Comparison of medical and social characteristics and quality of life of patients with primary- and secondary-progressive multiple sclerosis

Abstract

Management of patients with secondary progressive multiple sclerosis (SPMS) remains one of the most challenging tasks of modern neurology. Patients with SPMS present with more severe neurological symptoms, increased hospitalization frequency, pronounced cognitive impairment in most of them, and a higher level of fatigue than patients with relapsing-remitting MS (RRMS). Another unfavorable course of MS is primary progressive MS (PPMS) when there is a steady increase in neurological disorders from the very beginning of the disease.Objective: to compare medical and social characteristics and changes in quality of life (QoL) indexes in patients with PPMS and SPMS.Patients and methods. In total, 437 patients with PPMS from 19 constituent entities of the Russian Federation and 500 patients with SPMS from 15 Russian Federation regions were interviewed using the original medical and social questionnaire. At the same time, we studied the QoL of patients with PPMS and SPMS using the specific MusiQoL questionnaire.Results and discussion. Among the patients with PPMS, 54.3% were women and 45.7% – men. In patients with SPMS, women predominated (66.3% of women and 33.7% of men – the ratio was almost 2: 1). The degree of disability and the severity of the disease were higher in SPMS than in PPMS. The family continues to be the primary aid source in everyday life for patients with MS: 75–80% of patients who need such support receive it from their significant others. More patients with SPMS indicated a deterioration in their health status over the last year (70%, while among patients with PPMS – 55%). More patients with PPMS received outpatient care (82.1% compared to 64.7% in SPMS; p=0.01). Immobility and SPMS treatment problems were the main reasons for decreased outpatient care in patients with SPMS. Less than half of patients with SPMS (43.8%) and 62% of patients with PPMS received inpatient treatment. According to neurologists reports, there is a major problem in providing MS centers with effective drugs to treat both disease courses. When QoL was assessed, we found more profound changes in SPMS concerning both QoL's psychological and physical components. Only recently, a new drug, siponimod, has been approved for the treatment of SPMS. The lack of effective treatment formed the basis of negative attitudes towards the health care system in SPMS.Conclusion. QoL changes reflect the patient's attitude to his condition. The introduction of new drugs for the pathogenetic treatment of SPMS (siponimod) will improve the QoL indicators in SPMS.