Transition to secondary progression in relapsing-onset multiple sclerosis: Definitions and risk factors

Pietro Iaffaldano, Giuseppe Lucisano, Francesco Patti, Vincenzo Brescia Morra, Giovanna De Luca, Alessandra Lugaresi, Mauro Zaffaroni, Matilde Inglese, Giuseppe Salemi, Eleonora Cocco, Antonella Conte, Diana Ferraro, Simonetta Galgani, Roberto Bergamaschi, Carlo Pozzilli, Marco Salvetti, Giacomo Lus, Marco Rovaris, Giorgia Teresa Maniscalco, Francesco Ottavio LogulloDamiano Paolicelli, Mariaclara Achille, Giuseppina Marrazzo, Valeria Lovato, Giancarlo Comi, Massimo Filippi, Maria Pia Amato, Maria Trojano

Research output: Contribution to journalArticlepeer-review

Abstract

Background: No uniform criteria for a sensitive identification of the transition from relapsing–remitting multiple sclerosis (MS) to secondary-progressive multiple sclerosis (SPMS) are available. Objective: To compare risk factors of SPMS using two definitions: one based on the neurologist judgment (ND) and an objective data-driven algorithm (DDA). Methods: Relapsing-onset MS patients (n = 19,318) were extracted from the Italian MS Registry. Risk factors for SPMS and for reaching irreversible Expanded Disability Status Scale (EDSS) 6.0, after SP transition, were estimated using multivariable Cox regression models. Results: SPMS identified by the DDA (n = 2343, 12.1%) were older, more disabled and with a faster progression to severe disability (p < 0.0001), than those identified by the ND (n = 3868, 20.0%). In both groups, the most consistent risk factors (p < 0.05) for SPMS were a multifocal onset, an age at onset >40 years, higher baseline EDSS score and a higher number of relapses; the most consistent protective factor was the disease-modifying therapy (DMT) exposure. DMT exposure during SP did not impact the risk of reaching irreversible EDSS 6.0. Conclusion: A DDA definition of SPMS identifies more aggressive progressive patients. DMT exposure reduces the risk of SPMS conversion, but it does not prevent the disability accumulation after the SP transition.

Original languageEnglish
Pages (from-to)430-438
Number of pages9
JournalMultiple Sclerosis Journal
Volume 27
Issue number3
DOIs
Publication statusPublished - Mar 1 2021

Keywords

  • big data
  • data-driven algorithm
  • disease registry
  • Multiple sclerosis
  • prognosis
  • secondary progressive

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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