Multiple Sclerosis: A Method To Identify High Risk for Secondary Progression (P05.089)

Abstract

Objective: To predict secondary progression in remitting relapsing multiple sclerosis by including prognostic data successively as they appear during the individual course. Background Prediction of the highly variable outcome of multiple sclerosis has been a challenge for decades. A relationship between clinical and demographic predictors associated with the onset attack or initial phase of the disease and the risk of later progression was established, however with variable predictive ability, not reaching the level of useful individual prognostication. Design/Methods: This study was based on a temporally and geographically defined untreated incidence cohort followed for 45 years (n=307), and restricted to patients with a distinct second attack and MS according to the Poser criteria (N = 162). 123 of these patients converted to a secondary progressive course. There were 0.046 progression onset events per patient year. The risk of progression had an age related maximum around 30 years of age. We developed a statistical model that included information from the first relapse and onwards: number and time of new relapses, and clinical characteristics of these relapses. By applying the model on individual patients the momentary risk of secondary progression can be calculated. Results: Following a new relapse the risk increased abruptly, provided the relapse was not afferent and had no complete remission. The risk of progression then slowly changed during the subsequent years, influenced by age and time since last relapse. That model allows identification of patients with periods of high or low risk of progression, varying from 0.25 progression onset events per patient year. During high risk periods the expected time to secondary progression may then be as short as a few years. Conclusions: By applying the model we can find patients suitable for rescue therapy or for planning a trial of a new drug. Disclosure: Dr. Skoog has nothing to disclose. Dr. Runmarker has nothing to disclose. Dr. Oden has nothing to disclose. Dr. Andersen has nothing to disclose.