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

Abstract

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: 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: 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: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.

Chances and challenges of a long-term data repository in multiple sclerosis: 20th birthday of the German MS registry

“…As a result, the dataset is a combination of datasets of the German Multiple Sclerosis Society and the German Competence Network Multiple Sclerosis. The current minimal dataset (see Supplementary Table 1 ) contains information on disease onsets, diagnoses, MS disease courses 19 , 20 , disabilities (as measured in EDSS and MS Functional Composite as well by MS Symptoms), disease activity, MS therapy and socio-economic statuses 21 . In 2019, the GMSR dataset was extended by a pharmacovigilance module to include documentation on medical history, body mass index, adverse events and pregnancies (see Table 2 ).…”

Epilepsy as a predictor of disease progression in multiple sclerosis

“…The differences in disability were assessed up to 15 years after onset of MS, with a mean EDSS score of 3.2 in MSE− patients, which is close to common definitions of “benign” MS, 23 compared to 4.0 in MSE+ patients. Similarly, MSE+ patients met the EDSS milestones 4.0 and 6.0 to a greater extent.…”

Genetic, Environmental and Lifestyle Determinants of Accelerated Telomere Attrition as Contributors to Risk and Severity of Multiple Sclerosis

“…They act by suppressing or modulating immune functions, depleting (autoreactive) lymphocytes and/or inhibiting their migration into the CNS, as reviewed elsewhere [51]. However, undesirable side effects may occur during the course of treatment [52], and long-term prognosis of disease activity for individual patients remains difficult [53,54].…”