Clinical Features Predict Prognosis in Multiple Sclerosis
Clinical Features Predict Prognosis in Multiple Sclerosis
Degenhardt A, Ramagopalan SV, Scalfari A, Ebers GC
Nat Rev Neurol. 2009;5:672-682
Studies of the natural history of multiple sclerosis (MS) that looked at various clinical features as prognostic markers are reviewed. The importance of identifying clinical features that can accurately predict the prognosis in MS is paramount, not only for individual patient treatment decisions, but also for the appropriate design of clinical trials and interpretation of their findings. To date, clinical markers have had limited reliability for determining prognosis.
The study authors of this review identified studies meeting selection criteria of study samples of at least 100 patients with MS, a prospective follow-up for 9 years or more, and geographic referral base. Negative prognostic factors for all forms of MS combined were progressive disease and disability at 2 and 5 years.
Negative prognostic factors in relapsing remitting MS and secondary progressive MS combined were the onset of progression, higher relapse rate, greater disability in the first 5 years, shorter time before second relapse, and multisystem involvement. In secondary progressive MS, a shorter time to progression was an additional marker of poor prognosis, as was a faster rate of disability in the first 2 and 5 years for patients with primary progressive MS.
Based on this review, which is somewhat limited by differences in included study designs and populations, some potential prognostic markers have been identified for patients with MS. These may include onset of progression, rate of relapse, and the development of disability in the first 5 years of the clinical course. Further confirmation of these outcomes in longer-term clinical trials may allow better patient treatment at the individual level as well as selection of better therapeutic targets for future studies.
Clinical Prognostic Factors in Multiple Sclerosis: A Natural History Review
Degenhardt A, Ramagopalan SV, Scalfari A, Ebers GC
Nat Rev Neurol. 2009;5:672-682
Summary
Studies of the natural history of multiple sclerosis (MS) that looked at various clinical features as prognostic markers are reviewed. The importance of identifying clinical features that can accurately predict the prognosis in MS is paramount, not only for individual patient treatment decisions, but also for the appropriate design of clinical trials and interpretation of their findings. To date, clinical markers have had limited reliability for determining prognosis.
The study authors of this review identified studies meeting selection criteria of study samples of at least 100 patients with MS, a prospective follow-up for 9 years or more, and geographic referral base. Negative prognostic factors for all forms of MS combined were progressive disease and disability at 2 and 5 years.
Negative prognostic factors in relapsing remitting MS and secondary progressive MS combined were the onset of progression, higher relapse rate, greater disability in the first 5 years, shorter time before second relapse, and multisystem involvement. In secondary progressive MS, a shorter time to progression was an additional marker of poor prognosis, as was a faster rate of disability in the first 2 and 5 years for patients with primary progressive MS.
Viewpoint
Based on this review, which is somewhat limited by differences in included study designs and populations, some potential prognostic markers have been identified for patients with MS. These may include onset of progression, rate of relapse, and the development of disability in the first 5 years of the clinical course. Further confirmation of these outcomes in longer-term clinical trials may allow better patient treatment at the individual level as well as selection of better therapeutic targets for future studies.
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