TY - JOUR
T1 - Quantifying risk of early relapse in patients with first demyelinating events
T2 - Prediction in clinical practice
AU - Spelman, Tim
AU - Meyniel, Claire
AU - Rojas, Juan Ignacio
AU - Lugaresi, Alessandra
AU - Izquierdo, Guillermo
AU - Grand’Maison, Francois
AU - Boz, Cavit
AU - Alroughani, Raed A
AU - Havrdova, Eva
AU - Horakova, Dana
AU - Iuliano, Gerardo
AU - Duquette, Pierre Pascal
AU - Terzi, Murat
AU - Grammond, Pierre
AU - Hupperts, Raymond
AU - Lechner-Scott, Jeannette
AU - Oreja-Guevara, Celia
AU - Pucci, Eugenio
AU - Verheul, Freek
AU - Fiol, Marcela
AU - Van Pesch, Vincent
AU - Cristiano, Edgardo
AU - Petersen, Thor
AU - Moore, Fraser G A
AU - Kalincik, Tomas
AU - Jokubaitis, Vilija G
AU - Trojano, Maria
AU - Butzkueven, Helmut
AU - on behalf of the MSBasis (an MSBase Substudy) Investigators
PY - 2017/9/1
Y1 - 2017/9/1
N2 - Background: Characteristics at clinically isolated syndrome (CIS) examination assist in identification of patient at highest risk of early second attack and could benefit the most from early disease-modifying drugs (DMDs). Objective: To examine determinants of second attack and validate a prognostic nomogram for individualised risk assessment of clinical conversion. Methods: Patients with CIS were prospectively followed up in the MSBase Incident Study. Predictors of clinical conversion were analysed using Cox proportional hazards regression. Prognostic nomograms were derived to calculate conversion probability and validated using concordance indices. Results: A total of 3296 patients from 50 clinics in 22 countries were followed up for a median (inter-quartile range (IQR)) of 1.92 years (0.90, 3.71). In all, 1953 (59.3%) patients recorded a second attack. Higher Expanded Disability Status Scale (EDSS) at baseline, first symptom location, oligoclonal bands and various brain and spinal magnetic resonance imaging (MRI) metrics were all predictors of conversion. Conversely, older age and DMD exposure post-CIS were associated with reduced rates. Prognostic nomograms demonstrated high concordance between estimated and observed conversion probabilities. Conclusion: This multinational study shows that age at CIS onset, DMD exposure, EDSS, multiple brain and spinal MRI criteria and oligoclonal bands are associated with shorter time to relapse. Nomogram assessment may be useful in clinical practice for estimating future clinical conversion.
AB - Background: Characteristics at clinically isolated syndrome (CIS) examination assist in identification of patient at highest risk of early second attack and could benefit the most from early disease-modifying drugs (DMDs). Objective: To examine determinants of second attack and validate a prognostic nomogram for individualised risk assessment of clinical conversion. Methods: Patients with CIS were prospectively followed up in the MSBase Incident Study. Predictors of clinical conversion were analysed using Cox proportional hazards regression. Prognostic nomograms were derived to calculate conversion probability and validated using concordance indices. Results: A total of 3296 patients from 50 clinics in 22 countries were followed up for a median (inter-quartile range (IQR)) of 1.92 years (0.90, 3.71). In all, 1953 (59.3%) patients recorded a second attack. Higher Expanded Disability Status Scale (EDSS) at baseline, first symptom location, oligoclonal bands and various brain and spinal magnetic resonance imaging (MRI) metrics were all predictors of conversion. Conversely, older age and DMD exposure post-CIS were associated with reduced rates. Prognostic nomograms demonstrated high concordance between estimated and observed conversion probabilities. Conclusion: This multinational study shows that age at CIS onset, DMD exposure, EDSS, multiple brain and spinal MRI criteria and oligoclonal bands are associated with shorter time to relapse. Nomogram assessment may be useful in clinical practice for estimating future clinical conversion.
KW - CIS
KW - clinically definite multiple sclerosis
KW - clinically isolated syndrome
KW - CSF
KW - disease-modifying drugs
KW - MRI
KW - MS
KW - Nomogram
KW - second attack
UR - http://www.scopus.com/inward/record.url?scp=85027880005&partnerID=8YFLogxK
U2 - 10.1177/1352458516679893
DO - 10.1177/1352458516679893
M3 - Article
AN - SCOPUS:85027880005
SN - 1352-4585
VL - 23
SP - 1346
EP - 1357
JO - Multiple Sclerosis Journal
JF - Multiple Sclerosis Journal
IS - 10
ER -