CORe, Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia.
Central Clinical School, Monash University, Melbourne, VIC, Australia The Alfred, Melbourne, VIC, Australia.
Mult Scler. 2020 Jan;26(1):79-90. doi: 10.1177/1352458519868990. Epub 2019 Aug 9.
The risk factors for conversion from relapsing-remitting to secondary progressive multiple sclerosis remain highly contested.
The aim of this study was to determine the demographic, clinical and paraclinical features that influence the risk of conversion to secondary progressive multiple sclerosis.
Patients with adult-onset relapsing-remitting multiple sclerosis and at least four recorded disability scores were selected from MSBase, a global observational cohort. The risk of conversion to objectively defined secondary progressive multiple sclerosis was evaluated at multiple time points per patient using multivariable marginal Cox regression models. Sensitivity analyses were performed.
A total of 15,717 patients were included in the primary analysis. Older age (hazard ratio (HR) = 1.02, < 0.001), longer disease duration (HR = 1.01, = 0.038), a higher Expanded Disability Status Scale score (HR = 1.30, < 0.001), more rapid disability trajectory (HR = 2.82, < 0.001) and greater number of relapses in the previous year (HR = 1.07, = 0.010) were independently associated with an increased risk of secondary progressive multiple sclerosis. Improving disability (HR = 0.62, = 0.039) and disease-modifying therapy exposure (HR = 0.71, = 0.007) were associated with a lower risk. Recent cerebral magnetic resonance imaging activity, evidence of spinal cord lesions and oligoclonal bands in the cerebrospinal fluid were not associated with the risk of conversion.
Risk of secondary progressive multiple sclerosis increases with age, duration of illness and worsening disability and decreases with improving disability. Therapy may delay the onset of secondary progression.
复发缓解型多发性硬化向继发进展型多发性硬化转化的危险因素仍存在很大争议。
本研究旨在确定影响向继发进展型多发性硬化转化风险的人口统计学、临床和临床前特征。
从 MSBase 中选择了具有成人起病的复发缓解型多发性硬化症且至少有 4 次记录的残疾评分的患者。使用多变量边际 Cox 回归模型，在每个患者的多个时间点评估向客观定义的继发进展型多发性硬化的转化风险。进行了敏感性分析。
共纳入 15717 例患者进行主要分析。年龄较大（风险比 (HR) = 1.02， < 0.001）、疾病持续时间较长（HR = 1.01， = 0.038）、扩展残疾状况量表评分较高（HR = 1.30， < 0.001）、残疾进展较快（HR = 2.82， < 0.001）和前一年发作次数较多（HR = 1.07， = 0.010）与继发进展型多发性硬化的风险增加独立相关。改善残疾（HR = 0.62， = 0.039）和疾病修饰治疗暴露（HR = 0.71， = 0.007）与较低的风险相关。最近的脑磁共振成像活动、脊髓病变证据和脑脊液寡克隆带与转化风险无关。
继发进展型多发性硬化的风险随年龄、疾病持续时间和残疾恶化而增加，随残疾改善而降低。治疗可能会延迟继发进展的发生。
