Cecilia Smith Simonsen1,2,3, Heidi Øyen Flemmen4,5, Line Broch6,7,8, Cathrine Brunborg9, Pål Berg-Hansen7, Stine Marit Moen10, Elisabeth Gulowsen Celius7,8. 1. Department of Neurology, Vestre Viken Hospital Trust, Dronninggata, 3004, Drammen, Norway. cecsim@vestreviken.no. 2. Department of Neurology, Oslo University Hospital, Oslo, Norway. cecsim@vestreviken.no. 3. Institute of Clinical Medicine, University of Oslo, Oslo, Norway. cecsim@vestreviken.no. 4. Department of Neurology, Hospital Telemark HF, Skien, Oslo, Norway. 5. Institute of Health and Society, University of Oslo, Oslo, Norway. 6. Department of Neurology, Vestre Viken Hospital Trust, Dronninggata, 3004, Drammen, Norway. 7. Department of Neurology, Oslo University Hospital, Oslo, Norway. 8. Institute of Clinical Medicine, University of Oslo, Oslo, Norway. 9. Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway. 10. MS-Centre Hakadal, Grønvoll, Norway.
Abstract
OBJECTIVES: Over the past few decades, there has been an improvement in the rate of disability progression in multiple sclerosis (MS) patients, and most studies relate this evolvement to the introduction of disease-modifying therapies. However, several other factors have changed over this period, including access to MRI and newer diagnostic criteria. The aim of this study is to investigate changes in the natural course of MS over time in a near-complete and geographically well-defined population from the south-east of Norway. METHODS: We examined disease progression and demographics over two decades and assessed the effect of disease-modifying therapies using linear mixed-effect models. RESULTS: In a cohort of 2097 patients, we found a significant improvement in disability as measured by the Expanded Disability Status Scale (EDSS) stratified by age, and the improvement remained significant after adjusting for time on disease-modifying medications, gender and progressive MS at onset. The time from disease onset to EDSS 6 in the total cohort was 29.8 years (95% CI 28.5-31.1) and was significantly longer in patients diagnosed after 2006 compared to patients diagnosed before. There are significant differences between patient demographics, as well as time to EDSS 6, in the near-complete, geographically well-defined population compared to an additional cohort from the capital Oslo and its suburbs. CONCLUSION: The natural course of MS is improving, but the improvement seen in disease progression has multifaceted explanations. Our study underlines the importance of completeness of data, relevant timeframes and demographics when comparing different MS populations. Studies on incomplete populations should be interpreted with caution.
OBJECTIVES: Over the past few decades, there has been an improvement in the rate of disability progression in multiple sclerosis (MS) patients, and most studies relate this evolvement to the introduction of disease-modifying therapies. However, several other factors have changed over this period, including access to MRI and newer diagnostic criteria. The aim of this study is to investigate changes in the natural course of MS over time in a near-complete and geographically well-defined population from the south-east of Norway. METHODS: We examined disease progression and demographics over two decades and assessed the effect of disease-modifying therapies using linear mixed-effect models. RESULTS: In a cohort of 2097 patients, we found a significant improvement in disability as measured by the Expanded Disability Status Scale (EDSS) stratified by age, and the improvement remained significant after adjusting for time on disease-modifying medications, gender and progressive MS at onset. The time from disease onset to EDSS 6 in the total cohort was 29.8 years (95% CI 28.5-31.1) and was significantly longer in patients diagnosed after 2006 compared to patients diagnosed before. There are significant differences between patient demographics, as well as time to EDSS 6, in the near-complete, geographically well-defined population compared to an additional cohort from the capital Oslo and its suburbs. CONCLUSION: The natural course of MS is improving, but the improvement seen in disease progression has multifaceted explanations. Our study underlines the importance of completeness of data, relevant timeframes and demographics when comparing different MS populations. Studies on incomplete populations should be interpreted with caution.
Entities:
Keywords:
Disease course; Epidemiology; Multiple sclerosis; Natural history; Time to EDSS 6
Authors: Gavin Giovannoni; Giancarlo Comi; Stuart Cook; Kottil Rammohan; Peter Rieckmann; Per Soelberg Sørensen; Patrick Vermersch; Peter Chang; Anthony Hamlett; Bruno Musch; Steven J Greenberg Journal: N Engl J Med Date: 2010-01-20 Impact factor: 91.245
Authors: Chris H Polman; Stephen C Reingold; Brenda Banwell; Michel Clanet; Jeffrey A Cohen; Massimo Filippi; Kazuo Fujihara; Eva Havrdova; Michael Hutchinson; Ludwig Kappos; Fred D Lublin; Xavier Montalban; Paul O'Connor; Magnhild Sandberg-Wollheim; Alan J Thompson; Emmanuelle Waubant; Brian Weinshenker; Jerry S Wolinsky Journal: Ann Neurol Date: 2011-02 Impact factor: 10.422
Authors: Jeffrey A Cohen; Maria Trojano; Ellen M Mowry; Bernard Mj Uitdehaag; Stephen C Reingold; Ruth Ann Marrie Journal: Mult Scler Date: 2019-11-28 Impact factor: 6.312
Authors: Chris H Polman; Paul W O'Connor; Eva Havrdova; Michael Hutchinson; Ludwig Kappos; David H Miller; J Theodore Phillips; Fred D Lublin; Gavin Giovannoni; Andrzej Wajgt; Martin Toal; Frances Lynn; Michael A Panzara; Alfred W Sandrock Journal: N Engl J Med Date: 2006-03-02 Impact factor: 91.245
Authors: Gregory A Roth; Catherine O Johnson; Kalkidan Hassen Abate; Foad Abd-Allah; Muktar Ahmed; Khurshid Alam; Tahiya Alam; Nelson Alvis-Guzman; Hossein Ansari; Johan Ärnlöv; Tesfay Mehari Atey; Ashish Awasthi; Tadesse Awoke; Aleksandra Barac; Till Bärnighausen; Neeraj Bedi; Derrick Bennett; Isabela Bensenor; Sibhatu Biadgilign; Carlos Castañeda-Orjuela; Ferrán Catalá-López; Kairat Davletov; Samath Dharmaratne; Eric L Ding; Manisha Dubey; Emerito Jose Aquino Faraon; Talha Farid; Maryam S Farvid; Valery Feigin; João Fernandes; Joseph Frostad; Alemseged Gebru; Johanna M Geleijnse; Philimon Nyakauru Gona; Max Griswold; Gessessew Bugssa Hailu; Graeme J Hankey; Hamid Yimam Hassen; Rasmus Havmoeller; Simon Hay; Susan R Heckbert; Caleb Mackay Salpeter Irvine; Spencer Lewis James; Dube Jara; Amir Kasaeian; Abdur Rahman Khan; Sahil Khera; Abdullah T Khoja; Jagdish Khubchandani; Daniel Kim; Dhaval Kolte; Dharmesh Lal; Anders Larsson; Shai Linn; Paulo A Lotufo; Hassan Magdy Abd El Razek; Mohsen Mazidi; Toni Meier; Walter Mendoza; George A Mensah; Atte Meretoja; Haftay Berhane Mezgebe; Erkin Mirrakhimov; Shafiu Mohammed; Andrew Edward Moran; Grant Nguyen; Minh Nguyen; Kanyin Liane Ong; Mayowa Owolabi; Martin Pletcher; Farshad Pourmalek; Caroline A Purcell; Mostafa Qorbani; Mahfuzar Rahman; Rajesh Kumar Rai; Usha Ram; Marissa Bettay Reitsma; Andre M N Renzaho; Maria Jesus Rios-Blancas; Saeid Safiri; Joshua A Salomon; Benn Sartorius; Sadaf Ghajarieh Sepanlou; Masood Ali Shaikh; Diego Silva; Saverio Stranges; Rafael Tabarés-Seisdedos; Niguse Tadele Atnafu; J S Thakur; Roman Topor-Madry; Thomas Truelsen; E Murat Tuzcu; Stefanos Tyrovolas; Kingsley Nnanna Ukwaja; Tommi Vasankari; Vasiliy Vlassov; Stein Emil Vollset; Tolassa Wakayo; Robert Weintraub; Charles Wolfe; Abdulhalik Workicho; Gelin Xu; Simon Yadgir; Yuichiro Yano; Paul Yip; Naohiro Yonemoto; Mustafa Younis; Chuanhua Yu; Zoubida Zaidi; Maysaa El Sayed Zaki; Ben Zipkin; Ashkan Afshin; Emmanuela Gakidou; Stephen S Lim; Ali H Mokdad; Mohsen Naghavi; Theo Vos; Christopher J L Murray Journal: JAMA Cardiol Date: 2018-05-01 Impact factor: 14.676
Authors: Marinos G Sotiropoulos; Hrishikesh Lokhande; Brian C Healy; Mariann Polgar-Turcsanyi; Bonnie I Glanz; Rohit Bakshi; Howard L Weiner; Tanuja Chitnis Journal: Mult Scler J Exp Transl Clin Date: 2021-05-28
Authors: Melissa Wy Leung; Marloes T Bazelier; Patrick C Souverein; Bernard Mj Uitdehaag; Olaf H Klungel; Hubert Gm Leufkens; Romin Pajouheshnia Journal: Mult Scler Date: 2022-05-14 Impact factor: 5.855