Juan I Rojas1,2, Agustín Pappolla3, Patricio Blaya4, Mariano Marrodán5, María C Ysrraelit5, Geraldine Luetic6, Susana Liwacki7,8, Andrés Barboza9, Marcos Burgos10, Leila Cohen11, Carolina Mainella12, Gisela Zanga13, María L Menichini14, Dario Tavolini15, Verónica Tkachuk16, Pablo Lopez17, Felisa Lequizamon18, Eduardo Knorre18, Pedro Nofal19, Liliana Patrucco3, Jimena Miguez3, Edgardo Cristiano20, Marcela Fiol5, Jorge Correale5, María I Gaitán5, Ricardo Alonso11,19, Berenice Silva11, Orlando Garcea11, Adriana Carrá21,22, Nora Fernandez Liguori19,23, Marina Alonso Serena24, Edgar Carnero Contentti17. 1. Centro de Esclerosis Múltiple de Buenos Aires, (CEMBA), Billinghurst 1611, CP 1181, Buenos Aires, Argentina. rojasjuanignacio@gmail.com. 2. Servicio de Neurología, Unidad de EM y Enfermedades Desmielinizantes, Hospital Universitario de CEMIC, Buenos Aires, Argentina. rojasjuanignacio@gmail.com. 3. Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. 4. Neurocomp, Trelew, Argentina. 5. Department of Neurology, Fleni, Buenos Aires, Argentina. 6. Instituto de Neurociencias de Rosario, Rosario, Argentina. 7. Clínica Universitaria Reina Fabiola, Cordoba, Argentina. 8. Servicio de Neurología, Hospital Córdoba, Cordoba, Argentina. 9. Hospital Central de Mendoza, Mendoza, Argentina. 10. Servicio de Neurología, Hospital San Bernardo, Salta, Argentina. 11. Facultad de Medicina - UBA, Centro Universitario de Esclerosis Múltiple, Hospital Dr. J. M. Ramos Mejía, CABA, Buenos Aires, Argentina. 12. Hospital Español de Rosario, Santa Fe, Argentina. 13. Unidad Asistencial César Milstein, Buenos Aires, Argentina. 14. Sanatorio Británico, Rosario, Argentina. 15. INECO Neurociencias, Fundación INECO, Rosario, Argentina. 16. Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología, Hospital de Clínicas José de San Martín, Buenos Aires, Argentina. 17. Neuroimmunology Unit, Department of Neuroscience, Hospital Aleman, Buenos Aires, Argentina. 18. Hospital de Agudos, Dr. Teodoro Álvarez, Buenos Aires, Argentina. 19. Sanatorio Güemes, Buenos Aires, Argentina. 20. Centro de Esclerosis Múltiple de Buenos Aires, (CEMBA), Billinghurst 1611, CP 1181, Buenos Aires, Argentina. 21. Sección de Enfermedades Desmielinizantes, Hospital Británico, Buenos Aires, Argentina. 22. Instituto de Neurociencias - Fundación Favaloro/INECO, Buenos Aires, Argentina. 23. Hospital Enrique Tornú, Buenos Aires, Argentina. 24. Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Abstract
INTRODUCTION: We aimed to analyze the accumulative risk of MRI and OB factors for evolution from RIS to MS in subjects included in the Argentinean MS registry (NCT03375177). METHODS: RIS subjects were identified according to RIS diagnosis criteria. Subjects were longitudinally followed with clinical and MRI at intervals of 6 months. Time from RIS identification to the first clinical event was estimated using Kaplan-Meier. Multivariable Cox regression models were created to assess the independent predictive value of demographic characteristics, as well as clinical, OB and MRI data on time to the first clinical event. The single and increased risk factor of evolution of RIS was quantified. RESULTS: A total of 88 RIS subjects, mean follow-up time 42 ± 4 months were included. 39 (44.3%) and 23 (26.1%) had a new MRI lesion or a clinical event, respectively, during the follow-up. OB (HR 5.9, 95% CI 1.29-10.1, p = 0.004), infratentorial lesions (HR 3.7, 95% CI 1.09-7.5) and spinal cord lesions (HR 5.3, 95% CI 1.4-8.2, p = 0.01) at RIS identification were independent predictors associated with a subsequent clinical event. The accumulative risk showed that when two of the three factors (OB, infratentorial or spinal cord lesions) were present the HR was 10.4, 95% CI 4.4-22, p < 0.001, and when three factors were present, it was HR 15.6, 95% CI 5.7-28, p < 0.001 for a relapse. CONCLUSION: The presence of three factors significantly increased the risk of clinical event; high-risk subjects should probably be managed by a different approach than those used for individuals without high-risk factors.
INTRODUCTION: We aimed to analyze the accumulative risk of MRI and OB factors for evolution from RIS to MS in subjects included in the Argentinean MS registry (NCT03375177). METHODS: RIS subjects were identified according to RIS diagnosis criteria. Subjects were longitudinally followed with clinical and MRI at intervals of 6 months. Time from RIS identification to the first clinical event was estimated using Kaplan-Meier. Multivariable Cox regression models were created to assess the independent predictive value of demographic characteristics, as well as clinical, OB and MRI data on time to the first clinical event. The single and increased risk factor of evolution of RIS was quantified. RESULTS: A total of 88 RIS subjects, mean follow-up time 42 ± 4 months were included. 39 (44.3%) and 23 (26.1%) had a new MRI lesion or a clinical event, respectively, during the follow-up. OB (HR 5.9, 95% CI 1.29-10.1, p = 0.004), infratentorial lesions (HR 3.7, 95% CI 1.09-7.5) and spinal cord lesions (HR 5.3, 95% CI 1.4-8.2, p = 0.01) at RIS identification were independent predictors associated with a subsequent clinical event. The accumulative risk showed that when two of the three factors (OB, infratentorial or spinal cord lesions) were present the HR was 10.4, 95% CI 4.4-22, p < 0.001, and when three factors were present, it was HR 15.6, 95% CI 5.7-28, p < 0.001 for a relapse. CONCLUSION: The presence of three factors significantly increased the risk of clinical event; high-risk subjects should probably be managed by a different approach than those used for individuals without high-risk factors.
Authors: Naila Makhani; Christine Lebrun; Aksel Siva; Sona Narula; Evangeline Wassmer; David Brassat; J Nicholas Brenton; Philippe Cabre; Clarisse Carra Dallière; Jérôme de Seze; Francoise Durand Dubief; Matilde Inglese; Megan Langille; Guillaume Mathey; Rinze F Neuteboom; Jean Pelletier; Daniela Pohl; Daniel S Reich; Juan Ignacio Rojas; Veronika Shabanova; Eugene D Shapiro; Robert T Stone; Silvia Tenembaum; Mar Tintoré; Ugur Uygunoglu; Wendy Vargas; Sunita Venkateswaren; Patrick Vermersch; Orhun Kantarci; Darin T Okuda; Daniel Pelletier Journal: Mult Scler J Exp Transl Clin Date: 2019-03-20