Summary
The onset of secondary progression is a pivotal event in the course of relapsing-remitting (RR) multiple sclerosis (MS). Patients with secondary progressive MS (SPMS) experience continuous worsening of symptoms independent of the occurrence of relapses. Possible risk factors associated with the onset of SPMS remain under investigated in natural history studies of MS disease course. Koch M, Kingwell E, Rieckman P, Tremlett H; UBC MS Clinic Neurologists., J Neurol Neurosurg Psychiatry. 2010 Jul 16. [Epub ahead of print]
Details
Investigators used Kaplan-Meier survival analyses and Cox
regression models to investigate the influence of gender, onset
age and onset symptoms on time to and age at SPMS in British
Columbia (BC) MS patients with a RR disease onset who were not
exposed to immunomodulatory drugs.
Of 5778 patients in the BCMS database with definite MS, 5207
(90%) had an RR onset. Median time to SPMS was 21.4 years (95% CI
20.6 to 22.2), reached at a median age of 53.7 years (95% CI 53.1
to 54.3). Male gender and motor onset symptoms were associated
with a shorter time to and a younger age at SPMS. A younger age
at disease onset was associated with a longer time to SPMS but
also with a younger age at secondary progression. Other onset
symptoms were not associated with time to, or age at, SPMS.
Conclusions Three factors influencing the onset of SPMS in
untreated patients with RRMS were identified: motor onset
symptoms and male gender were associated with both a shorter time
to and a younger age at SPMS. A younger age at disease onset
should not be viewed as indicating a better prognosis.