ireland
| | - Maria Trojano
- Department of Basic Medical Sciences, Neuroscience, and Sense Organs; University of Bari; Bari Italy
| | | | | | - Alessandra Lugaresi
- Multiple Sclerosis Center, Department of Neuroscience and Imaging, University “G. d'Annunzio”; Chieti Italy
| | | | - Roberto Bergamaschi
- Neurological lnstitute of Scientific Research and Treatment Mondino; Pavia Italy
| | | | - Pierre Grammond
- Chaudière-Appalache Physical Disability Rehabilitation Center; Lévis Quebec Canada
| | | | - Cavit Boz
- Karadeniz Technical University; Trabzon Turkey
| | | | | | | | | | | | | | | | | | | | | | | | - Maria Pia Amato
- Department of Neurology; University of Florence; Florence Italy
| | - Mark Slee
- Flinders University and Medical Center; Adelaide Australia
| | | | | | - Mark Paine
- St Vincent's Hospital; Fitzroy Australia
| | | | | | - Norma Deri
- Fernandez Hospital; Buenos Aires Argentina
| | - Joseph Herbert
- New York University Hospital for Joint Diseases; New York NY
| | - Fraser Moore
- Jewish General Hospital, Montreal; Quebec Canada
| | | | | | | | | | | | - Vetere Santiago
- Hospital International General Acute Gral San Martin; La Plata Argentina
| | | | - Eli Skromne
- Hospital Angeles Mexico City; Mexico City Mexico
| | - Dieter Poehlau
- Multiple Sclerosis Center, Camillus Hospital; Asbach Germany
| | | | - Robyn Lucas
- National Center for Epidemiology and Population Health, Australian National University; Canberra Australia
| | - Helmut Butzkueven
- Department of Neurology; Royal Melbourne Hospital; Parkville Australia
- Department of Medicine, Royal Melbourne Hospital; University of Melbourne; Parkville Australia
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Hughes SE, Spelman T, Gray OM, Boz C, Trojano M, Lugaresi A, Izquierdo G, Duquette P, Girard M, Grand’Maison F, Grammond P, Oreja-Guevara C, Hupperts R, Bergamaschi R, Giuliani G, Lechner-Scott J, Barnett M, Edite Rio M, van Pesch V, Amato MP, Iuliano G, Slee M, Verheul F, Cristiano E, Fernández-Bolaños R, Poehlau D, Saladino ML, Deri N, Cabrera-Gomez J, Vella N, Herbert J, Skromne E, Savino A, Shaw C, Moore F, Vucic S, Petkovska-Boskova T, McDonnell G, Hawkins S, Kee F, Butzkueven H, Paolicelli D, Lucchese G, Iaffaldano P, Zwanikken C, De Luca G, Di Tommaso V, Travaglini D, Pietrolongo E, di Ioia M, Farina D, Mancinelli L, Marriott M, Kilpatrick T, King J, van der Walt A, Skibina O, Haartsen J, Chamorro B, Petersen T, Cartechini E, Pucci E, William D, Dark L, Fiol M, Correale J, Ysrraelit C, Den Braber-Moerland L, Jaacks G, Laffue A, Fernanda Páez M, Muñoz D, Oleschko Arruda W, Paine M, Vella M, Vetere S. Predictors and dynamics of postpartum relapses in women with multiple sclerosis. Mult Scler 2013; 20:739-46. [DOI: 10.1177/1352458513507816] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Several studies have shown that pregnancy reduces multiple sclerosis (MS) relapses, which increase in the early postpartum period. Postpartum relapse risk has been predicted by pre-pregnancy disease activity in some studies. Objective: To re-examine effect of pregnancy on relapses using the large international MSBase Registry, examining predictors of early postpartum relapse. Methods: An observational case–control study was performed including pregnancies post-MS onset. Annualised relapse rate (ARR) and median Expanded Disability Status Scale (EDSS) scores were compared for the 24 months pre-conception, pregnancy and 24 months postpartum periods. Clustered logistic regression was used to investigate predictors of early postpartum relapses. Results: The study included 893 pregnancies in 674 females with MS. ARR (standard error) pre-pregnancy was 0.32 (0.02), which fell to 0.13 (0.03) in the third trimester and rose to 0.61 (0.06) in the first three months postpartum. Median EDSS remained unchanged. Pre-conception ARR and disease-modifying treatment (DMT) predicted early postpartum relapse in a multivariable model. Conclusion: Results confirm a favourable effect on relapses as pregnancy proceeds, and an early postpartum peak. Pre-conception DMT exposure and low ARR were independently protective against postpartum relapse. This novel finding could provide clinicians with a strategy to minimise postpartum relapse risk in women with MS planning pregnancy.
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Affiliation(s)
- Stella E Hughes
- Department of Neurology, Royal Victoria Hospital, Belfast, UK
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, UK
| | - Tim Spelman
- Department of Neurology, Royal Melbourne Hospital, Victoria, Australia
| | | | - Cavit Boz
- Karadeniz Technical University, Trabzon, Turkey
| | | | - Alessandra Lugaresi
- MS Center, Department of Neuroscience and Imaging, University ‘G. d’Annunzio’, Chieti, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Dieter Poehlau
- Multiple Sclerosis Centre Kamillus-Klinik, Asbach, Germany
| | | | - Norma Deri
- Hospital Fernandez, Buenos Aires, Argentina
| | | | | | | | - Eli Skromne
- Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Mexico
| | - Aldo Savino
- Consultorio Privado, Buenos Aires, Argentina
| | | | | | - Steve Vucic
- Westmead Hospital, New South Wales, Australia
| | | | - Gavin McDonnell
- Department of Neurology, Royal Victoria Hospital, Belfast, UK
| | - Stanley Hawkins
- Department of Neurology, Royal Victoria Hospital, Belfast, UK
- Centre for Medical Education, Queen’s University Belfast, UK
| | - Frank Kee
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, UK
| | - Helmut Butzkueven
- Department of Neurology, Royal Melbourne Hospital, Victoria, Australia
- Department of Medicine, Melbourne Brain Centre, The University of Melbourne, Australia
- Department of Neurology, Box Hill Hospital, Monash University, Australia
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