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From the Department of Medicine (Neurology [H.T., D.P., V.D.] and Health Care and Epidemiology [H.T.]), University of British Columbia, Vancouver, Canada.
Address correspondence and reprint requests to Dr. Helen Tremlett, Department of Medicine (Neurology), Rm. S159, 2211 Wesbrook Mall, University of British Columbia, Vancouver, BC V6T 2B5, Canada; e-mail: tremlett{at}interchange.ubc.ca
Objective: To investigate disease progression and risk factors in a large geographically based population with multiple sclerosis (MS), using two different inception points—clinical onset and date of birth.
Methods: The authors reviewed a database of subjects with definite MS and symptom onset prior to July 1988. The main outcome was sustained progression to Expanded Disability Status Scale (EDSS) 6 (requires a cane), using the date of birth and date of MS onset as inception points in separate analyses. Risk factors examined were sex, relapsing vs primary progressive course, onset age, and onset symptoms.
Results: The study included 2,837 patients, followed prospectively for 22,723 patient years. The median time to EDSS 6 was 27.9 years, 15 years after onset; only 21% reached EDSS 6, and by age 50, 28% required a cane. Men progressed 38% more quickly than women from onset (p < 0.0005), yet both required canes at similar ages: 58.8 years for men and 60.1 for women (p = 0.082). A younger onset age predicted a slower progression, but those older at onset were consistently older when reaching EDSS 6. A primary progressive course predicted a more rapid progression from both onset (p < 0.0005) and birth (hazard ratio = 2.7 [95% CI: 2.2 to 3.3]). No onset symptom consistently predicted progression.
Conclusion: Disability progression in multiple sclerosis (MS) accrued more slowly than found in earlier longitudinal studies. The authors also challenged two fundamental concepts in MS, demonstrating that neither male sex nor older onset age was associated with worse disease outcome.
Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the January 24 issue to find the title link for this article.
Commentary, see page 157
Deceased.
Helen Tremlett is funded by a "Don Paty Career Development Award" from the MS Society of Canada, the Michael Smith Foundation for Health Research, and the Christopher Foundation. The BC-wide MS database was funded by an unrestricted grant from Don Paty and the MS/MRI research group. This analysis was funded by a grant from the MS Society of Canada.
Disclosure: The authors report no conflicts of interest.
Received May 11, 2005. Accepted in final form October 11, 2005.
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Neurology 2006 66: 157.
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