Real world prognosis in MS: does early versus late diagnosis matter?

ABSTRACT

Background

Multiple sclerosis (MS) often presents soon after the onset of a recognized clinically isolated syndrome (CIS). In order to interpret data from CIS trials, it is important to know whether patients presenting as classical CIS provide group data representative of RRMS.

Objective

We aimed to determine whether or not MS patients presenting soon after the onset of symptoms with clinically isolated syndromes have an identifiable clinical profile, including worse outcomes, versus MS patients presenting later.

Methods

Chart review of consecutive patients with newly diagnosed relapsing MS, diagnosed in our clinic between 1989 and 2005. We divided patients into an early presentation group (EP), versus the remaining late presenting group (LP), and analyzed the impact of delay in presentation on 10- and 15-year disability outcomes. We also sought to identify reasons for later presentation.

Results

The two groups were similar in terms of many demographics, clinical risk factors, and long-term disability outcomes (median EDSS 2.25 versus EDSS 2.0 at 10 years). Exceptionally, patients in the EP group had more frequent attacks in the first few years after onset and were diagnosed and treated earlier.

Conclusions

Patients in our MS clinic with EP versus LP were more likely to have multiple attacks in the first 2 years after onset and were treated earlier, but did not have a better 10- or 15-year outcome.

KEYWORDS:

• MS
• CIS
• disability
• relapses

Acknowledgments

We thank Teresa Hentosz for clerical assistance in the preparation of the manuscript.

Disclosure statement

Dr. TF Scott has received payments for research activities, advisory boards, promotional speaking and consulting for Genentech, Biogen, Novartis, and Genzyme. All other authors declare that they have no conflicts of interest.

Author contributions

Study concept and design: TFS, JZ, TQ, TD.

Acquisition, analysis, interpretation, and statistical analysis of data: TFS, JZ, TQ, RS, TD.

Drafting and the final work of the manuscript for intellectual content: TFS, JZ, TQ, RS.

All authors’ approval of the version to be published, and have agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Additional information

Funding

This study was supported by the Department of Neurology, Allegheny General Hospital, Allegheny Health Network.

Notes on contributors

Jikku Zachariah

Jikku Zachariah, DO, graduated from Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania in 2016, and completed his Neurology residency at Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pennsylvania in 2020. He is currently in a Neuroimmunology Fellowship at Temple University, Philadelphia, Pennsylvania with graduation in June 2021.

Timothy Quezada

Timothy Quezada, DO, MPH, received his Master of Public Health in Epidemiology from Tulane University, New Orleans, Louisiana in 2012, graduated from Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania in 2016, and completed his Neurology residency at Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pennsylvania in 2020. He served as Chief Neurology Resident in his senior year. He is in a Clinical Neurophysiology Fellowship Program, Allegheny General Hospital- Allegheny Health Network's Medical Education Consortium, Pittsburgh, Pennsylvania with graduation in June 2021.

Troy Desai

Troy Desai, MD, received his Medical Degree in 2004 from Ross University School of Medicine, Portsmouth, Commonwealth of Dominica, and completed his medical internship at St. Vincent Medical Center, Bridgeport, Connecticut in 2006, and Neurology residency training at Allegheny General Hospital, Pittsburgh, Pennsylvania from 2006 to 2009. He completed a Multiple Sclerosis Fellowship at Veterans Administration Medical Center, University of Maryland Medical Center in 2010. He is Co-director of the Allegheny Multiple Sclerosis Center, and an attending physician in the Neuroscience Institute, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pennsylvania. He specializes in providing comprehensive care for individuals with multiple sclerosis, including disease-modifying medications and treating exacerbations.

Rebecca E. Schorr

Rebecca E. Schorr, MPH, is a Senior Research Statistician at Highmark Health, Pittsburgh, Pennsylvania.

Thomas F. Scott

Thomas F. Scott, MD, has been at Allegheny General Hospital in Pittsburgh for the last 30 years where he is now a Professor of Neurology at Drexel University College of Medicine, after serving as the Director of Residency Training for 10 years. He is Co-director of the Allegheny Multiple Sclerosis Center, and an attending physician in the Neuroscience Institute, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pennsylvania. Dr. Scott graduated cum laude from Dartmouth College in 1981, attended West Virginia University Medical School and completed his Neurology residency at Medical University of South Carolina in 1989. He has received research grants from the Allegheny-Singer Research Institute, and The Pittsburgh Foundation to study the neuroimmunology of multiple sclerosis. Dr. Scott is a recipient of medical student teaching awards from both Drexel University and Temple University, and research awards from the Journal of Multiple Sclerosis and the Keystone chapter of the National Multiple Sclerosis Society.