Predicting long-term sustained disability progression

The ultimate treatment goal in MS is to prevent disability over the long term. However, randomised clinical trials (RCTs) usually evaluate short-term effect of therapies on disability, in the form of confirmed disability progression (CDP) after 3 and 6 months. Additionally, CDP events overestimate the accumulation of irreversible disability by up to 30% [1]. Changes in bowel and bladder function, and in pyramidal, cerebellar, and cerebral domains contribute more to confirmed EDSS worsening than other neurological domains [2].

Using the global MSBase registry, Prof. Tomas Kalincik (University of Melbourne, Australia), studied 6-month CDP events as indicators of long-term disability worsening. A total of 11,435 CDP events were identified in 6,902 patients.

This study showed that CDP can be defined in more detail at the occurrence of a CDP event. A low probability of recovery from a CDP event is associated with several factors, such as older age, male sex, progressive disease course, no recent MS relapse preceding the event, higher EDSS or greater change in disability, number of affected neurological domains, and worsening in pyramidal and cerebellar domains.

CDP events can be stratified with respect to their likelihood of being sustained in the long term. This approach can be applied using data that are routinely acquired in trials, thus enabling reanalysis of previously completed RCTs [3].

1. Kalincik T, et al. 2015;138(Pt 11):3287-98.
2. Stewart T, et al. Mult Scler. 2017;23:266-276.
3. Sharmin S, et al. ECTRIMS 2019, abstract 304.

Posted on 8 November 201922 March 2021