Diagnostic uncertainty during the transition to secondary progressive multiple sclerosis: Multicenter study in Argentina
Abstract
Background:
A period of diagnostic uncertainty often characterizes the clinical transition from relapsing to secondary progressive multiple sclerosis (SPMS).
Objective:
The aim of this study was to describe the length of time required to reclassify relapsing-remitting MS (RRMS) patients who have clinically transitioned to SPMS (diagnosis uncertainty).
Methods:
This is a retrospective multicenter cohort study conducted in Argentina, identifying in every center all patients with diagnosis of MS who transitioned from RRMS to SPMS during the follow-up. We identified the dates of the last definitive RRMS and first definitive SPMS diagnoses for diagnostic uncertainty. The time required to reclassify RRMS who transitioned to SPMS and the time from disease onset to reclassify SPMS were calculated using the Kaplan–Meier method.
Results:
A total of 170 patients were included, where the mean age at disease onset (first symptom) was 36 ± 6 years; the length of time required to reclassify RRMS patients who transitioned to SPMS was 3.3 ± 1.1 years (range = 1–7 years); and the time from disease onset to classify SPMS was 19.4 ± 8.5 years (range = 16–35 years).
Conclusion:
A period of diagnostic uncertainty regarding the transition from RRMS to SPMS was present in many of our patients, with a mean time of 3.3 years.
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References
1. Mahad DH, Trapp BD, Lassmann H. Pathological mechanisms in progressive multiple sclerosis. Lancet Neurol 2015; 14(2): 183–193.
2. Faissner S, Plemel JR, Gold R, et al. Progressive multiple sclerosis: From pathophysiology to therapeutic strategies. Nat Rev Drug Discov 2019; 18(12): 905–922.
3. Miller D, Barkhof F, Montalban X, et al. Clinically isolated syndromes suggestive of multiple sclerosis, part I: Natural history, pathogenesis, diagnosis, and prognosis. Lancet Neurol 2005; 4(5): 281–288.
4. Comi G, Radaelli M, Soelberg Sorensen P. Evolving concepts in the treatment of relapsing multiple sclerosis. Lancet 2017; 389(10076): 1347–1356.
5. Lublin FD, Reingold SC. Defining the clinical course of multiple sclerosis: Results of an international survey. Neurology 1996; 46(4): 907–911.
6. Lublin FD, Reingold SC, Cohen JA, et al. Defining the clinical course of multiple sclerosis: The 2013 revisions. Neurology 2014; 83: 278–286.
7. Katz Sand I, Krieger S, Farrell C, et al. Diagnostic uncertainty during the transition to secondary progressive multiple sclerosis. Mult Scler 2014; 20(12): 1654–1657.
8. Soelberg Sorensen P, Giovannoni G, Montalban X, et al. The multiple sclerosis care unit. Mult Scler 2019; 25: 627–636.
9. Thompson AJ, Banwell BL, Barkhof F, et al. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol 2018; 17: 162–173.
10. Polman CH, Reingold SC, Banwell B, et al. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol 2011; 69(2): 292–302.
11. Carnero Contentti E, Pettinicchi JP, Lopez PA, et al. Access and unmet needs to multiple sclerosis care in a cohort of Argentinean patients. Mult Scler Relat Disord 2019; 33: 88–93.
12. Rivera VM, Macias MA. Access and barriers to MS care in Latin America. Mult Scler J Exp Transl Clin 2017; 3(1): 2055217317700668.
13. Inojosa H, Proschmann U, Akgun K, et al. A focus on secondary progressive multiple sclerosis (SPMS): Challenges in diagnosis and definition. J Neurol 2019.
14. Lorscheider J, Buzzard K, Jokubaitis V, et al. Defining secondary progressive multiple sclerosis. Brain 2016; 139: 2395–2405.
15. Trojano M, Tintore M, Montalban X, et al. Treatment decisions in multiple sclerosis—Insights from real-world observational studies. Nat Rev Neurol 2017; 13(2): 105–118.
16. Kalincik T. Effectiveness of oral multiple sclerosis therapies in clinical context. Neurology 2019; 92(16): 737–738.
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Article first published online: June 2, 2020
Issue published: April 2021
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PubMed: 32484381
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