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. 2022 Sep;43(9):5459-5469.
doi: 10.1007/s10072-022-06169-7. Epub 2022 Jun 7.

Do patients' and referral centers' characteristics influence multiple sclerosis phenotypes? Results from the Italian multiple sclerosis and related disorders register

Roberto Bergamaschi  1 , Ettore Beghi  2 , Cristina Bosetti  2 , Michela Ponzio  3 , Claudia Santucci  2   4 , Vito Lepore  2 , Paola Mosconi  5   6 ; Italian Multiple Sclerosis and Related Disorders Register Centers Group and the Scientific Committee of Italian SM and Related Disorders Register; U Aguglia, M P Amato, A L Ancona, B Ardito, C Avolio, R Balgera, P Banfi, V Barcella, P Barone, P Bellantonio, A Berardinelli, R Bergamaschi, P Bertora, M Bianchi, P Bramanti, V Brescia Morra, G Brichetto, A M Brioschi, M Buccafusca, S Bucello, V Busillo, B Calchetti, R Cantello, M Capobianco, F Capone, L Capone, D Cargnelutti, M Carrozzi, E Cartechini, G Cavaletti, P Cavalla, M G Celani, R Clerici, M Clerico, E Cocco, P Confalonieri, M G Coniglio, A Conte, F Corea, S Cottone, P Crociani, F D'Andrea, M C Danni, G De Luca, D de Pascalis, M De Riz, F De Robertis, G De Rosa, N De Stefano, M Della Corte, A Di Sapio, R Docimo, M Falcini, N Falcone, S Fermi, E Ferraro, M T Ferrò, M Fortunato, M Foschi, A Gajofatto, A Gallo, P Gallo, M Gatto, P Gazzola, A Giordano, F Granella, M F Grasso, M G Grasso, L M E Grimaldi, P Iaffaldano, D Imperiale, M Inglese, R Iodice, S Leva, V Luezzi, A Lugaresi, G Lus, D Maimone, L Mancinelli, G T Maniscalco, G A Marfia, B Marini, A Marson, N Mascoli, L Massacesi, F Melani, M Merello, G Meucci, M Mirabella, S Montepietra, D Nasuelli, P Nicolao, F Passantino, F Patti, M Peresson, I Pesci, C Piantadosi, M L Piras, M Pizzorno, K Plewnia, C Pozzilli, A Protti, R Quatrale, S Realmuto, G Ribizzi, S Rinalduzzi, A Rini, S Romano, M Romeo, M Ronzoni, P Rossi, M Rovaris, G Salemi, G Santangelo, M Santangelo, G Santuccio, P Sarchielli, L Sinisi, P Sola, C Solaro, D Spitaleri, S Strumia, T Tassinari, S Tonietti, C Tortorella, R Totaro, A Tozzo, G Trivelli, M Ulivelli, P Valentino, S Venturi, M Vianello, M Zaffaroni, R Zarbo, Maria Trojano, Mario Alberto Battaglia, Marco Capobianco, Maura Pugliatti, Monica Ulivelli, Paola Mosconi, Claudio Gasperini, Francesco Patti, Maria Pia Amato, Roberto Bergamaschi, Giancarlo Comi
Affiliations

Do patients' and referral centers' characteristics influence multiple sclerosis phenotypes? Results from the Italian multiple sclerosis and related disorders register

Roberto Bergamaschi et al. Neurol Sci. 2022 Sep.

Abstract

Background: Multiple sclerosis (MS) is characterized by phenotypical heterogeneity, partly resulting from demographic and environmental risk factors. Socio-economic factors and the characteristics of local MS facilities might also play a part.

Methods: This study included patients with a confirmed MS diagnosis enrolled in the Italian MS and Related Disorders Register in 2000-2021. Patients at first visit were classified as having a clinically isolated syndrome (CIS), relapsing-remitting (RR), primary progressive (PP), progressive-relapsing (PR), or secondary progressive MS (SP). Demographic and clinical characteristics were analyzed, with centers' characteristics, geographic macro-areas, and Deprivation Index. We computed the odds ratios (OR) for CIS, PP/PR, and SP phenotypes, compared to the RR, using multivariate, multinomial, mixed effects logistic regression models.

Results: In all 35,243 patients from 106 centers were included. The OR of presenting more advanced MS phenotypes than the RR phenotype at first visit significantly diminished in relation to calendar period. Females were at a significantly lower risk of a PP/PR or SP phenotype. Older age was associated with CIS, PP/PR, and SP. The risk of a longer interval between disease onset and first visit was lower for the CIS phenotype, but higher for PP/PR and SP. The probability of SP at first visit was greater in the South of Italy.

Discussion: Differences in the phenotype of MS patients first seen in Italian centers can be only partly explained by differences in the centers' characteristics. The demographic and socio-economic characteristics of MS patients seem to be the main determinants of the phenotypes at first referral.

Keywords: Centers’ characteristics; Italian Multiple Sclerosis Register; Multiple sclerosis phenotypes; Real-world data.

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Conflict of interest statement

RB as an advisory board member reports, speakers’ honoraria, travel support, research grants, consulting fees, and stock support from Almiral, Bayer, Biogen, Merck, Novartis, Roche, Sanofi, and Teva. EB reports financial support for research from the Italian Ministry of Health, the American ALS Association, Swedish Orphan Biovitrum, and personal compensation from Arvelle Therapeutics for advisory board membership, outside the present study. PM, VL, CB, and CS report no conflicts of interest.

Figures

Fig. 1
Fig. 1
Distribution of study centers from Italian MS and Related Disorders Register by geographic macro-area at first visit and deprivation index
See this image and copyright information in PMC

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