Contemporary study of multiple sclerosis disability in South East Wales.

Autor:	Harding KE; Department of Neurology, Aneurin Bevan University Health Board, Newport, UK katharineharding@doctors.org.uk., Ingram G; Neurology Department, Swansea Bay University Health Board, Swansea, UK., Tallantyre EC; Helen Durham Centre for Neuroinflammatory Disease, Cardiff and Vale University Health Board, Cardiff, UK.; Institute of Psychological Medicine and Neurology, Cardiff University, Cardiff, UK., Joseph F; Department of Neurology, Aneurin Bevan University Health Board, Newport, UK., Wardle M; Helen Durham Centre for Neuroinflammatory Disease, Cardiff and Vale University Health Board, Cardiff, UK., Pickersgill TP; Helen Durham Centre for Neuroinflammatory Disease, Cardiff and Vale University Health Board, Cardiff, UK., Willis MD; Helen Durham Centre for Neuroinflammatory Disease, Cardiff and Vale University Health Board, Cardiff, UK., Tomassini V; Institute of Psychological Medicine and Neurology, Cardiff University, Cardiff, UK.; Institute of Advanced Biomedical Technologies (ITAB), Department of Neuroscience and Imaging and Clinical Sciences, Multiple Sclerosis Center, Neurological Clinic, SS Annunziata Hospital, Università degli Studi Gabriele d'Annunzio Chieti Pescara, Chieti, Italy., Pearson OR; Neurology Department, Swansea Bay University Health Board, Swansea, UK., Robertson NP; Helen Durham Centre for Neuroinflammatory Disease, Cardiff and Vale University Health Board, Cardiff, UK.; Institute of Psychological Medicine and Neurology, Cardiff University, Cardiff, UK.
Jazyk:	angličtina
Zdroj:	Journal of neurology, neurosurgery, and psychiatry [J Neurol Neurosurg Psychiatry] 2023 Apr; Vol. 94 (4), pp. 272-279. Date of Electronic Publication: 2022 Nov 03.
DOI:	10.1136/jnnp-2022-330013
Abstrakt:	Background: A contemporary understanding of disability evolution in multiple sclerosis (MS) is an essential tool for individual disease management and planning of interventional studies. We have used prospectively collected longitudinal data to analyse disability progression and variation in a British MS cohort. Methods: Cox proportional hazards regression was used to estimate hazard of Expanded Disability Status Scale (EDSS) 4.0 and 6.0. A continuous Markov model was used to estimate transitional probabilities for individual EDSS scores. Models were adjusted for age at MS onset, sex and disease-modifying treatments (DMTs) exposure. Results: 2135 patients were included (1487 (70%) female, 1922 (89%) relapsing onset). 865 (41%) had used DMTs. Median time to EDSS 4.0 and 6.0 was 18.2 years (95% CI 16.3 to 20.2) and 22.1 years (95% CI 20.5 to 24.5). In the Markov model, the median time spent at EDSS scores of <6 (0.40-0.98 year) was shorter than the time spent at EDSS scores of ≥6 (0.87-4.11 year). Hazard of change in EDSS was greatest at EDSS scores <6 (HR for increasing EDSS: 1.02-1.33; decreasing EDSS: 0.34-1.27) compared with EDSS scores ≥6 (HR for increasing EDSS: 0.08-0.61; decreasing EDSS: 0.18-0.54). Conclusions: These data provide a detailed contemporary model of disability outcomes in a representative population-based MS cohort. They support a trend of increasing time to disability milestones compared with historical reference populations, and document disability variation with the use of transitional matrices. In addition, they provide essential information for patient counselling, clinical trial design, service planning and offer a comparative baseline for assessment of therapeutic interventions. Competing Interests: Competing interests: MW and MDW declare no financial interests. KEH reports speaker and personal fees from Roche, Merck and Biogen, and travel grants to attend educational meetings from Roche, Novartis, Merck and Biogen. ECT has received honoraria for consulting work from Novartis, Merck, Biogen and Roche, and funding to attend or speak at educational meetings from Biogen, Janssen, Merck, Roche, Takeda and Novartis. TPP reports honoraria from Roche and MedDay Pharma, travel expenses from Sanofi Genzyme and Novartis, and is Treasurer for the BMA. FJ reports honoraria and support to attend educational meetings from Biogen and Teva Pharmaceutical Industries. GI reports payments and honoraria for speaking, travel, and advisory boards from Merck, Sanofi Genzyme, Novartis and Biogen. VT has received honoraria, travel grants and research grant support from Roche, Merck, Biogen, Novartis, Viatris, Bristol Myers Squibb, Almirall, Sanofi.OP reports speaker fees, consultancy fees, and personal fees from Biogen, Sanofi Genzyme, Roche, Merck and Novartis, and grant support from Biogen and Sanofi Genzyme. NPR reports honoraria from Roche, Sanofi Genzyme and Novartis, and research grants from Novartis, Sanofi Genzyme and Biogen. (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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