Multiple Sclerosis Progression and Relapse Activity in Children-Reference-Cited by-同舟云学术

Multiple Sclerosis Progression and Relapse Activity in Children

Published:2024-01-01 Issue:1 Volume:81 Page:50
ISSN:2168-6149
Container-title:JAMA Neurology
language:en
Short-container-title:JAMA Neurol

Author:

Iaffaldano Pietro¹,Portaccio Emilio²,Lucisano Giuseppe¹³,Simone Marta⁴,Manni Alessia¹,Guerra Tommaso¹,Paolicelli Damiano¹,Betti Matteo²,De Meo Ermelinda²,Pastò Luisa²,Razzolini Lorenzo²,Rocca Maria A.⁵⁶,Ferrè Laura⁵,Brescia Morra Vincenzo⁷,Patti Francesco⁸,Zaffaroni Mauro⁹,Gasperini Claudio¹⁰,De Luca Giovanna¹¹,Ferraro Diana¹²,Granella Franco¹³,Pozzilli Carlo¹⁴,Romano Silvia¹⁵,Gallo Paolo¹⁶,Bergamaschi Roberto¹⁷,Coniglio Maria Gabriella¹⁸,Lus Giacomo¹⁹,Vianello Marika²⁰,Banfi Paola²¹,Lugaresi Alessandra²²²³,Totaro Rocco²⁴,Spitaleri Daniele²⁵,Cocco Eleonora²⁶,Di Palma Franco²⁷,Maimone Davide²⁸,Valentino Paola²⁹,Torri Clerici Valentina³⁰,Protti Alessandra³¹,Maniscalco Giorgia Teresa³²,Salemi Giuseppe³³,Pesci Ilaria³⁴,Aguglia Umberto³⁵,Lepore Vito³⁶,Filippi Massimo⁵⁶,Trojano Maria¹,Amato Maria Pia²³⁷,Ferraro Elisabetta³⁸,Logullo Francesco O.³⁸,Marfia Girolama A.³⁸,Bombardi Roberto³⁸,Nasuelli Davide³⁸,Bellantonio Paolo³⁸,De Riz Milena³⁸,Gazzola Paola³⁸,Cavaletti Guido³⁸,Inglese Matilde³⁸,Conte Antonella³⁸,Tedeschi Gioacchino³⁸,Di Sapio Alessia³⁸,Leone Alessandro³⁸,Montepietra Sara³⁸,Marini Bruno³⁸,Gatto Maurizia³⁸,Sessa Maria³⁸,Ferrò Maria T.³⁸,Rini Augusto³⁸,Cargnelutti Daniela³⁸,Mirabella Massimiliano³⁸,Burlina Alessandro³⁸,Avolio Carlo³⁸,Cavalla Paola³⁸,Rovaris Marco³⁸,Ardito Bonaventura³⁸,Piantadosi Carlo³⁸,Confalonieri Paolo A.³⁸,Clerici Raffaella³⁸,Strumia Silvia³⁸,De Robertis Francesca³⁸,Quatrale Rocco³⁸,Sinisi Leonardo³⁸,Fioretti Cristina³⁸,Di Lazzaro Vincenzo³⁸,Bucello Sebastiano³⁸,Mancinelli Luca³⁸,Ribizzi Giuseppe³⁸,Zarbo Roberto³⁸,Grimaldi Luigi M. E.³⁸,Corea Francesco³⁸,Sidoti Vincenzo³⁸,Massacesi Luca³⁸,Balgera Roberto³⁸,Romano Marcello C.³⁸,D'Andrea Francesco³⁸,Ancona Anna Luisa³⁸,Pizzorno Matteo³⁸,Rinalduzzi Steno³⁸,Passantino Francesco³⁸,Capone Lorenzo³⁸,Bianchi Marta³⁸,Venturi Simonetta³⁸,Trivelli Giuseppe³⁸,Brichetto Giampaolo³⁸,Fermi Silvia³⁸,Bramanti Placido³⁸,Iodice Rosa³⁸,Piras Maria Luisa³⁸,Celani Maria Grazia³⁸,Barone Paolo³⁸,Tassinari Tiziana³⁸,Marson Annamaria³⁸,Clerico Marinella³⁸,Banfi Paola³⁸,Solaro Claudio³⁸,

Affiliation:

1. Department of Translational Biomedicines and Neurosciences, University of Bari Aldo Moro, Bari, Italy

2. Department of Neurofarba, University of Florence, Florence, Italy

3. Center for Outcomes Research and Clinical Epidemiology (CORESEARCH), Pescara, Italy

4. Dipartimento di Medicina di Precisione e Rigenerativa e Area Jonica (DiMePRe-J), University of Bari Aldo Moro, Bari, Italy

5. Neurology Unit and MS Center, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), San Raffaele Scientific Institute, Milan, Italy

6. Vita-Salute San Raffaele University, Milan, Italy

7. Multiple Sclerosis Clinical Care and Research Center, Department of Neuroscience (NSRO), Federico II University, Naples, Italy

8. Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate, GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania, Catania, Italy

9. Multiple Sclerosis Center, Hospital of Gallarate, ASST della Valle Olona, Gallarate (Varese), Italy

10. Centro Sclerosi Multipla–Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy

11. Centro Sclerosi Multipla, Clinica Neurologica, Policlinico SS. Annunziata, Chieti, Italy

12. Department of Neurosciences, Ospedale Civile di Baggiovara, Azienda Ospedaliero–Universitaria di Modena, Modena, Italy

13. Unit of Neurosciences, Department of Medicine and Surgery, University of Parma, Parma, Italy

14. Multiple Sclerosis Center, Department of Human Neuroscience, S. Andrea Hospital, Rome, Italy

15. Department of Neurosciences, Mental Health and Sensory Organs, Centre for Experimental Neurological Therapies (CENTERS), Sapienza University of Rome, Rome, Italy

16. Department of Neurosciences, Multiple Sclerosis Centre–Veneto Region (CeSMuV), University Hospital of Padua, Padua, Italy

17. IRCCS Mondino Foundation, Pavia, Italy

18. Center for Multiple Sclerosis, ASM P.O. “Madonna Delle Grazie,” Matera, Italy

19. Multiple Sclerosis Center, II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy

20. Unit of Neurology, Cà Foncello Hospital, Treviso, Italy

21. Neurology and Stroke Unit, University of Insubria, Varese, Italy

22. IRCCS Istituto Scienze Neurologiche di Bologna, Bologna, Italy

23. Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy

24. San Salvatore Hospital, Demyelinating Disease Center, L’Aquila, Italy

25. Department of Neurology, AORN San G. Moscati di Avellino, Avellino, Italy

26. University of Cagliari, Department of Medical Science and Public Health, Centro Sclerosi Multipla, Cagliari, Italy

27. Department of Neurology, ASST Lariana Ospedale S. Anna, Como, Italy

28. Department of Neurology, Ospedale Garibaldi, Catania, Italy

29. Institute of Neurology, Magna Græcia University of Catanzaro, Catanzaro, Italy

30. IRCCS Istituto Neurologico C. Besta, Neuroimmunology Unit, Milan, Italy

31. Department of Neuroscience, Niguarda Hospital, Milano, Italy

32. A Cardarelli Hospital, Neurological Clinic and Multiple Sclerosis Center, Naples, Italy

33. Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy

34. Multiple Sclerosis Center, UO Neurology, Fidenza Hospital, Fidenza, Italy

35. Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy

36. Public Health Department, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy

37. IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy

38. for the Italian Multiple Sclerosis Register

Abstract

ImportanceAlthough up to 20% of patients with multiple sclerosis (MS) experience onset before 18 years of age, it has been suggested that people with pediatric-onset MS (POMS) are protected against disability because of greater capacity for repair.ObjectiveTo assess the incidence of and factors associated with progression independent of relapse activity (PIRA) and relapse-associated worsening (RAW) in POMS compared with typical adult-onset MS (AOMS) and late-onset MS (LOMS).Design, Setting, and ParticipantsThis cohort study on prospectively acquired data from the Italian MS Register was performed from June 1, 2000, to September 30, 2021. At the time of data extraction, longitudinal data from 73 564 patients from 120 MS centers were available in the register.Main Outcomes and MeasuresThe main outcomes included age-related cumulative incidence and adjusted hazard ratios (HRs) for PIRA and RAW and associated factors.ExposuresClinical and magnetic resonance imaging features, time receiving disease-modifying therapy (DMT), and time to first DMT.ResultsAfter applying the inclusion and exclusion criteria, the study assessed 16 130 patients with MS (median [IQR] age at onset, 28.7 [22.8-36.2 years]; 68.3% female). Compared with AOMS and LOMS, patients with POMS had less disability, exhibited more active disease, and were exposed to DMT for a longer period. A first 48-week-confirmed PIRA occurred in 7176 patients (44.5%): 558 patients with POMS (40.4%), 6258 patients with AOMS (44.3%), and 360 patients with LOMS (56.8%) (P &lt; .001). Factors associated with PIRA were older age at onset (AOMS vs POMS HR, 1.42; 95% CI, 1.30-1.55; LOMS vs POMS HR, 2.98; 95% CI, 2.60-3.41; P &lt; .001), longer disease duration (HR, 1.04; 95% CI, 1.04-1.05; P &lt; .001), and shorter DMT exposure (HR, 0.69; 95% CI, 0.64-0.74; P &lt; .001). The incidence of PIRA was 1.3% at 20 years of age, but it rapidly increased approximately 7 times between 21 and 30 years of age (9.0%) and nearly doubled for each age decade from 40 to 70 years (21.6% at 40 years, 39.0% at 50 years, 61.0% at 60 years, and 78.7% at 70 years). The cumulative incidence of RAW events followed a similar trend from 20 to 60 years (0.5% at 20 years, 3.5% at 30 years, 7.8% at 40 years, 14.4% at 50 years, and 24.1% at 60 years); no further increase was found at 70 years (27.7%). Delayed DMT initiation was associated with higher risk of PIRA (HR, 1.16; 95% CI, 1.00-1.34; P = .04) and RAW (HR, 1.75; 95% CI, 1.28-2.39; P = .001).Conclusions and RelevancePIRA can occur at any age, and although pediatric onset is not fully protective against progression, this study’s findings suggest that patients with pediatric onset are less likely to exhibit PIRA over a decade of follow-up. However, these data also reinforce the benefit for DMT initiation in patients with POMS, as treatment was associated with reduced occurrence of both PIRA and RAW regardless of age at onset.

Publisher

American Medical Association (AMA)

Subject

Neurology (clinical)

Link

https://jamanetwork.com/journals/jamaneurology/articlepdf/2812352/jamaneurology_iaffaldano_2023_oi_230087_1703025824.26629.pdf

Reference20 articles.

1. Greater sensitivity to multiple sclerosis disability worsening and progression events using a roving versus a fixed reference value in a prospective cohort study.;Kappos;Mult Scler,2018

2. Silent progression in disease activity-free relapsing multiple sclerosis.;Cree;Ann Neurol,2019

3. Contribution of relapse-independent progression vs relapse-associated worsening to overall confirmed disability accumulation in typical relapsing multiple sclerosis in a pooled analysis of 2 randomized clinical trials.;Kappos;JAMA Neurol,2020

4. How patients with multiple sclerosis acquire disability.;Lublin;Brain,2022

5. Progression is independent of relapse activity in early multiple sclerosis: a real-life cohort study.;Portaccio;Brain,2022

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