Claudia Cristina Ferreira Vasconcelos1, Juliana Calvet Kallenbach Aurenção2, Luiz Claudio Santos Thuler3, Solange Camargo4, Marcos Papais Alvarenga5, Regina Maria Papais Alvarenga6. 1. Universidade Federal do Estado do Rio de Janeiro, Rua Mariz e Barros 775, Departamento de Neurologia, Tijuca, Rio de Janeiro CEP: 20270-901, Brazil. Electronic address: cfvas@hotmail.com. 2. Universidade Federal do Estado do Rio de Janeiro, Rua Mariz e Barros 775, Departamento de Neurologia, Tijuca, Rio de Janeiro CEP: 20270-901, Brazil. Electronic address: julianacka@hotmail.com. 3. Universidade Federal do Estado do Rio de Janeiro and Instituto Nacional de Câncer, Rua André Cavalcanti, 37 - Centro, Rio de Janeiro, RJ CEP 20231050, Brazil. Electronic address: lthuler@inca.gov.br. 4. Hospital Federal da Lagoa - Departamento de Neurologia, Rua Jardim Botânico, 501, Rio de Janeiro, Brazil. Electronic address: solangecamargo@ig.com.br. 5. Hospital Federal da Lagoa - Departamento de Neurologia, Rua Jardim Botânico, 501, Rio de Janeiro, Brazil. Electronic address: marcospalvarenga@hotmail.com. 6. Universidade Federal do Estado do Rio de Janeiro and Hospital Federal da Lagoa, Rua Mariz e Barros 775, Departamento de Neurologia, Tijuca, Rio de Janeiro CEP: 20270-901, Brazil. Electronic address: regina_alvarenga2004@hotmail.com.
Abstract
BACKGROUND: Predicting the long-term prognosis of patients with multiple sclerosis (MS) remains an uncertain and difficult task, with most data having been obtained exclusively from Caucasian cohorts. OBJECTIVE: To investigate clinical prognostic factors in a Brazilian mixed-race cohort. METHODS: Demographic, clinical and therapeutic factors were investigated in 303 patients with relapsing-remitting MS in relation to the following outcomes: time until reaching Expanded Disability Status Scale (EDSS) 3 and EDSS 6, and until secondary progression. RESULTS: Benign course was significantly more frequent among Caucasians when compared to Afrodescendants. Patients with a malignant course had more than one relapse in the first year of the disease and reached EDSS 3 faster if treatment was not started. In the multivariate analysis, the following factors were associated with a significantly shorter time until the established outcomes: male gender, being of African descent, non-recovery after the first relapse, two or more relapses during the first year, a short interval between initial relapses, initial polysymptomatic presentation of pyramidal and cerebellar dysfunction and no treatment prior to reaching EDSS 3. CONCLUSIONS: Being of African descent was found to be an unfavorable factor for all outcomes, reinforcing the need to take ethnicity into consideration when defining treatment, particularly in mixed MS populations.
BACKGROUND: Predicting the long-term prognosis of patients with multiple sclerosis (MS) remains an uncertain and difficult task, with most data having been obtained exclusively from Caucasian cohorts. OBJECTIVE: To investigate clinical prognostic factors in a Brazilian mixed-race cohort. METHODS: Demographic, clinical and therapeutic factors were investigated in 303 patients with relapsing-remitting MS in relation to the following outcomes: time until reaching Expanded Disability Status Scale (EDSS) 3 and EDSS 6, and until secondary progression. RESULTS: Benign course was significantly more frequent among Caucasians when compared to Afrodescendants. Patients with a malignant course had more than one relapse in the first year of the disease and reached EDSS 3 faster if treatment was not started. In the multivariate analysis, the following factors were associated with a significantly shorter time until the established outcomes: male gender, being of African descent, non-recovery after the first relapse, two or more relapses during the first year, a short interval between initial relapses, initial polysymptomatic presentation of pyramidal and cerebellar dysfunction and no treatment prior to reaching EDSS 3. CONCLUSIONS: Being of African descent was found to be an unfavorable factor for all outcomes, reinforcing the need to take ethnicity into consideration when defining treatment, particularly in mixed MS populations.
Authors: Seth N Levin; Claire S Riley; Amar Dhand; Charles C White; Shruthi Venkatesh; Blake Boehm; Caren Nassif; Lauren Socia; Kaho Onomichi; Victoria M Leavitt; Libby Levine; Rock Heyman; Rebecca S Farber; Wendy S Vargas; Zongqi Xia; Philip L De Jager Journal: Neurology Date: 2020-08-07 Impact factor: 9.910