Division of Health Policy & Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
Division of Neurology, Faculty of Medicine, The University of British Columbia and Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, Canada.
Mult Scler. 2020 Oct;26(12):1510-1518. doi: 10.1177/1352458519866613. Epub 2019 Jul 29.
Relapsing-onset multiple sclerosis (MS) typically starts in early- to mid-adulthood, yet the trajectory of disease activity over the subsequent lifetime remains poorly defined. Previous studies have not quantified the age-specific portion of decreases in annualized relapse rates (ARR).
The aim of this article is to determine, under a range of disease-related assumptions, the age-specific component of decreases in ARR over time among adults with relapsing-onset MS.
We used a simulation modeling approach to examine a range of assumptions about changes in ARR due to age versus disability status. Scenarios included variations in initial ARR and rate of worsening on the Expanded Disability Status Scale. Model parameters were developed through analysis of MS patients in British Columbia, Canada, and literature review.
We found a substantial age-specific decrease in ARR in all simulated scenarios, independent of disability worsening. Under a range of clinically plausible assumptions, 88%-97% of the decrease was attributed to age and 3%-13% to disability. The age-specific decrease ranged from 22% to 37% per 5 years for a wide range of initial ARR (0.33-1.0).
Decreases in ARR were due mostly to age rather than disability status. To facilitate informed decision making in MS, it is important to quantify the dynamic relationship between relapses and age.
复发缓解型多发性硬化症（MS）通常在成年早期至中期发病，但随后一生中疾病活动的轨迹仍不清楚。以前的研究尚未量化年度复发率（ARR）下降的年龄特异性部分。
本文旨在确定在一系列与疾病相关的假设下，复发缓解型 MS 成人中 ARR 随时间的年龄特异性下降部分。
我们使用模拟建模方法来检查由于年龄与残疾状况而导致 ARR 变化的一系列假设。方案包括初始 ARR 和扩展残疾状况量表恶化率的变化。模型参数是通过对加拿大不列颠哥伦比亚省的 MS 患者进行分析和文献综述得出的。
我们发现，在所有模拟场景中，ARR 都有明显的年龄特异性下降，与残疾恶化无关。在一系列临床合理的假设下，ARR 下降的 88%-97%归因于年龄，3%-13%归因于残疾。ARR 初始值为 0.33-1.0 时，ARR 的年龄特异性下降范围为每 5 年 22%-37%。
ARR 的下降主要归因于年龄而不是残疾状况。为了促进 MS 中的知情决策，量化复发与年龄之间的动态关系非常重要。
