Clinical Predictors Of Expanded Disability Status Scale Rank Change Over 5-Year Intervals In The MSBase Registry (P4.187)

OBJECTIVE: To determine clinical predictors of Expanded Disability Status Scale (EDSS) rank change over 5-year intervals as potential markers of multiple sclerosis (MS) severity, using an international cohort in the MSBase Registry. BACKGROUND: Given clinical heterogeneity in MS, it is desirable to define predictors of later outcomes. Using the MSBase Registry, we previously showed that EDSS ranking allows prediction of 5-year disability outcome. METHODS: Two MSBase Registry cohorts, in which EDSS rank change was previously described, were analysed. We included patients with relapsing remitting MS (RRMS) with 5-year prospectively acquired EDSS data. Intervals were years 1-6 (‘early RRMS’) and years 5-10 (‘later RRMS’) after CIS. As change in EDSS rank was statistically skewed, quantile (median) regression was performed to assess predictors of rank change over the 5-year intervals. Predictors included age, sex and imaging findings with stratification by EDSS, disease-modifying treatment (DMT) and annualised relapse rate (ARR). RESULTS: In the ‘early RRMS’ group, age and ARR ‘on treatment’ predicted EDSS rank worsening, whereas DMT possession ratio (over 50% during interval) predicted rank improvement. In the ‘later RRMS’ group, ARR ‘on treatment’ also predicted rank change but ARR ‘off treatment’ and DMT possession ratio (>50%) had no effect. Male sex and infratentorial MRI lesions were also predictive of worse outcome in the ‘later RRMS’ group. CONCLUSIONS: This is the first study evaluating predictors of EDSS rank change over 5-year intervals. The positive impact of treatment was observed in the early (but not the later) cohort in this study, supporting the case for early treatment in MS. The study confirms the relevance of on-treatment relapses for worse disability outcomes. Study Support: The MSBase Registry is supported by the independent MSBase Foundation Ltd which receives financial support from Merck Serono, Biogen Idec, Novartis, Bayer Schering and Sanofi Aventis. Disclosure: Dr. Hughes has nothing to disclose. Dr. Spelman has received personal compensation for activities with Biogen Idec. Dr. Trojano has received personal compensation for activities with Sanofi-Aventis Pharmaceuticals Inc., Biogen Idec, Novartis and Bayer Schering as a consultant or speaker. Dr. Trojano has received research support from Merck Serono, Biogen Idec and Novartis. Dr. Lugaresi has received personal compensation for activities with Biogen Idec, Bayer Schering, Merck Serono, Novartis and Sanofi-Aventis Pharmaceuticals Inc. as a speaker. Dr. Lugaresi has received research support from Biogen Idec, Bayer Schering, Merck Serono, Novartis and Sanofi-Aventis Pharmaceuticals, Inc. Dr. Izquierdo has received personal compensation for activities with Biogen Idec, Merck & Co. Inc., Bayer Pharmaceuticals Corp., Sanofi-Aventis Pharmaceuticals Inc., Teva Neuroscience, and Novartis. Dr. Grand-Maison has received personal compensation for activities with Sanofi-Aventis Pharmaceuticals Inc., Bayer Pharmaceuticals Corp., Serono Inc., Biogen Idec, Genzyme Corp., and Novartis. Dr. Grand-Maison has received research support from Sanofi-Aventis Pharmaceuticals Inc., Bayer Pharmaceuticals Corp., Serono Inc., Biogen Idec, Genzyme Corp., and Novartis. Dr. Duquette has received personal compensation for activities with Berlex, Biogen Idec, Serono, Novartis, and Teva Neuroscience. Dr. Girard has nothing to disclose. Dr. Grammond has received personal compensation for activities with Biogen Idec. Dr. Oreja-Guevara has received personal compensation for activities with Bayer Schering, Biogen Idec, Genzyme Corp., Novartis and Merck Serono as a speaker. Dr. Oreja-Guevara has received research support from Biogen Idec and Merck Serono. Dr. Hupperts has received personal compensation for activities with Novartis, Biogen Idec, Teva Neuroscience, Sanofi-Aventis Pharmaceuticals Inc., and Merck Serono. Dr. Boz has nothing to disclose. Dr. Bergamaschi has nothing to disclose. Dr Lechner-Scott has received personal compensation for activities with Biogen Idec, Bayer Schering, Sanofi-Aventis Pharmaceuticals Inc., and Merck Serono as a speaker and advisory board member. Dr. Rio has nothing to disclose. Dr. Lechner-Scott has received personal compensation for activities with Biogen Idec, Bayer Schering, Serono Inc., and Sanofi-Aventis Pharmaceuticals Inc. as a consultant and speaker. Dr Lechner Scott has received research support from Biogen Idec, Merck Serono, Sanofi-Aventis Pharmaceuticals, Inc., and Bayer Schering. Dr. Van Pesch has received personal compensation for activities with Biogen Idec, Sanofi-Aventis Pharmaceuticals Inc., and Merck Serono. Dr. Iuliano has received personal compensation for activities with Bayer Schering, Sanofi-Aventis Pharmaceuticals inc., Merck Serono, Novartis, and Biogen Idec. Dr. Fiol has received personal compensation for activities with Bayer Pharmaceuticals Corp., and Merck Serono. Dr. Verheul has received personal compensation for activities with Merck Serono, Biogen Idec, and Novartis. Dr. Barnett has nothing to disclose. Dr. Slee has nothing to disclose. Dr. Herbert has received personal compensation for activities with Biogen Idec, Teva Neuroscience, Serono Inc., and Bayer Pharmaceuticals Inc. Dr. Herbert has received research support from Teva Neuroscience, Novartis, Biogen Idec, BioMS, and INC Research. Dr. Kister has nothing to disclose. Dr. Vella has nothing to disclose. Dr. Moore has received personal compensation for activities with Serono Inc., and Bayer Pharmaceuticals Corp. Dr. Petkovska-Boskova has nothing to disclose. Dr. Shaygannejad has nothing to disclose. Dr. Jokubaitis has received research support from Merck Serono. Dr. McDonnell has nothing to disclose. Dr. Hawkins has nothing to disclose. Dr. Kee has nothing to disclose. Dr. Butzkueven has received personal compensation for activities with Biogen Idec, Novartis, and CSL Ltd. Dr. Butzkueven has received research support from Merck & Co., Inc., Biogen Idec, and Novartis. Dr. Gray has received personal compensation for activities with Sanofi-Aventis Pharmaceuticals Inc., and Merck Serono.