Is benign MS really benign? What a meaningful classification beyond the EDSS must take into consideration.

Disability Evaluation Disease Progression Female Humans Multiple Sclerosis / diagnosis Neurodegenerative Diseases Time Factors
Benign MS EDSS progression Multiple sclerosis National MS registries Prognostic factors

Journal

Multiple sclerosis and related disorders
ISSN: 2211-0356
Titre abrégé: Mult Scler Relat Disord
Pays: Netherlands
ID NLM: 101580247

Informations de publication

Date de publication:
Nov 2020
Historique:
received: 04 06 2020
revised: 26 08 2020
accepted: 02 09 2020
pubmed: 28 9 2020
medline: 15 5 2021
entrez: 27 9 2020
Statut: ppublish

Résumé

Multiple sclerosis (MS) is a neuroinflammatory and neurodegenerative disease with an unpredictable course that has a broad clinical spectrum and progresses over time. If a person with MS (PwMS) shows overall mild to moderate disability even after a long duration of disease, the term benign MS (BMS) is used. However, there is currently no generally accepted definition of BMS. Most definitions are based on EDSS in connection with disease duration, i.e. EDSS ≤3.0 after 15 years' disease duration. The question arises whether focusing on EDSS alone is adequate for classifying the disease course taking into account that 'hidden' or 'soft' symptoms are not sufficiently covered by this instrument. The aims of the study are to assess the prevalence of BMS in one of the largest patient cohorts, to describe the prevalence of patients without disabilities and to assess the further disability progression of these patients over another 15 years. Based on data exported from the German MS Registry, PwMS with a disease duration of 15 years or more were included in the analyses. PwMS were divided into BMS (EDSS ≤3.0) or non-benign (NBMS, EDSS >3.0). Out of 31,824 PwMS included in the German MS Register, we identified 10,874 patients with a disease duration ≥15 years of whom 4,511 (42%) showed an EDSS ≤3.0 fulfilling the criterion of benign MS. In the subgroup with EDSS measured exactly at 15 years' disease duration, the proportion was 54%. This proportion decreased continuously with increasing disease duration and fell to 30% after 30 years. Female sex (hazard ratio [HR]: 0.84) was associated with BMS, while a progressive (HR: 2.09) and late disease onset (HR: 1.29) were associated with NBMS (p<0.001). With a more rigorous definition of BMS (EDSS ≤1.0, absence of disability, and active employment), only 580 (13%) of the initial BMS remained 'benign'. Our data propose an alternative definition (EDSS ≤1.0, absence from any disability, and the ability to work after 15 years of disease duration) which might truly reflect BMS.

Sections du résumé

BACKGROUND BACKGROUND
Multiple sclerosis (MS) is a neuroinflammatory and neurodegenerative disease with an unpredictable course that has a broad clinical spectrum and progresses over time. If a person with MS (PwMS) shows overall mild to moderate disability even after a long duration of disease, the term benign MS (BMS) is used. However, there is currently no generally accepted definition of BMS. Most definitions are based on EDSS in connection with disease duration, i.e. EDSS ≤3.0 after 15 years' disease duration. The question arises whether focusing on EDSS alone is adequate for classifying the disease course taking into account that 'hidden' or 'soft' symptoms are not sufficiently covered by this instrument. The aims of the study are to assess the prevalence of BMS in one of the largest patient cohorts, to describe the prevalence of patients without disabilities and to assess the further disability progression of these patients over another 15 years.
METHODS METHODS
Based on data exported from the German MS Registry, PwMS with a disease duration of 15 years or more were included in the analyses. PwMS were divided into BMS (EDSS ≤3.0) or non-benign (NBMS, EDSS >3.0).
RESULTS RESULTS
Out of 31,824 PwMS included in the German MS Register, we identified 10,874 patients with a disease duration ≥15 years of whom 4,511 (42%) showed an EDSS ≤3.0 fulfilling the criterion of benign MS. In the subgroup with EDSS measured exactly at 15 years' disease duration, the proportion was 54%. This proportion decreased continuously with increasing disease duration and fell to 30% after 30 years. Female sex (hazard ratio [HR]: 0.84) was associated with BMS, while a progressive (HR: 2.09) and late disease onset (HR: 1.29) were associated with NBMS (p<0.001). With a more rigorous definition of BMS (EDSS ≤1.0, absence of disability, and active employment), only 580 (13%) of the initial BMS remained 'benign'.
CONCLUSION CONCLUSIONS
Our data propose an alternative definition (EDSS ≤1.0, absence from any disability, and the ability to work after 15 years of disease duration) which might truly reflect BMS.

Identifiants

DOI: 10.1016/j.msard.2020.102485 PMID: 32980646
pubmed: 32980646
pii: S2211-0348(20)30560-5
doi: 10.1016/j.msard.2020.102485
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

102485

Informations de copyright

Copyright © 2020 The Authors. Published by Elsevier B.V. All rights reserved.

Auteurs

David Ellenberger (D)

German MS-Register by the German MS Society, MS Forschungs- und Projektentwicklungs-gGmbH, Hannover, Germany. Electronic address: ellenberger@msregister.de.

Peter Flachenecker (P)

Neurological Rehabilitation Center Quellenhof, Bad Wildbad, Germany.

Judith Haas (J)

MS-Center, Jewish Hospital, Berlin, Germany; Deutsche Multiple Sklerose Gesellschaft, Bundesverband e.V., Hannover, Germany.

Kerstin Hellwig (K)

Katholisches Klinikum Bochum, Klinikum der Ruhr Universität, Bochum, Germany.

Friedemann Paul (F)

Experimental and Clinical Research Center and NeuroCure Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.

Alexander Stahmann (A)

German MS-Register by the German MS Society, MS Forschungs- und Projektentwicklungs-gGmbH, Hannover, Germany.

Clemens Warnke (C)

Department of Neurology, Medical Faculty, University Hospital of Köln, Köln, Germany.

Uwe K Zettl (UK)

Department of Neurology, Neuroimmunological Section, University of Rostock, Rostock, Germany.

Paulus S Rommer (PS)

Department of Neurology, Neuroimmunological Section, University of Rostock, Rostock, Germany; Department of Neurology, Medical University of Vienna, Vienna, Austria.

Articles similaires

[Redispensing of expensive oral anticancer medicines: a practical application].

Lisanne N van Merendonk, Kübra Akgöl, Bastiaan Nuijen
1.00
Humans Antineoplastic Agents Administration, Oral Drug Costs Counterfeit Drugs

Smoking Cessation and Incident Cardiovascular Disease.

Jun Hwan Cho, Seung Yong Shin, Hoseob Kim et al.
1.00
Humans Male Smoking Cessation Cardiovascular Diseases Female

Evaluation of Low-Value Services Across Major Medicare Advantage Insurers and Traditional Medicare.

Ciara Duggan, Adam L Beckman, Ishani Ganguli et al.
1.00
Humans United States Aged Cross-Sectional Studies Medicare Part C

Effectiveness of Virtual Yoga for Chronic Low Back Pain: A Randomized Clinical Trial.

Hallie Tankha, Devyn Gaskins, Amanda Shallcross et al.
1.00
Humans Yoga Low Back Pain Female Male

Classifications MeSH

questionsmedicales.fr › Diagnostic › Techniques et procédures diagnostiques › Évaluation de l'invalidité › Is benign MS really benign? What a meaningful...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Caractéristiques de la maladie › Évolution de la maladie › Is benign MS really benign? What a meaningful...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Is benign MS really benign? What a meaningful...
questionsmedicales.fr › Maladies du système immunitaire › Maladies auto-immunes › Maladies auto-immunes du système nerveux › Maladies démyélinisantes auto-immunes du SNC › Sclérose en plaques › Is benign MS really benign? What a meaningful...
questionsmedicales.fr › Maladies du système nerveux › Maladies neurodégénératives › Is benign MS really benign? What a meaningful...
questionsmedicales.fr › Phénomènes physiques › Temps › Facteurs temps › Is benign MS really benign? What a meaningful...