Early Predictors of 9-Year Disability in Pediatric Multiple Sclerosis.
Ann Neurol
; 89(5): 1011-1022, 2021 05.
Article
en En
| MEDLINE
| ID: mdl-33598931
ABSTRACT
OBJECTIVE:
The purpose of this study was to assess early predictors of 9-year disability in pediatric patients with multiple sclerosis.METHODS:
Clinical and magnetic resonance imaging (MRI) assessments of 123 pediatric patients with multiple sclerosis were obtained at disease onset and after 1 and 2 years. A 9-year clinical follow-up was also performed. Cox proportional hazard and multivariable regression models were used to assess independent predictors of time to first relapse and 9-year outcomes.RESULTS:
Time to first relapse was predicted by optic nerve lesions (hazard ratio [HR] = 2.10, p = 0.02) and high-efficacy treatment exposure (HR = 0.31, p = 0.005). Predictors of annualized relapse rate were at baseline, presence of cerebellar (ß = -0.15, p < 0.001), cervical cord lesions (ß = 0.16, p = 0.003), and high-efficacy treatment exposure (ß = -0.14, p = 0.01); considering also 1-year variables, number of relapses (ß = 0.14, p = 0.002), and the previous baseline predictors; considering 2-year variables, time to first relapse (2-year ß = -0.12, p = 0.01) entered, whereas high-efficacy treatment exposure exited the model. Predictors of 9-year disability worsening were at baseline, presence of optic nerve lesions (odds ratio [OR] = 6.45, p = 0.01); considering 1-year and 2-year variables, Expanded Disability Status Scale (EDSS) changes (1-year OR = 26.05, p < 0.001; 2-year OR = 16.38, p = 0.02), and ≥ 2 new T2-lesions in 2 years (2-year OR = 4.91, p = 0.02). Predictors of higher 9-year EDSS score were at baseline, EDSS score (ß = 0.58, p < 0.001), presence of brainstem lesions (ß = 0.31, p = 0.04), and number of cervical cord lesions (ß = 0.22, p = 0.05); considering 1-year and 2-year variables, EDSS changes (1-year ß = 0.79, p < 0.001; 2-year ß = 0.55, p < 0.001), and ≥ 2 new T2-lesions (1-year ß = 0.28, p = 0.03; 2-year ß = 0.35, p = 0.01).INTERPRETATION:
A complete baseline MRI assessment and an accurate clinical and MRI monitoring during the first 2 years of disease contribute to predict 9-year prognosis in pediatric patients with multiple sclerosis. ANN NEUROL 2021;891011-1022.
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Evaluación de la Discapacidad
/
Esclerosis Múltiple
Tipo de estudio:
Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Adolescent
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Child
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Female
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Humans
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Male
Idioma:
En
Revista:
Ann Neurol
Año:
2021
Tipo del documento:
Article
País de afiliación:
Italia