Skip to main content
Long-term evolution of multiple sclerosis disability in the treatment era.
- University of California, San Francisco MS-EPIC Team:;
- Cree, Bruce AC;
- Gourraud, Pierre-Antoine;
- Oksenberg, Jorge R;
- Bevan, Carolyn;
- Crabtree-Hartman, Elizabeth;
- Gelfand, Jeffrey M;
- Goodin, Douglas S;
- Graves, Jennifer;
- Green, Ari J;
- Mowry, Ellen;
- Okuda, Darin T;
- Pelletier, Daniel;
- von Büdingen, H-Christian;
- Zamvil, Scott S;
- Agrawal, Alisha;
- Caillier, Stacy;
- Ciocca, Caroline;
- Gomez, Refujia;
- Kanner, Rachel;
- Lincoln, Robin;
- Lizee, Antoine;
- Qualley, Pamela;
- Santaniello, Adam;
- Suleiman, Leena;
- Bucci, Monica;
- Panara, Valentina;
- Papinutto, Nico;
- Stern, William A;
- Zhu, Alyssa H;
- Cutter, Gary R;
- Baranzini, Sergio;
- Henry, Roland G;
- Hauser, Stephen L
- et al.
Published Web Location
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4974846/No data is associated with this publication.
Abstract
Objective
To characterize the accrual of long-term disability in a cohort of actively treated multiple sclerosis (MS) patients and to assess whether clinical and magnetic resonance imaging (MRI) data used in clinical trials have long-term prognostic value.Methods
This is a prospective study of 517 actively managed MS patients enrolled at a single center.Results
More than 91% of patients were retained, with data ascertained up to 10 years after the baseline visit. At this last assessment, neurologic disability as measured by the Expanded Disability Status Scale (EDSS) was stable or improved compared to baseline in 41% of patients. Subjects with no evidence of disease activity (NEDA) by clinical and MRI criteria during the first 2 years had long-term outcomes that were no different from those of the cohort as a whole. 25-OH vitamin D serum levels were inversely associated with short-term MS disease activity; however, these levels had no association with long-term disability. At a median time of 16.8 years after disease onset, 10.7% (95% confidence interval [CI] = 7.2-14%) of patients reached an EDSS ≥ 6, and 18.1% (95% CI = 13.5-22.5%) evolved from relapsing MS to secondary progressive MS (SPMS).Interpretation
Rates of worsening and evolution to SPMS were substantially lower when compared to earlier natural history studies. Notably, the NEDA 2-year endpoint was not a predictor of long-term stability. Finally, the data call into question the utility of annual MRI assessments as a treat-to-target approach for MS care. Ann Neurol 2016;80:499-510.Many UC-authored scholarly publications are freely available on this site because of the UC's open access policies. Let us know how this access is important for you.