Objective The purpose of this study was to assess early predictors of 9-year disability in pediatric patients with multiple sclerosis.Methods Clinical and magnetic resonance imaging (MRI) assessments of 123 pediatric patients with multiple sclerosis were obtained at disease onset and after 1 and 2 years. 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, whereas high-efficacy treatment exposure exited 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-year 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 2 years (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 lesions (beta = 0.31, p = 0.04), and number of cervical cord lesions (beta = 0.22, p = 0.05); considering 1-year 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 2 years of disease contribute to predict 9-year prognosis in pediatric patients with multiple sclerosis. ANN NEUROL 2021
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. - 89:(2021), pp. 1011-1022. [10.1002/ana.26052]
Early Predictors of 9-Year Disability in Pediatric Multiple Sclerosis
De Meo, Ermelinda;Bonacchi, Raffaello;Rocca, Maria Assunta;Filippi, Massimo
2021-01-01
Abstract
Objective The purpose of this study was to assess early predictors of 9-year disability in pediatric patients with multiple sclerosis.Methods Clinical and magnetic resonance imaging (MRI) assessments of 123 pediatric patients with multiple sclerosis were obtained at disease onset and after 1 and 2 years. 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, whereas high-efficacy treatment exposure exited 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-year 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 2 years (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 lesions (beta = 0.31, p = 0.04), and number of cervical cord lesions (beta = 0.22, p = 0.05); considering 1-year 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 2 years of disease contribute to predict 9-year prognosis in pediatric patients with multiple sclerosis. ANN NEUROL 2021I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
