Factors associated with benign multiple sclerosis in the New York State MS Consortium (NYSMSC)

Abstract

BackgroundThis retrospective analysis explored prognostic factors associated with a benign multiple sclerosis (BMS) disease course at baseline and over the 4-year follow-up.MethodsPatients from the centralized New York State Multiple Sclerosis Consortium registry were classified as having BMS according to 3 different criteria centered on disease duration and disability. Additional analyses explored prognostic factors associated with BMS using the most conservative disability criteria (Expanded Disability Status Scale ≤2 and disease duration ≥10 years).ResultsAmong 6258 patients who fulfilled eligibility criteria, 19.8 % to 33.3 % were characterized as having BMS, at baseline depending on classification criteria used. Positive prognostic factors for BMS at baseline included female sex (p < 0.0001) and younger age at onset (p < 0.0001); negative prognostic factors included progressive-onset type of MS and African-American race. Of the 1237 BMS patients (per most conservative criteria), 742 were followed for a median of 4 years to explore effect of disease-modifying treatment (DMT) on benign status. DMT (p = 0.009) and longer disease duration (p = 0.007) were the only significant positive predictors of maintaining BMS at follow-up. The protective effect was stronger for patients taking DMT at both enrollment and follow-up (OR = 0.71; p = 0.006).ConclusionsThere is a need for development of more reliable prognostic indicators of BMS. Use of DMT was significantly associated with maintaining a benign disease state.Electronic supplementary materialThe online version of this article (doi:10.1186/s12883-016-0623-2) contains supplementary material, which is available to authorized users.

Grey matter atrophy in patients with benign multiple sclerosis

“…Our results support the assumption that subclinical inflammatory disease activity also occurs in seemingly benign and mild MS. So, there is justification for DMT use also in the benign course of the disease, regardless of the clinical relapse rate (Montalban et al., 2018 ; Ziemssen et al., 2016 ; Zivadinov et al., 2016 ). However, the evidence of the DMT effect on GM atrophy, especially in benign MS, is presently scarce.…”

“…So far, there are no established predictors for long‐term outcomes. It seems that a significant proportion of patients with benign MS develop cognitive decline, overall disability, and brain atrophy after a long follow‐up period (i.e., more than 20 years), even though there are no clinical relapses and neurological signs remain mild (Correale et al., 2012 ; Hirst et al., 2008 ; Mesaros et al., 2009 ; Portaccio et al., 2009 ; Rovaris et al., 2008 ; Zivadinov et al., 2016 ). The extent of brain atrophy in benign MS compared with an age‐matched healthy control group is scarcely investigated, reporting reduced subcortical and cortical GM in benign MS patients compared to healthy controls (Mesaros et al., 2008 ; Rovaris et al., 2008 ).…”

Prognostic-disability Biomarkers in Multiple Sclerosis: Review of the Literature from the Last Five Years

“…In another study, benign MS was defined as having EDSS values below 2 and 3 separately for 10-year disease duration and 19.8% to 33.3% among 6258 patients were characterized as having benign MS. Positive prognostic factors at baseline included female sex and younger age at onset, and disease-modifying treatment and longer disease duration were found to be positive predictors at the end of 4 th year (9). In another study with long-term follow-up, the benign MS definitions of the previous study were used, female sex and the presence of fully recovering attacks with a low number of attacks indicated favorable outcome at the 20 th and 30 th years and 30 th year, respectively.…”

Are highly active and aggressive multiple sclerosis the same entity?

“…Risk factors include demographic and clinical characteristics, MRI activity, and other biomarkers. Natural history cohort studies have demonstrated that men with MS reach disability milestones faster and in larger numbers than women (12,13). However, other studies have found no association between sex and future disability (14).…”