Effect of Changes in MS Diagnostic Criteria Over 25 Years on Time to Treatment and Prognosis in Patients With Clinically Isolated Syndrome

被引:54
作者
Tintore, Mar [1 ]
Cobo-Calvo, Alvaro [1 ]
Carbonell, Pere [1 ]
Arrambide, Georgina [1 ]
Otero-Romero, Susana [1 ]
Rio, Jordi [1 ]
Tur, Carmen [1 ]
Comabella, Manuel [1 ]
Nos, Carlos [1 ]
Arevalo, Maria Jesus [1 ]
Midaglia, Luciana [1 ]
Galan, Ingrid [1 ]
Vidal-Jordana, Angela [1 ]
Castillo, Joaquin [1 ]
Rodriguez-Acevedo, Breogan [1 ]
Zabalza de Torres, Ana [1 ]
Salerno, Annalaura [2 ,3 ,4 ,5 ]
Auger, Cristina [2 ,3 ,4 ,5 ]
Sastre-Garriga, Jaume [1 ]
Rovira, Alex [2 ,3 ,4 ,5 ]
Montalban, Xavier [1 ]
机构
[1] Univ Autonoma Barcelona, Dept Neurol Neuroimmunol, Barcelona, Spain
[2] Univ Autonoma Barcelona, Ctr Esclerosi Multiple Catalunya Cemcat, Barcelona, Spain
[3] Univ Autonoma Barcelona, Dept Radiol IDI, Barcelona, Spain
[4] Univ Autonoma Barcelona, Neuroradiol Sect, Barcelona, Spain
[5] Univ Autonoma Barcelona, Hosp Univ Vall dHebron, Vall dHebron Inst Recerca, Magnet Resonance Unit, Barcelona, Spain
关键词
MULTIPLE-SCLEROSIS; DISABILITY MILESTONES; AGE; PROGRESSION; PREVALENCE; GUIDELINES; REVISIONS;
D O I
10.1212/WNL.0000000000012726
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background and Objectives To explore whether time to diagnosis, time to treatment initiation, and age to reach disability milestones have changed in patients with clinically isolated syndrome (CIS) according to different multiple sclerosis (MS) diagnostic criteria periods. Methods This retrospective study was based on data collected prospectively from the Barcelona-CIS cohort between 1994 and 2020. Patients were classified into 5 periods according to different MS criteria, and the times to MS diagnosis and treatment initiation were evaluated. The age at which patients with MS reached an Expanded Disability Status Scale (EDSS) score >= 3.0 was assessed by Cox regression analysis according to diagnostic criteria periods. Last, to remove the classic Will Rogers phenomenon by which the use of different MS criteria over time might result in a changes of prognosis, the 2017 McDonald criteria were applied, and age at EDSS score >= 3.0 was assessed by Cox regression. Results In total, 1,174 patients were included. The median time from CIS to MS diagnosis and from CIS to treatment initiation showed a 77% and 82% reduction from the Poser to the McDonald 2017 diagnostic criteria periods, respectively. Patients of a given age diagnosed in more recent diagnostic criteria periods had a lower risk of reaching an EDSS score >= 3.0 than patients of the same age diagnosed in earlier diagnostic periods (reference category Poser period): adjusted hazard ratio (aHR) 0.47 (95% confidence interval 0.24-0.90) for McDonald 2001, aHR 0.25 (0.12-0.54) for McDonald 2005, aHR 0.30 (0.12-0.75) for McDonald 2010, and aHR 0.07 (0.01-0.45) for McDonald 2017. Patients in the early-treatment group displayed an aHR of 0.53 (0.33-0.85) of reaching age at EDSS score >= 3.0 compared to those in the late-treatment group. Changes in prognosis together with early-treatment effect were maintained after the exclusion of possible bias derived from the use of different diagnostic criteria over time (Will Rogers phenomenon). Discussion A continuous decrease in the time to MS diagnosis and treatment initiation was observed across diagnostic criteria periods. Overall, patients diagnosed in more recent diagnostic criteria periods displayed a lower risk of reaching disability. The prognostic improvement is maintained after the Will Rogers phenomenon is discarded, and early treatment appears to be the most likely contributing factor.
引用
收藏
页码:E1641 / E1652
页数:12
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