In Relapsing MS, Fatigue, Limb Problems May Signal Risk for Disease Conversion

Woman wheelchair
Woman wheelchair
In older patients with relapsing multiple sclerosis, patient-reported fatigue and problems with lower extremities may signal conversion to secondary progressive disease.
The following article is part of live conference coverage from the 2017 American Academy of Neurology (AAN) annual meeting in Boston, Massachusetts. Neurology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in neurology. Check back for the latest news from AAN 2017.

BOSTON — In patients with relapsing-remitting multiple sclerosis (RRMS), fatigue and lower limb problems may predict the risk of conversion to secondary progressive MS (SPMS).

Results from the study1 were presented at the 2017 annual meeting of the American Academy of Neurology, held from April 22nd to 28th, in Boston, Massachusetts.

It is well known that older age at disease onset, a high frequency of relapses, and male sex contribute to a greater risk for MS disease conversion. In this study, Caila Vaughn, PhD, MPH, of the New York State Multiple Sclerosis Consortium and the State University of New York at Buffalo, and colleagues chose to explore patient-reported outcomes that might be predictive of conversion from RRMS to SPMS.

The study included 155 patients with RRMS (age ≥50 years) with a disease duration of at least 15 years. Analyses to evaluate the predictive value of patient-reported outcomes were performed at study enrollment and 5-year follow-up.

At 5-year follow-up, 47 (30.3%) patients with RRMS had progression to SPMS; these patients were older at study enrollment (54.8 vs 52.1; P =.01) and had a higher Kurtzke Expanded Disability Status Scale (EDSS) score at baseline (3.5 vs 2.6; P <.001) and at 5-year follow-up (5.6 vs 3.0; P <.001). Those who experienced disease progression at follow-up were more likely to report problems with their lower limbs at baseline compared with those who did not experience progression (53.2% vs 21.5%, OR 3.0; P <.001) and were also more likely to report fatigue in varying degrees (91.5% vs 68.2%; OR 4.2; P =.004). Overall, fatigue and lower limb problems were strongly correlated with conversion to SPMS even after adjusting for age, disease duration, and EDSS score (P =.001).

Given the results, the investigators suggested that identifying these patients prior to conversion would allow for health care providers to target them with tailored therapeutic strategies.

“With the aging population, this information will be vital as people with MS, their families, and policy makers make decisions about their care,” Dr Vaughn said in an ANN press release.2

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  1. Vaughn C, Kavak K, Bushra A, et al. Self-reported fatigue and lower limb problems predictive of conversion to secondary progressive multiple sclerosis in an aging sample of patients. Presented at: 2017 American Academy of Neurology Annual Meeting. April 22-28, 2017; Boston, MA.
  2. How can we predict whose MS will worsen? [news release]. American Academy of Neurology press room: March 1, 2017.