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Observational Study
. 2016 Jul 8;11(7):e0158978.
doi: 10.1371/journal.pone.0158978. eCollection 2016.

Long Term Clinical Prognostic Factors in Relapsing-Remitting Multiple Sclerosis: Insights from a 10-Year Observational Study

Gabriel Bsteh  1 , Rainer Ehling  1 , Andreas Lutterotti  1   2 , Harald Hegen  1 , Franziska Di Pauli  1 , Michael Auer  1 , Florian Deisenhammer  1 , Markus Reindl  1 , Thomas Berger  1
Affiliations
Observational Study

Long Term Clinical Prognostic Factors in Relapsing-Remitting Multiple Sclerosis: Insights from a 10-Year Observational Study

Gabriel Bsteh et al. PLoS One. .

Abstract

Background: Multiple sclerosis (MS) has a highly heterogenic course making prediction of long term outcome very difficult.

Objective: The objective was to evaluate current and identify additional clinical factors that are linked to long term outcome of relapsing-remitting MS assessed by disability status 10 years after disease onset.

Methods: This observational study included 793 patients with relapsing-remitting MS. Clinical factors hypothesized to influence long term outcome measured by EDSS scores 10 years after disease onset were analysed by Kaplan-Meier-estimates. Multinomial logistic regression models regarding mild (EDSS ≤2.5), moderate (EDSS 3.0-5.5) or severe (EDSS ≥6.0) disability were calculated to correct for confounders.

Results: Secondary progression was the strongest predictor of severe disability (Hazard ratio [HR] 503.8, 95% confidence interval [CI] 160.0-1580.1); p<0.001). Complete remission of neurological symptoms at onset reduced the risk of moderate disability (HR 0.42; CI 0.23-0.77; p = 0.005), while depression (HR 3.59; CI 1.14-11.24; p = 0.028) and cognitive dysfunction (HR 4.64; CI 1.11-19.50; p = 0.036) 10 years after disease onset were associated with severe disability. Oligoclonal bands and pregnancy were not correlated with disability.

Conclusion: We were able to identify clinically apparent chronic depression and cognitive dysfunction to be associated with adverse long term outcome in MS and to confirm that pregnancy has no negative impact. Additionally, we emphasize the positive predictive value of complete remission of initial symptoms.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Inclusion flow chart.
Abbreviations: ADEM = acute demyelinating encephalomyelitis; MS = multiple sclerosis; NMO = neuromyelitis optica; PPMS = primary progressive MS; RRMS = relapsing-remitting MS
Fig 2
Fig 2. time to depression.
Kaplan-Meier curves of the risk of developing depression according to disability status 10 years after onset. Log rank test used for calculation of significancy.
Fig 3
Fig 3. time to cognitive dysfunction.
Kaplan-Meier curves of the risk of developing cognitive dysfunction according to disability status 10 years after onset. Log rank test used for calculation of significancy.
See this image and copyright information in PMC

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