Free Communications 1Friday, October 04, 2013, 09:15 - 09:27
Predicting early conversion to multiple sclerosis in patients with clinically isolated syndromes: the importance of an integrated modeling of risk factorsV. Martinelli, G. Dalla Costa, B. Colombo, G. Di Maggio, R. Furlan, L. Leocani, M. Filippi, G. Comi (Milan, IT)
Background and Aims: The burden of multiple sclerosis (MS) continues to increase worldwide particularly in developed countries. As the current paradigm in multiple sclerosis is that axonal damage occurs early in the course of the disease and is therefore recognized the importance of an early diagnosis and treatment, the integration of all risk factors into an estimate of absolute risk is a starting point for an accurate risk management in individuals.
The aim of the current study is to investigate risk factors for the early development of clinically definite multiple sclerosis (CDMS) in patients with clinically isolated syndromes (CIS).
Methods: In this retrospective study patients admitted to San Raffaele Hospital within 3 months of CIS onset and with a minimum follow up of 2 years have been included. We evaluated baseline clinical data as well as MRI, multimodal evoked potential (MEP) and CSF data and assessed their prognostic value for subsequent development of CDMS.
311 CIS patients who met inclusion criteria and with complete data were identified. 210 (67,5%) were female (female:male ratio = 2:1) and the median age of CIS onset was 31.8 years (IQR 25.4-37.6).
170 CIS patients have MRI and neurophysiological data assessed so far. Among them, 91 (54%) patients developed CDMS during the entire follow up and 34% (58/170) at 2-year follow-up.
In a Cox proportional hazards model, intrathecal oligoclonal IgG bands (OCB) increased the risk of a second relapse at two year (hazard ratio, HR: 1.76; 95% confidence interval, CI: 0.93-3.1; adjusted for gender, age, MRI T2 and gadolinium (Gd)-enhancing lesions, MEP score). Gd-enhancing lesions were present in 79 patients (46%) and also moderately increased the risk of early CDMS (HR 1.41, CI: 0.8-2.5). Compared to those with 0 or 1 MRI lesions (17 patients, 10%), patients with 2-9 lesions (98 patients, 57.6%) showed a HR (adjusted for gender, age, OCB, gd-enhancing lesions, MEP score) for conversion to CDMS of 4.19 (1.01-7.53) and patients with >9 lesions (55 patients, 32.4%) of 5.79 (1.36-14.7).
Conclusions: Magnetic risonance imaging and CSF oligoclonal bands are independent risk factors for the early development of CDMS. The integration of MRI, CSF and multimodal evoked potential data is essential for an accurate risk management in patients with clinically isolated syndromes.
V. Martinelli has received personal compensation for activities with Biogen Dompe, Merck Serono, Bayer Schering, TEVA and Sanofi Aventis as a speaker. M. Filippi has received honoraria for lectures and travel expenses and consulting fees as an investigator in previous and current treatment trials from Teva, Merck Serono, Bayer Schering Pharma AG, Biogen-Dompe and Genmab; received research support from Teva, Merck Serono,Bayer Schering Pharma, Biogen-Dompe and Genmab. reports no disclosures. G. Comi has received compensation for consulting services and/or speaking activities from Bayer Schering Pharma AG, Serono Symposia International Foundation, Merck Serono International, Teva, Sanofi-Aventis and Biogen Dompe. G. Dalla Costa, B. Colombo, R. Furlan and L. Leocani report no discosures.