期刊
ANNALS OF NEUROLOGY
卷 80, 期 4, 页码 499-510出版社
WILEY
DOI: 10.1002/ana.24747
关键词
-
资金
- NIH - National Institute of Neurological Diseases and Stroke [RO1NS26799, K23 NS048869, K23 NS067055]
- Valhalla Foundation
Objective: To characterize the accrual of long-term disability in a cohort of actively treated multiple sclerosis (MS) patients and to assess whether clinical and magnetic resonance imaging (MRI) data used in clinical trials have long-term prognostic value. Methods: This is a prospective study of 517 actively managed MS patients enrolled at a single center. Results: More than 91% of patients were retained, with data ascertained up to 10 years after the baseline visit. At this last assessment, neurologic disability as measured by the Expanded Disability Status Scale (EDSS) was stable or improved compared to baseline in 41% of patients. Subjects with no evidence of disease activity (NEDA) by clinical and MRI criteria during the first 2 years had long-term outcomes that were no different from those of the cohort as a whole. 25-OH vitamin D serum levels were inversely associated with short-term MS disease activity; however, these levels had no association with long-term disability. At a median time of 16.8 years after disease onset, 10.7% (95% confidence interval [CI] 57.2-14%) of patients reached an EDSS >= 6, and 18.1% (95% CI=13.5-22.5%) evolved from relapsing MS to secondary progressive MS (SPMS). Interpretation: Rates of worsening and evolution to SPMS were substantially lower when compared to earlier natural history studies. Notably, the NEDA 2-year endpoint was not a predictor of long-term stability. Finally, the data call into question the utility of annual MRI assessments as a treat-to-target approach for MS care.
作者
我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。
推荐
暂无数据