Определение развития инвалидности у пациентов с умеренной и высокой степенью инвалидности в амбулаторных условиях с повторным множественным склерозом с использованием EDS-Plus: перспективное исследование в Аргентине.
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Alonso Ricardo, Eizaguirre Maria Barbara, Casas Magdalena, Lazaro Luciana, Laffue Alfredo, Mainella Carolina, Tavolini Dario, Leguizamon Felisa, Jose Gustavo, Rojas Juan Ignacio, Burgos Marcos, Deri Norma, Liwacki Susana, Tkachuk Veronica, Silva Berenice
Аннотация
Оригинал публикации
Determination of disability progression in moderately and highly disabled ambulatory patients with relapsing-remitting multiple sclerosis using the EDSS-Plus: A prospective study in Argentina.
BACKGROUND: Multiple Sclerosis (MS) is a chronic autoimmune disease causing central nervous system damage. Relapsing-remitting MS (RRMS) is the most common type. Disability in MS can result from relapse-associated worsening (RAW) or progression independent of relapse activity (PIRA), impacting quality of life. The Expanded Disability Status Scale (EDSS) is commonly used but has limitations. The Multiple Sclerosis Functional Composite (MSFC) improves progression detection sensitivity.
OBJECTIVE: To analyze disability progression in a subgroup of RRMS patients (EDSS 3.0-6.5) and compare EDSS-Plus (EDSS, T25FW, and 9HPT) and EDSS-Plus with cognition (EDSS-Plus cog) to EDSS in assessing disease progression.
METHODOLOGY: An 18-month prospective study in Argentina involved RRMS patients meeting the 2017 McDonald criteria and an EDSS between 3.0 and 6.5 at baseline. Patients received standard care and were assessed using EDSS, T25FW, 9HPT, and SDMT. Progression was defined as a ≥ 1.0-point increase in EDSS (baseline ≤5.5) or ≥0.5-point increase (baseline ≥6.0) over 24 weeks.
RESULTS: EDSS-Plus and EDSS-Plus cog identified more progressors than EDSS, especially in patients with higher baseline disability (EDSS >4). Progression rates were 14 % for EDSS, 22.17 % for EDSS-Plus, and 25.33 % for EDSS-Plus cog. Progressors showed higher fatigue, depression, and anxiety scores.
CONCLUSION: EDSS-Plus and EDSS-Plus cog are more sensitive than EDSS in detecting disability progression in RRMS patients, particularly those with higher baseline disability. However, this increase in detected progression events reflects the broader assessment criteria rather than necessarily indicating greater accuracy in identifying true disease progression.