期刊
MULTIPLE SCLEROSIS JOURNAL
卷 26, 期 13, 页码 1658-1669出版社
SAGE PUBLICATIONS LTD
DOI: 10.1177/1352458519877810
关键词
Clinically isolated syndromes; multiple sclerosis; MRI; prognosis; disease-modifying treatment; prediction
资金
- Instituto Carlos III [PI15/00170, PI14/01439]
- Genzyme foundation [GENZYME-2015-01]
- Red Espanola de Esclerosis Multiple (REEM) - FIS
- Instituto de Salud Carlos III
- Ministry of Economy and Competitiveness in Spain
- Ajuts per donar Suport als Grups de Recerca de Catalunya - 'Agencia de Gestio d'Ajuts Universitaris i de Recerca' (AGAUR) of the Generalitat de Catalunya in Spain
- European Regional Development Fund
Objective: To explore the long-term outcomes of patients with clinically isolated syndromes from the Barcelona cohort. Methods: We selected patients with a follow-up longer than 10 years to (1) estimate the risks of multiple sclerosis (MS) and disability accumulation according to the baseline number of T2 lesions and to compare treated versus untreated patients and early versus delayed treatment, and (2) to study baseline features of patients with aggressive MS (Expanded Disability Status Scale (EDSS) > 6.0 at 10 years). Results: In all, 401 patients were included (mean follow-up of 14.4 (standard deviation of 2.9) years). A higher number of T2 lesions was associated with an earlier MS diagnosis and an earlier risk of irreversible disability. Early treatment was associated with a decreased risk of EDSS of 3.0: adjusted hazard ratio = 0.4, 95% confidence interval = (0.2, 0.7). Patients with aggressive MS differed in their baseline brain magnetic resonance images: The median (interquartile range) number of T2 lesions and contrast-enhancing lesions (CEL) was 71 (28-95) versus 7 (1-19) and 3 (1-24) versus 0 (0-1), respectively. The cut-offs that better classified patients with aggressive MS were 20 for T2 lesions and 2 for CEL. Conclusion: Although MS natural history is changing, a high lesion load at onset is helpful to identify patients at risk of presenting an aggressive MS.
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