Abstract
BackgroundWe aimed to determine the association of clinical and routine cerebrospinal fluid biochemical markers (total protein, IgG index and oligoclonal bands) with disability in multiple sclerosis and whether these biomarkers assessed at diagnosis add prognostic value.MethodsWe followed a cohort of patients included in the Multiple Sclerosis Lorraine Register (eastern France) who had a diagnosis of multiple sclerosis for at least 5 years, as well as biological markers values and MRI findings (Barkhof’s criteria). In a Cox regression model, endpoint was time to score of 4 on the Expanded Disability Status Scale (EDSS) (i.e., limited time walking without aid or rest for more than 500 m).ResultsFor 407 patients included, the median time from multiple sclerosis onset to EDSS score 4 was 4.5 years [2.2–7.2]. Cerebrospinal fluid total protein factor < 500 mg/L was associated with EDSS score 4 on bivariate analysis (hazard ratio 0.66, 95% confidence interval 0.46–0.95, p = 0.02). On multivariate analysis, older age at disease onset (≥50 years) and initial primary progressive course of MS but not biological markers predicted worse prognosis.ConclusionRoutine cerebrospinal fluid biological markers at diagnosis were not prognostic factors of multiple sclerosis progression.
Highlights
We aimed to determine the association of clinical and routine cerebrospinal fluid biochemical markers with disability in multiple sclerosis and whether these biomarkers assessed at diagnosis add prognostic value
Patient sampling Inclusion criteria were time from multiple sclerosis (MS) onset of at least 5 years [24], a lumbar puncture within 10 years after the MS onset, with complete routine cerebrospinal fluid (CSF) biological data available (CSF oligoclonal IgG bands (OCGBs) are stable over time [33,34,35] reflecting status at diagnosis if puncture was performed later), and Barkhof ’s criteria available
We defined a treatment variable, with treatment as present as soon as the first treatment longer than six months before the time to assignment of irreversible EDSS4 for each patient. We considered that this six months time threshold was the minimal time after which we could estimate the beneficial role of the treatment
Summary
We aimed to determine the association of clinical and routine cerebrospinal fluid biochemical markers (total protein, IgG index and oligoclonal bands) with disability in multiple sclerosis and whether these biomarkers assessed at diagnosis add prognostic value. Among CSF markers, oligoclonal IgG bands (OCGBs) are present in more than 95% of patients with MS [3,4] and may have utility and prognostic value for MS diagnosis [5]. Another prognostic CSF marker may be IgG index [6]. CSF markers with prognostic value at diagnosis would provide the physician with useful information early in the disease course to adjust treatment, without waiting for further clinical manifestations
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