Risk Factors for Disease Progression in a Diverse US Population-based Multiple Sclerosis Cohort (S45.003)

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OBJECTIVE: The objective of this study was to evaluate demographic, environmental and clinical variables and their relationship with disease progression in a new incident and demographically diverse multiple sclerosis (MS) cohort. BACKGROUND: MS is the most common progressive neurological disease of young adults. Its incidence and prevalence have been increasing in racial groups and regions of the world previously uncommonly affected, including African Americans, Hispanics, Asians and individuals from the Middle East. There are few population-based MS cohorts evaluating disability progression, most of which are biased towards individuals of European descent. DESIGN/METHODS: In the population-based Gulf War era MS cohort (n=2,691) we assessed disease progression on the Kurtzke Disability Status Scale (DSS). This cohort comprised incident cases with US military service between 1990-2007, with neurological disability assessed at diagnosis and the most recent examination. Race, ethnicity, sex, geographic location, deployment to a war theater, and clinical variables were coded from patient databases. Time from disease onset to DSS 6 (cane) and DSS 7 (restricted to wheelchair) was assessed using Kaplan-Meier curves and a Cox proportional hazard model. RESULTS: Over a mean follow-up period of 8 years from disease onset, African Americans (AA) and males were significant independent predictors of progression to DSS 6 and DSS 7. Patients with a progressive disease course, motor or multiple symptoms at onset were also significant predictors of progression to DSS 6 and 7. Use of disease modifying therapies was protective for progression to DSS 6. Deployment to a war theater and geographic location at entry to the military were not predictors of neurological progression. CONCLUSIONS: We found male sex, African American race, and motor/multiple symptoms at onset were significant risk factors for neurological progression in a contemporary incident MS cohort. Use of DMTs was found to be protective in limiting disease progression.

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