Which Patients with Multiple Sclerosis Are Likely to Get Worse?

Scientists are working to identify factors that can accurately predict outcomes for patients with relapsing remitting multiple sclerosis (RRMS). A paper authored by Anthony Traboulsee, MD, of the Division of Neurology in the Department of Medicine at the University of British Columbia in Vancouver, Canada, and colleagues describing some of the work being done to identify such prognostic factors was published recently in the Multiple Sclerosis Journal -- Experimental, Translational and Clinical.

The authors begin by saying, “early determination of clinical, magnetic resonance imaging (MRI), and/or biological markers that are prognostic for long-term outcomes would be valuable, to enable management strategies tailored to the needs of individual patients.” They add that currently no such measures have been shown to be prognostic factors on a consistent basis.

In order to investigate whether prognostic factors could be identified, the researchers used long-term follow up (LTFU) data from the Prevention of Relapses with Interferon beta-1a Subcutaneously in Multiple Sclerosis (PRISMS) study. The objective with this study “was to determine whether prestudy and baseline characteristics, indicators of early MRI and clinical activity, and indicators of treatment exposure could be identified as prognostic factors of long-term clinical and MRI outcomes in patients with RRMS,” they said.

Specifically, the researchers examined post hoc data from all 392 patients in the LTFU, and “in the subcohort originally randomized to sc IFN B-1a (early-start patients, n = 259).” They considered several outcome variables, many related to the Expanded Disability Status Scale (EDSS).

The disease course and treatment response in MS are highly heterogenous over time, leading the researchers say that identifying prognostic factors could help single out the patients at greatest risk for long-term disability and “Help determine appropriate long-term treatment.”

Although the patients in the PRISMS LTFU study began as a somewhat homogeneous population, the researchers say, “after eight years, the levels of disability and disability progression were much more heterogeneous, making this a valuable cohort in which to explore early predictors of relatively long-term clinical outcomes.”

The present analysis showed that “higher baseline brain volume predicted better long-term clinical outcomes, while larger increases in EDSS score during the first 24 months predicted worse outcomes,” report the authors. Additionally, patients who took IFN B-1a treatments longer had better outcomes. The researchers conclude, “Relapse rate and changes in MRI disease measures in the first two years of treatment were also predictors of long-term outcomes, but not as consistently so as change in EDSS score over a similar period.”

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