Open AccessConfirmed disability progression provides limited predictive information regarding future disease progression in multiple sclerosis
Author(s) -
Brian Healy,
Bonnie Glanz,
Elyse Swallow,
James Signorovitch,
Kaitlin Hagan,
Diego Augusto Santos Silva,
Corey Pelletier,
Tanuja Chitnis,
Howard L. Weiner
Publication year - 2021
Publication title -
multiple sclerosis journal, experimental, translational and clinical
Language(s) - English
Resource type - Journals
ISSN - 2055-2173
DOI - 10.1177/2055217321999070
Subject(s) - expanded disability status scale , multiple sclerosis , medicine , proportional hazards model , akaike information criterion , clinically isolated syndrome , predictive value , physical therapy , statistics , psychiatry , mathematics
Background Although confirmed disability progression (CDP) is a common outcome in multiple sclerosis (MS) clinical trials, its predictive value for long-term outcomes is uncertain.Objective To investigate whether CDP at month 24 predicts subsequent disability accumulation in MS.Methods The Comprehensive Longitudinal Investigation of Multiple Sclerosis at Brigham and Women’s Hospital includes participants with relapsing-remitting MS or clinically isolated syndrome with Expanded Disability Status Scale (EDSS) scores ≤5 (N = 1214). CDP was assessed as a predictor of time to EDSS score 6 (EDSS 6) and to secondary progressive MS (SPMS) using a Cox proportional hazards model; adjusted models included additional clinical/participant characteristics. Models were compared using Akaike’s An Information Criterion.Results CDP was directionally associated with faster time to EDSS 6 in univariate analysis (HR = 1.61 [95% CI: 0.83, 3.13]). After adjusting for month 24 EDSS, CDP was directionally associated with slower time to EDSS 6 (adjusted HR = 0.65 [0.32, 1.28]). Models including CDP had worse fit statistics than those using EDSS scores without CDP. When models included clinical and magnetic resonance imaging measures, T2 lesion volume improved fit statistics. Results were similar for time to SPMS.Conclusions CDP was less predictive of time to subsequent events than other MS clinical features.