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Late‐onset and young‐onset relapsing‐remitting multiple sclerosis: evidence from a retrospective long‐term follow‐up study
Author(s) -
D'Amico E.,
Patti F.,
Zanghì A.,
Chisari C. G.,
Lo Fermo S.,
Zappia M.
Publication year - 2018
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/ene.13745
Subject(s) - medicine , expanded disability status scale , multiple sclerosis , age of onset , cohort , natural history , pediatrics , proportional hazards model , retrospective cohort study , young adult , relapsing remitting , disease , psychiatry
Background and purpose Late‐onset multiple sclerosis (MS) has a prevalence of about 10–20% in natural history MS studies. Few data have been published about the long‐term disease trajectory in the cohort of late‐onset relapsing‐remitting MS ( LORRMS ). The aim of this study was to identify the risk factors for reaching an Expanded Disability Status Scale ( EDSS ) score of 6.0 in LORRMS (onset at >40 years of age) and young‐onset relapsing‐remitting MS ( YORRMS ) (onset between 18 and 40 years of age). Methods Clinical and radiological [magnetic resonance imaging (MRI) of the brain] follow‐up data were collected. Disability was assessed by EDSS score. A Cox proportional hazards model was used to evaluate the demographic and clinical predictors of reaching an EDSS score of 6.0 in the two cohorts. Results A total of 671 patients with relapsing‐remitting MS were enrolled, 143 (21.3%) with LORRMS and 528 (78.7%) with YORRMS . In LORRMS, age at onset was 47.8 ± 5.3 (mean ± SD ) years and duration of follow‐up was 120.7 ± 52.7 months. In YORRMS, age at onset was 27 ± 2.7 years and duration of follow‐up was 149.9 ± 92.7 months. The survival curve analyses showed a higher probability of reaching an EDSS score of 6.0 for LORRMS in a shorter time (months) than for YORRMS (94.2 vs. 103.2 months; log‐rank 8.8; P < 0.05). On MRI, YORRMS showed more brain inflammatory features than LORRMS . In the multivariate Cox model, age at onset [Exp(B) value, 6.5; 95% confidence interval, 1.9–22.6; P < 0.001] and male gender [Exp(B) value, 1.7; 95% confidence interval, 1.0–2.8; P < 0.05] were the strongest predictors of reaching an EDSS score of 6.0. Conclusions The male population with LORRMS reached severe disability faster than those with YORRMS , even when YORRMS showed more brain inflammatory features on MRI .