Characteristics of Multiple Sclerosis Patients by Phenotype: A Cross-Sectional Analysis Using the CLIMB Study
Gauruv Bose1, Nupur Greene2, Brian Healy3, Howard Weiner4, Lisa Farnett2, Keiko Higuchi2, Tanuja Chitnis4
1Brigham and Women’s Hospital; and University of Ottawa and Ottawa Hospital Research Institute, 2Sanofi, 3Brigham and Women's Hospital, 4Brigham and Women's Hospital and Harvard Medical School
Objective:
To investigate how multiple sclerosis (MS) prevalence and characteristics vary across different MS phenotypes within the Comprehensive Longitudinal Investigation of MS at the Brigham and Women’s Hospital (CLIMB) Study.
Background:
MS is categorized into phenotypes based on its clinical course. Understanding how characteristics vary across phenotype, and how characteristics change at the time of phenotype transition is of interest, as treatment intervention at, or prior to this stage, may impact long-term treatment outcomes.
Design/Methods:
Retrospective analysis of the US-based CLIMB Study identified people with MS (pwMS) (aged 18-65y), and stratified them based on phenotype at “index” (Dec-22-2021): relapsing-remitting MS [RRMS], primary-progressive MS [PPMS], active secondary-progressive MS [aSPMS], non-relapsing secondary-progressive MS [nrSPMS]. Demographics were extracted alongside disability scores (Expanded Disability Status Scale [EDSS]). Between-group differences were calculated using chi-square (categorical variables) or Kruskal-Wallis by ranks (continuous variables) tests. Data are presented mean±SD.
Results:
The analyzed cohort (n=2,599 pwMS) included: RRMS, n=1,891[72.8%]; PPMS, n=133[5.1%]; nrSPMS, n=534[20.5%]; aSPMS, n=41[1.6%] patients. Overall, 46.6%-75.9% of cohorts were female. Age at MS onset was lower for aSPMS (32.2±12.7y), RRMS (32.6±9.7y), and nrSPMS (33.8±10.4y) vs. PPMS (44.4±10.7y; P<0.001). Disease duration (at index) ranged from 16.2±9.9y (RRMS) to 26.1±11.8y (nrSPMS). RRMS patients had a shorter duration to first treatment vs. other phenotypes (4.2y vs. 7.2-9.4y; P<0.001). The majority of aSPMS (61.0%) and RRMS (68.7%) patients were receiving disease-modifying therapies (DMTs) at index vs. nrSPMS (58.2%) and PPMS (51.9%). EDSS scores were higher for nrSPMS (5.9±1.8), PPMS (5.9±1.8), and aSPMS (5.7±1.9), than for RRMS (1.9±1.5; P<0.001).
Conclusions:
Among pwMS in the United States identified in this cohort, 20.5% had nrSPMS. Characteristics varied by phenotype, with nrSPMS and PPMS patients waiting longer for first treatment and being less likely to be on DMTs, despite higher disability burden vs. RRMS patients. This highlights an unmet clinical need among patients with progressive MS.