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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Article info
Publication history
Published online: June 25, 2021
Accepted:
June 22,
2021
Received in revised form:
June 10,
2021
Received:
March 15,
2021
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
