OBJECTIVES: To assess early predictors of 9-year disability in pediatric multiple sclerosis patients.METHODS: Clinical and MRI assessments of 123 pediatric multiple sclerosis patients were obtained at disease onset and after 1 and 2years. 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 (beta=-0.15, p<0.001), cervical cord lesions (beta=0.16, p=0.003) and high-efficacy treatment exposure (beta=-0.14, p=0.01); considering also 1-year variables, number of relapses (beta=0.14, p=0.002) and the previous baseline predictors; considering 2-year variables, time to first relapse (2-year: beta=-0.12, p=0.01) entered, while high-efficacy treatment exposure exit from 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- 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 2years (2-year: OR=4.91, p=0.02). Predictors of higher 9-year EDSS score were: at baseline, EDSS score (beta=0.58, p<0.001), presence of brainstem (beta=0.31, p=0.04) and number of cervical cord lesions (beta=0.22, p=0.05); considering 1- and 2-year variables, EDSS changes (1-year: beta=0.79, p<0.001; 2-year: beta=0.55, p<0.001), and ≥2 new T2-lesions (1-year: beta=0.28, p=0.03; 2-year: beta=0.35, p=0.01).INTERPRETATION: A complete baseline MRI assessment and an accurate clinical and MRI monitoring during the first 2years of disease contribute to predict 9-year prognosis in pediatric multiple sclerosis. This article is protected by copyright. All rights reserved.
Early Predictors of 9-Year Disability in Pediatric Multiple Sclerosis / De Meo, Ermelinda; Bonacchi, Raffaello; Moiola, Lucia; Colombo, Bruno; Sangalli, Francesca; Zanetta, Chiara; Amato, Maria Pia; Martinelli, Vittorio; Rocca, Maria Assunta; Filippi, Massimo. - In: ANNALS OF NEUROLOGY. - ISSN 0364-5134. - ELETTRONICO. - (2021), pp. 0-0. [10.1002/ana.26052]
Early Predictors of 9-Year Disability in Pediatric Multiple Sclerosis
Amato, Maria Pia;
2021
Abstract
OBJECTIVES: To assess early predictors of 9-year disability in pediatric multiple sclerosis patients.METHODS: Clinical and MRI assessments of 123 pediatric multiple sclerosis patients were obtained at disease onset and after 1 and 2years. 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 (beta=-0.15, p<0.001), cervical cord lesions (beta=0.16, p=0.003) and high-efficacy treatment exposure (beta=-0.14, p=0.01); considering also 1-year variables, number of relapses (beta=0.14, p=0.002) and the previous baseline predictors; considering 2-year variables, time to first relapse (2-year: beta=-0.12, p=0.01) entered, while high-efficacy treatment exposure exit from 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- 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 2years (2-year: OR=4.91, p=0.02). Predictors of higher 9-year EDSS score were: at baseline, EDSS score (beta=0.58, p<0.001), presence of brainstem (beta=0.31, p=0.04) and number of cervical cord lesions (beta=0.22, p=0.05); considering 1- and 2-year variables, EDSS changes (1-year: beta=0.79, p<0.001; 2-year: beta=0.55, p<0.001), and ≥2 new T2-lesions (1-year: beta=0.28, p=0.03; 2-year: beta=0.35, p=0.01).INTERPRETATION: A complete baseline MRI assessment and an accurate clinical and MRI monitoring during the first 2years of disease contribute to predict 9-year prognosis in pediatric multiple sclerosis. This article is protected by copyright. All rights reserved.
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