Baseline predictors of disability worsening among patients wth a Clinically Isolated Syndrome.
Enric Monreal Laguillo1, José Ignacio Fernández-Velasco2, Susana Sainz de la Maza1, Noelia Villarrubia3, Mercedes Espiño2, Fernando Rodríguez-Jorge1, Juan Luís Chico-García1, Jaime Masjuanvallejo1, Lucienne Costa-Frossard1, Luisa Villar4
1Neurology, 2Immunology, Hospital Universitario Ramón y Cajal, 3Ramon y Cajal University Hospital, 4Immunology, Hospital Ramon Y Cajal
Objective:
To determine which variables at disease onset might independently predict disability worsening in patients with clinically isolated syndrome (CIS), and whether disease-modifying treatments (DMTs) might prevent a worse evolution.
Background:
A large amount of evidence has been accumulated concerning several prognostic factors that could help detect patients with aggressive MS, but the identification of patients with MS at higher risk of progression still needs to be refined.
Design/Methods:
Single-center, observational study from June 1996 to August 2022. All consecutive patients with a clinically isolated syndrome (CIS) with CSF and serum obtained within 12 months from disease onset were prospectively collected. Multivariable Cox regression models were used to study the risk of 6-month confirmed disability worsening (6mCDW), Expanded Disability Status Scale (EDSS) score of 3, relapse-associated worsening (RAW), and progression independent of relapse activity (PIRA).
Results:
We included 327 patients with a median (interquartile range, IQR) age at first symptom of 33.9 (27.1–42.4) years and a median (IQR) follow-up of 5.43 (3.17–9.08) years. A higher T2 lesion load and higher baseline EDSS were associated with higher risk of 6mCDW and EDSS of 3. However, sNfL >10 pg/ml and LS-OCMB showed the highest risk of both outcomes. In contrast, DMTs, but especially HE-DMTs, were associated with a lower risk of 6mCDW and EDSS 3. A higher risk of RAW was observed only among patients with high sNfL levels and LS-OCMB, counteracted by DMTs. However, no effect was observed with DMTs in the risk of PIRA and the only predictors of a higher risk of this outcome were a higher age of disease onset and LS-OCMB.
Conclusions:
Biomarkers such as LS-OCMB and sNfL levels obtained within first year of disease might predict patients with a higher risk of disability worsening among patients with a CIS. These patients are optimal candidates to receive early DMTs, especially HE-DMTs.