MS Progression Time Predicts Disability

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Information provided by:
Cherie C. Binns RN BS MSCN - a member of the MS Views and News advisory panel

This report is part of a 12-month Clinical Context series.
By Nancy Walsh, Staff Writer, MedPage Today
Published: November 19, 2012
Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston and Dorothy Caputo, MA, BSN, RN, Nurse Planner

Action Points

• A study found inconsistent outcomes among patients with early relapses of multiple sclerosis (MS), with some progressing rapidly to using a cane or becoming bedridden, but others not progressing at all over a 28-year follow-up period.
• Note that time to secondary progression appeared more predictive of later disability than timing or number of early relapses.

Time to secondary progression in multiple sclerosis (MS), not the frequency of early inflammatory attacks, was the strongest predictor of severe disability later on, researchers found.The likelihood of needing a cane for walking was reduced by 24% among patients who were free from progression for 5 years (OR 0.76, 95% CI 0.69 to 0.84), according to George C. Ebers, MD, of the University of Oxford in England, and colleagues.In addition, the probability of needing a walking aid fell by 42% (OR 0.58, 95% CI 0.51 to 0.67) for those without progression for 10 years and by 56% (OR 0.44, 95% CI 0.37 to 0.52) for those remaining progression-free for 15 years, the researchers reported online in Archives of Neurology."This study provides evidence that severe disability accumulation is induced by mechanisms tied to the onset and evolution of the progressive phase, which are largely independent of inflammatory attacks," they observed.Despite previous experience showing that the number of early relapses in MS correlates poorly with eventual disability, the rate of these attacks is often used as a marker for progression to disability, particularly in clinical trials.Continue Reading
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