Routine CSF parameters as predictors of disease course in multiple sclerosis: an MSBase cohort study.
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Dekeyser Cathérine, Hautekeete Matthias, Cambron Melissa, Van Pesch Vincent, Patti Francesco, Kuhle Jens, Khoury Samia, Lechner Scott Jeanette, Gerlach Oliver, Lugaresi Alessandra, Maimone Davide, Surcinelli Andrea, Grammond Pierre, Kalincik Tomas, Habek Mario, Willekens Barbara, Macdonell Richard, Lalive Patrice, Csepany Tunde, Butzkueven Helmut, Boz Cavit, Tomassini Valentina, Foschi Matteo, Sánchez-Menoyo José Luis, Altintas Ayse, Mrabet Saloua, Iuliano Gerardo, Sa Maria Jose, Alroughani Raed, Karabudak Rana, Aguera-Morales Eduardo, Gray Orla, de Gans Koen, van der Walt Anneke, McCombe Pamela A, Deri Norma, Garber Justin, Al-Asmi Abdullah, Skibina Olga, Duquette Pierre, Cartechini Elisabetta, Spitaleri Daniele, Gouider Riadh, Soysal Aysun, Van Hijfte Liesbeth, Slee Mark, Amato Maria Pia, Buzzard Katherine, Laureys Guy
Аннотация
METHODS: This large-scale cohort study included persons with MS with CSF data documented in the MSBase registry. CSF parameters to predict time to reach confirmed Expanded Disability Status Scale (EDSS) scores 4, 6 and 7 and annualised relapse rate in the first 2 years after diagnosis (ARR2) were assessed using (cox) regression analysis.
RESULTS: In total, 11 245 participants were included of which 93.7% (n=10 533) were persons with relapsing-remitting MS (RRMS). In RRMS, the presence of CSF oligoclonal bands (OCBs) was associated with shorter time to disability milestones EDSS 4 (adjusted HR=1.272 (95% CI, 1.089 to 1.485), p=0.002), EDSS 6 (HR=1.314 (95% CI, 1.062 to 1.626), p=0.012) and EDSS 7 (HR=1.686 (95% CI, 1.111 to 2.558), p=0.014). On the other hand, the presence of CSF pleocytosis (≥5 cells/µL) increased time to moderate disability (EDSS 4) in RRMS (HR=0.774 (95% CI, 0.632 to 0.948), p=0.013). None of the CSF variables were associated with time to disability milestones in persons with primary progressive MS (PPMS). The presence of CSF pleocytosis increased ARR2 in RRMS (adjusted R2=0.036, p=0.015).
CONCLUSIONS: In RRMS, the presence of CSF OCBs predicts shorter time to disability milestones, whereas CSF pleocytosis could be protective. This could however not be found in PPMS. CSF pleocytosis is associated with short-term inflammatory disease activity in RRMS. CSF analysis provides prognostic information which could aid in clinical and therapeutic decision-making.