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Early predictors of conversion to secondary progressive multiple sclerosis

  • Mahdi Barzegar
    Affiliations
    Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

    Department of neurology, Isfahan University of Medical Sciences, Isfahan, Iran
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  • Soroush Najdaghi
    Affiliations
    Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

    Department of neurology, Isfahan University of Medical Sciences, Isfahan, Iran
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  • Alireza Afshari-Safavi
    Affiliations
    Department of neurology, Isfahan University of Medical Sciences, Isfahan, Iran

    Department of Biostatistics and Epidemiology, Faculty of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran
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  • Nasim Nehzat
    Affiliations
    Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

    Universal Council of Epidemiology (UCE), Universal Scientific Education and Research Network (USERN), Tehran University of Medical Sciences, Tehran, Iran
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  • Omid Mirmosayyeb
    Affiliations
    Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

    Department of neurology, Isfahan University of Medical Sciences, Isfahan, Iran

    Universal Council of Epidemiology (UCE), Universal Scientific Education and Research Network (USERN), Tehran University of Medical Sciences, Tehran, Iran
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  • Vahid Shaygannejad
    Correspondence
    Corresponding author.
    Affiliations
    Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

    Department of neurology, Isfahan University of Medical Sciences, Isfahan, Iran
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      Highlights

      • The estimated number of patients converted to SPMS was 10% at 10-years, 50% at 20-years, and 93% at 30-years.
      • Older age at onset, higher EDSS at onset, smoking, motor dysfunction, cerebellar dysfunction, and presence of lesions in spinal cord increased the risk of conversion from RRMS to SPMS.
      • There was no significant difference between escalation and early intensive therapy approaches in the risk of transition to progressive phase.

      Abstract

      Background

      : We conducted this study to estimated the time of conversion from relapsing-remitting MS (RRMS) to SPMS and its early predictor factors.

      Methods

      : In this retrospective study, demographic, clinical, and imaging data from MS patients at diagnosis were extracted. Cox proportional hazards model was used to assess the association between various baseline characteristics and conversion to SPMS. We also assessed the association brtween escalation and early intensive therapy approaches with transition to progressive phase.

      Results

      : Out of 1903 patients with RRMS at baseline, 293 (15.4%) patients progressed to SPMS during follow-up. The estimated number of patients converted to SPMS was 10% at 10-years, 50% at 20-years, and 93% at 30-years. On multivariate Cox regression analysis older age at onset (HR: 1.067, 95%CI: 1.048–1.085, p < 0.001), smoking (HR: 2.120, 95%CI: 1.203–3.736, p = 0.009), higher EDSS at onset (HR: 1.199, 95%CI: 1.109–1.295, p < 0.001), motor dysfunction (HR: 2.470, 95%CI: 1.605–3.800, p < 0.001), cerebellar dysfunction (HR: 3.096, 95%CI: 1.840–5.211, p < 0.001), and presence of lesions in spinal cord (HR: 0.573, 95%CI: 0.297–0.989, p = 0.042) increased the risk of conversion from RRMS to SPMS. No significant difference between escalation and EIT groups in the risk of transition to progressive phase (weighted HR = 1.438; 95% CI: 0.963, 2.147; p = 0.076) was found.

      Conclusion

      : Our data support previous observations that smoking is a modifiable risk factor for secondary progressive MS and confirms that spinal cord involvement, age, and more severe disease at onset are prognostic factors for converting to secondary progressive MS.

      Keywords

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