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Contemporary study of multiple sclerosis disability in South East Wales

Harding, Katharine Elizabeth, Ingram, Gillian, Tallantyre, Emma Clare ORCID:, Joseph, Fady, Wardle, Mark, Pickersgill, Trevor P., Willis, Mark D. ORCID:, Tomassini, Valentina ORCID:, Pearson, Owen Rhys and Robertson, Neil P. ORCID: 2023. Contemporary study of multiple sclerosis disability in South East Wales. Journal of Neurology, Neurosurgery and Psychiatry 94 (4) , pp. 272-279. 10.1136/jnnp-2022-330013

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Background A contemporary understanding of disability evolution in multiple sclerosis (MS) is an essential tool for individual disease management and planning of interventional studies. We have used prospectively collected longitudinal data to analyse disability progression and variation in a British MS cohort. Methods Cox proportional hazards regression was used to estimate hazard of Expanded Disability Status Scale (EDSS) 4.0 and 6.0. A continuous Markov model was used to estimate transitional probabilities for individual EDSS scores. Models were adjusted for age at MS onset, sex and disease-modifying treatments (DMTs) exposure. Results 2135 patients were included (1487 (70%) female, 1922 (89%) relapsing onset). 865 (41%) had used DMTs. Median time to EDSS 4.0 and 6.0 was 18.2 years (95% CI 16.3 to 20.2) and 22.1 years (95% CI 20.5 to 24.5). In the Markov model, the median time spent at EDSS scores of <6 (0.40–0.98 year) was shorter than the time spent at EDSS scores of ≥6 (0.87–4.11 year). Hazard of change in EDSS was greatest at EDSS scores <6 (HR for increasing EDSS: 1.02–1.33; decreasing EDSS: 0.34–1.27) compared with EDSS scores ≥6 (HR for increasing EDSS: 0.08–0.61; decreasing EDSS: 0.18–0.54). Conclusions These data provide a detailed contemporary model of disability outcomes in a representative population-based MS cohort. They support a trend of increasing time to disability milestones compared with historical reference populations, and document disability variation with the use of transitional matrices. In addition, they provide essential information for patient counselling, clinical trial design, service planning and offer a comparative baseline for assessment of therapeutic interventions.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
MRC Centre for Neuropsychiatric Genetics and Genomics (CNGG)
Publisher: BMJ Publishing Group
ISSN: 0022-3050
Date of First Compliant Deposit: 15 February 2023
Date of Acceptance: 20 October 2022
Last Modified: 12 Nov 2023 19:23

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