Effect of Changes in MS Diagnostic Criteria Over 25 Years on Time to Treatment and Prognosis in Patients With Clinically Isolated Syndrome.

Adult Demyelinating Diseases / diagnosis Disease Progression Humans Multiple Sclerosis / diagnosis Retrospective Studies Spain Time-to-Treatment

Journal

Neurology
ISSN: 1526-632X
Titre abrégé: Neurology
Pays: United States
ID NLM: 0401060

Informations de publication

Date de publication:
26 10 2021
Historique:
received: 04 01 2021
accepted: 12 08 2021
pubmed: 16 9 2021
medline: 30 10 2021
entrez: 15 9 2021
Statut: ppublish

Résumé

To explore whether time to diagnosis, time to treatment initiation, and age to reach disability milestones have changed in patients with clinically isolated syndrome (CIS) according to different multiple sclerosis (MS) diagnostic criteria periods. This retrospective study was based on data collected prospectively from the Barcelona-CIS cohort between 1994 and 2020. Patients were classified into 5 periods according to different MS criteria, and the times to MS diagnosis and treatment initiation were evaluated. The age at which patients with MS reached an Expanded Disability Status Scale (EDSS) score ≥3.0 was assessed by Cox regression analysis according to diagnostic criteria periods. Last, to remove the classic Will Rogers phenomenon by which the use of different MS criteria over time might result in a changes of prognosis, the 2017 McDonald criteria were applied, and age at EDSS score ≥3.0 was assessed by Cox regression. In total, 1,174 patients were included. The median time from CIS to MS diagnosis and from CIS to treatment initiation showed a 77% and 82% reduction from the Poser to the McDonald 2017 diagnostic criteria periods, respectively. Patients of a given age diagnosed in more recent diagnostic criteria periods had a lower risk of reaching an EDSS score ≥3.0 than patients of the same age diagnosed in earlier diagnostic periods (reference category Poser period): adjusted hazard ratio (aHR) 0.47 (95% confidence interval 0.24-0.90) for McDonald 2001, aHR 0.25 (0.12-0.54) for McDonald 2005, aHR 0.30 (0.12-0.75) for McDonald 2010, and aHR 0.07 (0.01-0.45) for McDonald 2017. Patients in the early-treatment group displayed an aHR of 0.53 (0.33-0.85) of reaching age at EDSS score ≥3.0 compared to those in the late-treatment group. Changes in prognosis together with early-treatment effect were maintained after the exclusion of possible bias derived from the use of different diagnostic criteria over time (Will Rogers phenomenon). A continuous decrease in the time to MS diagnosis and treatment initiation was observed across diagnostic criteria periods. Overall, patients diagnosed in more recent diagnostic criteria periods displayed a lower risk of reaching disability. The prognostic improvement is maintained after the Will Rogers phenomenon is discarded, and early treatment appears to be the most likely contributing factor.

Sections du résumé

BACKGROUND AND OBJECTIVES
To explore whether time to diagnosis, time to treatment initiation, and age to reach disability milestones have changed in patients with clinically isolated syndrome (CIS) according to different multiple sclerosis (MS) diagnostic criteria periods.
METHODS
This retrospective study was based on data collected prospectively from the Barcelona-CIS cohort between 1994 and 2020. Patients were classified into 5 periods according to different MS criteria, and the times to MS diagnosis and treatment initiation were evaluated. The age at which patients with MS reached an Expanded Disability Status Scale (EDSS) score ≥3.0 was assessed by Cox regression analysis according to diagnostic criteria periods. Last, to remove the classic Will Rogers phenomenon by which the use of different MS criteria over time might result in a changes of prognosis, the 2017 McDonald criteria were applied, and age at EDSS score ≥3.0 was assessed by Cox regression.
RESULTS
In total, 1,174 patients were included. The median time from CIS to MS diagnosis and from CIS to treatment initiation showed a 77% and 82% reduction from the Poser to the McDonald 2017 diagnostic criteria periods, respectively. Patients of a given age diagnosed in more recent diagnostic criteria periods had a lower risk of reaching an EDSS score ≥3.0 than patients of the same age diagnosed in earlier diagnostic periods (reference category Poser period): adjusted hazard ratio (aHR) 0.47 (95% confidence interval 0.24-0.90) for McDonald 2001, aHR 0.25 (0.12-0.54) for McDonald 2005, aHR 0.30 (0.12-0.75) for McDonald 2010, and aHR 0.07 (0.01-0.45) for McDonald 2017. Patients in the early-treatment group displayed an aHR of 0.53 (0.33-0.85) of reaching age at EDSS score ≥3.0 compared to those in the late-treatment group. Changes in prognosis together with early-treatment effect were maintained after the exclusion of possible bias derived from the use of different diagnostic criteria over time (Will Rogers phenomenon).
DISCUSSION
A continuous decrease in the time to MS diagnosis and treatment initiation was observed across diagnostic criteria periods. Overall, patients diagnosed in more recent diagnostic criteria periods displayed a lower risk of reaching disability. The prognostic improvement is maintained after the Will Rogers phenomenon is discarded, and early treatment appears to be the most likely contributing factor.

Identifiants

DOI: 10.1212/WNL.0000000000012726 PMID: 34521693
pubmed: 34521693
pii: WNL.0000000000012726
doi: 10.1212/WNL.0000000000012726
doi:

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

e1641-e1652

Commentaires et corrections

Type : CommentIn

Informations de copyright

© 2021 American Academy of Neurology.

Auteurs

Mar Tintore (M)

From the Department of Neurology/Neuroimmunology (M.T., A.C.-C., P.C., G.A., S.O.-R., J.R., C.T., M.C., C.N., M.J.A., L.M., I.G., A.V.-J., J.C., B.R.-A., A.Z., J.S.-G., X.M.) Centre d'Esclerosi Múltiple de Catalunya (Cemcat), and Department of Radiology (IDI) (A.S., C.A., À.R.), Section of Neuroradiology and Magnetic Resonance Unit, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain. mtintore@cem-cat.org.
ORCID: 0000-0001-9999-5359

Alvaro Cobo-Calvo (A)

From the Department of Neurology/Neuroimmunology (M.T., A.C.-C., P.C., G.A., S.O.-R., J.R., C.T., M.C., C.N., M.J.A., L.M., I.G., A.V.-J., J.C., B.R.-A., A.Z., J.S.-G., X.M.) Centre d'Esclerosi Múltiple de Catalunya (Cemcat), and Department of Radiology (IDI) (A.S., C.A., À.R.), Section of Neuroradiology and Magnetic Resonance Unit, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain.
ORCID: 0000-0002-2574-0721

Pere Carbonell (P)

From the Department of Neurology/Neuroimmunology (M.T., A.C.-C., P.C., G.A., S.O.-R., J.R., C.T., M.C., C.N., M.J.A., L.M., I.G., A.V.-J., J.C., B.R.-A., A.Z., J.S.-G., X.M.) Centre d'Esclerosi Múltiple de Catalunya (Cemcat), and Department of Radiology (IDI) (A.S., C.A., À.R.), Section of Neuroradiology and Magnetic Resonance Unit, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain.

Georgina Arrambide (G)

From the Department of Neurology/Neuroimmunology (M.T., A.C.-C., P.C., G.A., S.O.-R., J.R., C.T., M.C., C.N., M.J.A., L.M., I.G., A.V.-J., J.C., B.R.-A., A.Z., J.S.-G., X.M.) Centre d'Esclerosi Múltiple de Catalunya (Cemcat), and Department of Radiology (IDI) (A.S., C.A., À.R.), Section of Neuroradiology and Magnetic Resonance Unit, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain.
ORCID: 0000-0002-2657-5510

Susana Otero-Romero (S)

From the Department of Neurology/Neuroimmunology (M.T., A.C.-C., P.C., G.A., S.O.-R., J.R., C.T., M.C., C.N., M.J.A., L.M., I.G., A.V.-J., J.C., B.R.-A., A.Z., J.S.-G., X.M.) Centre d'Esclerosi Múltiple de Catalunya (Cemcat), and Department of Radiology (IDI) (A.S., C.A., À.R.), Section of Neuroradiology and Magnetic Resonance Unit, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain.

Jordi Río (J)

From the Department of Neurology/Neuroimmunology (M.T., A.C.-C., P.C., G.A., S.O.-R., J.R., C.T., M.C., C.N., M.J.A., L.M., I.G., A.V.-J., J.C., B.R.-A., A.Z., J.S.-G., X.M.) Centre d'Esclerosi Múltiple de Catalunya (Cemcat), and Department of Radiology (IDI) (A.S., C.A., À.R.), Section of Neuroradiology and Magnetic Resonance Unit, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain.

Carmen Tur (C)

From the Department of Neurology/Neuroimmunology (M.T., A.C.-C., P.C., G.A., S.O.-R., J.R., C.T., M.C., C.N., M.J.A., L.M., I.G., A.V.-J., J.C., B.R.-A., A.Z., J.S.-G., X.M.) Centre d'Esclerosi Múltiple de Catalunya (Cemcat), and Department of Radiology (IDI) (A.S., C.A., À.R.), Section of Neuroradiology and Magnetic Resonance Unit, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain.
ORCID: 0000-0003-1849-3184

Manuel Comabella (M)

From the Department of Neurology/Neuroimmunology (M.T., A.C.-C., P.C., G.A., S.O.-R., J.R., C.T., M.C., C.N., M.J.A., L.M., I.G., A.V.-J., J.C., B.R.-A., A.Z., J.S.-G., X.M.) Centre d'Esclerosi Múltiple de Catalunya (Cemcat), and Department of Radiology (IDI) (A.S., C.A., À.R.), Section of Neuroradiology and Magnetic Resonance Unit, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain.

Carlos Nos (C)

From the Department of Neurology/Neuroimmunology (M.T., A.C.-C., P.C., G.A., S.O.-R., J.R., C.T., M.C., C.N., M.J.A., L.M., I.G., A.V.-J., J.C., B.R.-A., A.Z., J.S.-G., X.M.) Centre d'Esclerosi Múltiple de Catalunya (Cemcat), and Department of Radiology (IDI) (A.S., C.A., À.R.), Section of Neuroradiology and Magnetic Resonance Unit, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain.

María Jesús Arévalo (MJ)

From the Department of Neurology/Neuroimmunology (M.T., A.C.-C., P.C., G.A., S.O.-R., J.R., C.T., M.C., C.N., M.J.A., L.M., I.G., A.V.-J., J.C., B.R.-A., A.Z., J.S.-G., X.M.) Centre d'Esclerosi Múltiple de Catalunya (Cemcat), and Department of Radiology (IDI) (A.S., C.A., À.R.), Section of Neuroradiology and Magnetic Resonance Unit, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain.

Luciana Midaglia (L)

From the Department of Neurology/Neuroimmunology (M.T., A.C.-C., P.C., G.A., S.O.-R., J.R., C.T., M.C., C.N., M.J.A., L.M., I.G., A.V.-J., J.C., B.R.-A., A.Z., J.S.-G., X.M.) Centre d'Esclerosi Múltiple de Catalunya (Cemcat), and Department of Radiology (IDI) (A.S., C.A., À.R.), Section of Neuroradiology and Magnetic Resonance Unit, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain.

Ingrid Galán (I)

From the Department of Neurology/Neuroimmunology (M.T., A.C.-C., P.C., G.A., S.O.-R., J.R., C.T., M.C., C.N., M.J.A., L.M., I.G., A.V.-J., J.C., B.R.-A., A.Z., J.S.-G., X.M.) Centre d'Esclerosi Múltiple de Catalunya (Cemcat), and Department of Radiology (IDI) (A.S., C.A., À.R.), Section of Neuroradiology and Magnetic Resonance Unit, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain.

Angela Vidal-Jordana (A)

From the Department of Neurology/Neuroimmunology (M.T., A.C.-C., P.C., G.A., S.O.-R., J.R., C.T., M.C., C.N., M.J.A., L.M., I.G., A.V.-J., J.C., B.R.-A., A.Z., J.S.-G., X.M.) Centre d'Esclerosi Múltiple de Catalunya (Cemcat), and Department of Radiology (IDI) (A.S., C.A., À.R.), Section of Neuroradiology and Magnetic Resonance Unit, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain.
ORCID: 0000-0002-7270-5507

Joaquin Castilló (J)

From the Department of Neurology/Neuroimmunology (M.T., A.C.-C., P.C., G.A., S.O.-R., J.R., C.T., M.C., C.N., M.J.A., L.M., I.G., A.V.-J., J.C., B.R.-A., A.Z., J.S.-G., X.M.) Centre d'Esclerosi Múltiple de Catalunya (Cemcat), and Department of Radiology (IDI) (A.S., C.A., À.R.), Section of Neuroradiology and Magnetic Resonance Unit, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain.

Breogán Rodríguez-Acevedo (B)

From the Department of Neurology/Neuroimmunology (M.T., A.C.-C., P.C., G.A., S.O.-R., J.R., C.T., M.C., C.N., M.J.A., L.M., I.G., A.V.-J., J.C., B.R.-A., A.Z., J.S.-G., X.M.) Centre d'Esclerosi Múltiple de Catalunya (Cemcat), and Department of Radiology (IDI) (A.S., C.A., À.R.), Section of Neuroradiology and Magnetic Resonance Unit, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain.
ORCID: 0000-0002-0314-753X

Ana Zabalza de Torres (A)

From the Department of Neurology/Neuroimmunology (M.T., A.C.-C., P.C., G.A., S.O.-R., J.R., C.T., M.C., C.N., M.J.A., L.M., I.G., A.V.-J., J.C., B.R.-A., A.Z., J.S.-G., X.M.) Centre d'Esclerosi Múltiple de Catalunya (Cemcat), and Department of Radiology (IDI) (A.S., C.A., À.R.), Section of Neuroradiology and Magnetic Resonance Unit, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain.
ORCID: 0000-0003-3860-5251

Annalaura Salerno (A)

From the Department of Neurology/Neuroimmunology (M.T., A.C.-C., P.C., G.A., S.O.-R., J.R., C.T., M.C., C.N., M.J.A., L.M., I.G., A.V.-J., J.C., B.R.-A., A.Z., J.S.-G., X.M.) Centre d'Esclerosi Múltiple de Catalunya (Cemcat), and Department of Radiology (IDI) (A.S., C.A., À.R.), Section of Neuroradiology and Magnetic Resonance Unit, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain.

Cristina Auger (C)

From the Department of Neurology/Neuroimmunology (M.T., A.C.-C., P.C., G.A., S.O.-R., J.R., C.T., M.C., C.N., M.J.A., L.M., I.G., A.V.-J., J.C., B.R.-A., A.Z., J.S.-G., X.M.) Centre d'Esclerosi Múltiple de Catalunya (Cemcat), and Department of Radiology (IDI) (A.S., C.A., À.R.), Section of Neuroradiology and Magnetic Resonance Unit, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain.

Jaume Sastre-Garriga (J)

From the Department of Neurology/Neuroimmunology (M.T., A.C.-C., P.C., G.A., S.O.-R., J.R., C.T., M.C., C.N., M.J.A., L.M., I.G., A.V.-J., J.C., B.R.-A., A.Z., J.S.-G., X.M.) Centre d'Esclerosi Múltiple de Catalunya (Cemcat), and Department of Radiology (IDI) (A.S., C.A., À.R.), Section of Neuroradiology and Magnetic Resonance Unit, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain.

Àlex Rovira (À)

From the Department of Neurology/Neuroimmunology (M.T., A.C.-C., P.C., G.A., S.O.-R., J.R., C.T., M.C., C.N., M.J.A., L.M., I.G., A.V.-J., J.C., B.R.-A., A.Z., J.S.-G., X.M.) Centre d'Esclerosi Múltiple de Catalunya (Cemcat), and Department of Radiology (IDI) (A.S., C.A., À.R.), Section of Neuroradiology and Magnetic Resonance Unit, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain.

Xavier Montalban (X)

From the Department of Neurology/Neuroimmunology (M.T., A.C.-C., P.C., G.A., S.O.-R., J.R., C.T., M.C., C.N., M.J.A., L.M., I.G., A.V.-J., J.C., B.R.-A., A.Z., J.S.-G., X.M.) Centre d'Esclerosi Múltiple de Catalunya (Cemcat), and Department of Radiology (IDI) (A.S., C.A., À.R.), Section of Neuroradiology and Magnetic Resonance Unit, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Effect of Changes in MS Diagnostic Criteria...
questionsmedicales.fr › Maladies du système nerveux › Maladies démyélinisantes › Effect of Changes in MS Diagnostic Criteria...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Caractéristiques de la maladie › Évolution de la maladie › Effect of Changes in MS Diagnostic Criteria...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Effect of Changes in MS Diagnostic Criteria...
questionsmedicales.fr › Maladies du système immunitaire › Maladies auto-immunes › Maladies auto-immunes du système nerveux › Maladies démyélinisantes auto-immunes du SNC › Sclérose en plaques › Effect of Changes in MS Diagnostic Criteria...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Effect of Changes in MS Diagnostic Criteria...
questionsmedicales.fr › Régions géographiques › Europe › Espagne › Effect of Changes in MS Diagnostic Criteria...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Soins aux patients › Délai jusqu'au traitement › Effect of Changes in MS Diagnostic Criteria...