Application of definitions for conversion to secondary progressive MS in a Danish nationwide population
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- Application of definitions for conversion to secondary progressive MS in a Danish nationwide population
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Background: The number of patients with relapsing remitting multiple sclerosis (RRMS) who convert to secondary progressive (SP) MS is uncertain, and with emerging treatment options for SPMS, it is important to identify RRMS patients in transition to the SP phase. The objective of the present study was to characterize clinical parameters and use of disease modifying therapies in patients diagnosed with SPMS and RRMS patients already entered the SP phase by use of the Danish Multiple Sclerosis Registry (DMSR). Methods: We used a cross-sectional design, including all living patients with MS as of June 30, 2020 from DMSR. First, we applied the MSBase definition of SPMS on all RRMS patients. Second, we applied the slightly modified inclusion criteria from the EXPAND clinical trial on patients with clinically confirmed SPMS and patients with RRMS fulfilling the MSBase definition of SPMS to identify SPMS patients recently progressed who may benefit from treatment with disease modifying therapy. We compared clinical characteristics and disease-modifying therapy use in the different patient groups. Results: Among patients with clinically confirmed SPMS, application of a slightly modified EXPAND trial inclusion criteria for SPMS (m-EXPAND) captured patients who had converted to SPMS more recently and who had relapsed and initiated high-efficacy treatment more frequently. Moreover, our RRMS patients fulfilling the “SPMS”-criteria according to MSBase and recently progression according to m-EXPAND had similar characteristics and remarkably resembled the SPMS population in the EXPAND trial. Conclusion: Our results indicate that data-driven diagnostic definitions might help identify RRMS patients at risk for SPMS and we highlight the challenges and reluctance in diagnosing SPMS in clinical practice.
|Tidsskrift||Multiple Sclerosis and Related Disorders|
|Status||Udgivet - 2021|
We thank all Danish neurologist contributing to the data collection in The Danish Multiple Sclerosis Registry and The Danish Multiple Sclerosis Society for funding The Danish Multiple Sclerosis Registry. We also thank Lars Forsberg from Department of Clinical Neuroscience, Karolinska Institutet for sharing his R script for the MSBase algorithm.
This work was supported by Novartis Denmark . The sponsor reviewed the final draft manuscript for submission, but had no role in study design, in the collection, analysis and interpretation of data, and in the writing of the report.
T. I. Kopp has served on scientific advisory board from Novartis and received support to congress participation from Biogen. S. Bramow received financial support for congress participation and consultancy honoraria from Biogen. Z. Illes has served on scientific advisory boards, served as a consultant, received support for congress participation, received speaker honoraria, and received research support among others from Biogen, Merck-Serono, Sanofi-Genzyme, Novartis, Roche, Lundbeckfonden, Alexion. M. Kant has nothing to declare. C. Kristensen has served on scientific advisory board for Biogen, Sanofi, Roche, Novartis and Merck, has received honoraria for lecturing from Biogen and Merck and has received support for congress participation from Biogen and Roche. P.V. Rasmussen has served on scientific advisory board for Biogen, Sanofi, Roche, Novartis, Merck, and Alexion, has received honoraria for lecturing from Biogen, Merck, Novartis, Roche, has received support for congress participation from Biogen, Genzyme, Roche, Merck, Novartis. F. Sellebjerg has served on scientific advisory boards for, served as consultant for, received support for congress participation or received speaker honoraria from Alexion, Biogen, Merck, Novartis, Roche and Sanofi Genzyme. His-laboratory has received research support from Biogen, Merck, Novartis, Roche and Sanofi Genzyme. M. Magyari has served on scientific advisory board for Biogen, Sanofi, Roche, Novartis, Merck, Abbvie, Alexion has received honoraria for lecturing from Biogen, Merck, Novartis, Sanofi, Genzyme, has received research support and support for congress participation from Biogen, Genzyme, Roche, Merck, Novartis.