Traboulsee Anthony L, Cornelisseª Peter, Sandberg-Wollheim Magnhild, Uitdehaag Bernard Mj, Kappos Ludwig, Jongen Peter J, Constantinescu Cris S, di Cantogno Elisabetta Verdun, Li David Kb
Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
Merck Serono S.A., Geneva, Switzerland.
Mult Scler J Exp Transl Clin. 2016 Sep 6;2:2055217316666406. doi: 10.1177/2055217316666406. eCollection 2016 Jan-Dec.
The objective of this article is to investigate potential clinical and MRI predictors of long-term outcomes in multiple sclerosis (MS).
This was a post hoc analysis using data from all 382 patients in the PRISMS long-term follow-up (LTFU) study collected up to eight years after randomisation. An additional analysis was performed including only those patients originally randomised to receive early subcutaneous interferon (IFN) β-1a ( = 259). Baseline/prestudy variables, indicators of early clinical and MRI activity (baseline to month 24), and indicators of IFN β-1a treatment exposure (including medication possession ratio (MPR)) were investigated as candidate prognostic factors for outcomes measured from baseline and from month 24 to LTFU. Explanatory variables identified from univariate regression models ( ≤ 0.15) were selected for inclusion in stepwise multiple regression models.
Candidate prognostic factors selected by the univariate analysis ( ≤ 0.15) included age, MS duration, baseline brain volume, EDSS score, and log(T2 burden of disease (BOD)). In most of the multivariate regression models applied, higher baseline brain volume and MPR predicted better long-term clinical outcomes, while higher baseline and greater early increase in EDSS score predicted worse outcomes.
Identification of markers that may be prognostic for long-term disability could help identify MS patients at higher risk of disability progression.
本文旨在研究多发性硬化症（MS）长期预后的潜在临床和MRI预测因素。
这是一项事后分析，使用了PRISMS长期随访（LTFU）研究中所有382例患者的数据，这些数据是在随机分组后长达八年收集的。还进行了一项额外分析，仅纳入最初随机接受早期皮下注射干扰素（IFN）β-1a的患者（n = 259）。研究了基线/研究前变量、早期临床和MRI活动指标（基线至第24个月）以及IFNβ-1a治疗暴露指标（包括药物持有率（MPR）），作为从基线以及从第24个月至长期随访期间所测量结局的候选预后因素。从单变量回归模型（p≤0.15）中确定的解释变量被选入逐步多元回归模型。
单变量分析（p≤0.15）选择的候选预后因素包括年龄、MS病程、基线脑容量、扩展残疾状态量表（EDSS）评分以及log（T2疾病负担（BOD））。在大多数应用的多元回归模型中，较高的基线脑容量和MPR预测了更好的长期临床结局，而较高的基线和EDSS评分的早期较大增加则预测了更差的结局。
识别可能对长期残疾具有预后意义的标志物，有助于识别残疾进展风险较高的MS患者。
