Heterogeneity on long-term disability trajectories in patients with secondary progressive MS: a latent class analysis from Big MS Data network.
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Signori Alessio, Lorscheider Johannes, Vukusic Sandra, Trojano Maria, Iaffaldano Pietro, Hillert Jan, Hyde Robert, Pellegrini Fabio, Magyari Melinda, Koch-Henriksen Nils, Sørensen Per Soelberg, Spelman Tim, van der Walt Anneke, Horakova Dana, Havrdova Eva, Girard Marc, Eichau Sara, Grand'Maison Francois, Gerlach Oliver, Terzi Murat, Ozakbas Serkan, Skibina Olga, Van Pesch Vincent, Sa Maria Jose, Prevost Julie, Alroughani Raed, McCombe Pamela A, Gouider Riadh, Mrabet Saloua, Castillo-Trivino Tamara, Zhu Chao, de Gans Koen, Sánchez-Menoyo José Luis, Yamout Bassem, Khoury Samia, Sormani Maria Pia, Kalincik Tomas, Butzkueven Helmut, Big MS Data Network
Аннотация
METHODS: All patients with MS collected within Big MS registries who received an SPMS diagnosis from physicians (cohort 1) or satisfied the Lorscheider criteria (cohort 2) were considered. Longitudinal Expanded Disability Status Scale (EDSS) scores were modelled by a latent class growth analysis (LCGA), using a non-linear function of time from the first EDSS visit in the range 3-4.
RESULTS: A total of 3613 patients with SPMS were included in the cohort 1. LCGA detected three different subgroups of patients with a mild (n=1297; 35.9%), a moderate (n=1936; 53.6%) and a severe (n=380; 10.5%) disability trajectory. Median time to EDSS 6 was 12.1, 5.0 and 1.7 years, for the three groups, respectively; the probability to reach EDSS 6 at 8 years was 14.4%, 78.4% and 98.3%, respectively. Similar results were found among 7613 patients satisfying the Lorscheider criteria.
CONCLUSIONS: Contrary to previous interpretations, patients with SPMS progress at greatly different rates. Our identification of distinct trajectories can guide better patient selection in future phase 3 SPMS clinical trials. Additionally, distinct trajectories could reflect heterogeneous pathological mechanisms of progression.