Progression of Relapsing-Remitting Multiple Sclerosis despite the new era of treatments
DOI:
https://doi.org/10.11606/issn.2176-7262.rmrp.2022.196823Keywords:
Multiple sclerosis, Disease progression, TherapeuticsAbstract
Objective. The present study aims to evaluate the conditions associated with the progression of Multiple Sclerosis (MS) and patients' dysfunctions. Methods. We perform a retrospective longitudinal analytical observational study in 46 patients with MS from a polyclinic at Rio de Janeiro, Brazil. We used the Expanded Disability Status Scale (EDSS) to rank the patients according to their disability and establish correlation with risk factors, treatment and time of disease. Results. Of 46 patients, 69.6% were female and 67.4% were white. Patients with fewer functional systems affected at the beginning of the disease had a longer time for disease progression, according to EDSS. Low efficacy drugs led to a high rate of discontinuation of the treatment. Patients who used a continuously treatment took longer to reach higher EDSS values than those who discontinued treatment. Conclusion. Despite the control of MS with high effective drugs, there is still some disability for the patient. The factors that influenced the progression of the disability were: multiple symptoms at the beginning of the disease, more than 30 years old at the beginning of the MS, delay in diagnosis and initiation of treatment, among others.
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Ropper AH, Samuels M, Klein J, Prasad S. Adams and Victor's Principles of Neurology. Edition 11. New York: McGraw-Hill Education 2019.
Ribeiro TA, Duarte AL, Silva DJ, Borges FE, Costa VM, Papais-Alvarenga RM, et al. Prevalence of multiple sclerosis in Goiânia, Goiás, Brazil. Arq Neuropsiquiatr. 2019; May 77(5): 352-356. https://doi.org/10.1590/0004-282X20190032
Ford H. Clinical presentation and diagnosis of multiple sclerosis. Clin Med (Lond). 2020; 20(4) 380-383. https://doi.org/10.7861/clinmed.2020-0292
Negreiros AA, Sousa-Munãz RL, Oliveira BE, Nóbrega PV, Monteiro LL. Clinical and epidemiological profile of patients diagnosed with multiple sclerosis in João Pessoa, Paraíba, Brazil. Arq Neuro-Psiquiatria. 2015; 73(9):741-745. https://doi.org/10.1590/0004-282X20150111
Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology. 1983; 33(11):1444. https://doi.org/10.1212/WNL.33.11.1444
Damasceno A, Glehn FV, Brandão CO, Damasceno BP, Cendes F. Prognostic indicators for long-term disability in multiple sclerosis patients. J Neurol Sci. 2013; 324(1-2):29-33. https://doi.org/10.1016/j.jns.2012.09.020
Amezcua L, McCauley JL. Race and ethnicity on MS presentation and disease course. Mult Scler J. 2020; 26(5):561-657. https://doi.org/10.1177/1352458519887328
Vasconcelos CC, Aurenção JC, Thuler LC, Camargo S, Alvarenga MP, Alvarenga RM. Prognostic factors associated with long-term disability and secondary progression in patients with Multiple Sclerosis. Multiple Sclerosis and Mult Scler Relat Disord. 2016; 8:27-34. https://doi.org/10.1016/j.msard.2016.03.011
Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J, et al. Harrison's Principles of Internal Medicine. 19th edition. New York: McGraw Hill Education, 2015.
Alroughani R, Inshasi J, Deleu D., Al-Hashel J, Shakra M, Elalamy O. An overview of high-efficacy drugs for multiple sclerosis: Gulf region expert opinion. Neurol. Ther. 2019; 8(1):13–23. https://doi.org/10.6084/m9.figshare.7687670
Brazil. Department of Health. Ordinance nº 3, 2021, February, 5th, Official Diary of the Union, Edition: 31, section 1, p. 88.
Pour GA, Rasekhi AR. Multiple Sclerosis: a risk factor analysis in Iran. Arch Iran Med. 2002; 5(3):191-193.
Baggio BF, Teles RA, Renosto A, Alvarenga LF. Perfil epidemiológico de indivíduos com Esclerose Múltipla de uma associação de referência. Rev. Neurociênc. 2011; 19(3):458-61. https://doi.org/10.34024/rnc.2011.v19.8347
Teixeira CA. Clinical and epidemiological characteristics of 146 patients with multiple sclerosis followed up in the city of Fortaleza, CE, Brazil, between 1979 and 2010 [dissertation]. Fortaleza: Medical Course, Federal University of Ceara, 2011.
Martyn CN, Gale CR. The epidemiology of multiple sclerosis. Acta Neurol Scand Suppl. 1997; 169:3-7. https://doi.org/10.1111/j.1600-0404.1997.tb08143.x
Nazish S, Shahid R, Zafar A, Alshamrani F, Sulaiman AA, Alabdali M, et al. Clinical Presentations and Phenotypic Spectrum of Multiple Sclerosis at a University Hospital in Saudi Arabia. J Clin Neurol. 2018; 14(3):359–365. https://doi.org/10.3988/jcn.2018.14.3.359
Skoog B, Runmarker B, Windbland S, Ekholm S, Andersen O. A representative cohort of patients with non-progressive multiple sclerosis at the age of normal life expectancy. Brain. 2012; 135(3):900-11. https://doi.org/10.1093/brain/awr336
Ghezzi A, Pozzilli C, Liguori M, Marrosu MG, Milani N, Milanese C, et al. Prospective study of multiple sclerosis with early onset. Mult Scler. 2002; 8(2):115-118. https://doi.org/10.1191/1352458502ms786oa.
Debouverie M. Gender as a prognostic factor and it s impact on the incidence of multiple sclerosis in Lorraine, France. J Neurol Sci. 2009;. 286(1-2):14-17. https://doi.org/10.1016/j.jns.2009.07.012
Hawkins SA, McDonnell GV. Benign multiple sclerosis: Clinical course, long term follow up, and assessment of prognostic factors. J Neurol Neurosurg Psychiatry. 1999; 67(2):148-152. http://dx.doi.org/10.1136/jnnp.67.2.148
Hojjati SM, Hojjati AS, Baes M, Bijani A. Relation between EDSS and monosymptomatic or polysymptomatic onset in clinical manifestations of multiple sclerosis in Babol, northern Iran. Caspian J Intern Med. 2014; 5(1):5-8.
Décard BF, Wyl VV, Benkert P, Lorscheider J, Hänni P, Lienert C, et al. Time to relapse is comparable in pediatric- and adult-onset multiple sclerosis patients after the initiation of disease-modifying therapy. In: 34th Congress of the European Committee for Treatment and Research in Multiple Sclerosis, 2018, October 10-12, Berlin, Germany.
Laffaldano P, Lucisano G, Butzkueven H, Hillert J, Hyde R, Koch-henriksen, et al. The optimal time to start treatment in relapsing remitting multiple sclerosis patients: results from the Big Multiple Sclerosis Data Network. In: 34th Congress of the European Committee for Treatment and Research in Multiple Sclerosis, 2018, October 10-12, Berlin, Germany.
Kaufmann M, Kuhle J, Puhan MA, Kamm CP, Chan A, Salmen A, et al. Factors associated with time from first-symptoms to diagnosis and treatment initiation of Multiple Sclerosis in Switzerland. Mult Scler J Exp Transl Clin . 2018; 4(4):1-10. https://doi.org/10.1177/2055217318814562
Giovannoni G, Butzkueven H, Dhib-Jalbut S, Hobart J, Kobelt G, Pepper G, et al. Brain health: time matters in multiple sclerosis. Mult Scler Relat Disord. 2016; 9(1):5-48. https://doi.org/10.1016/j.msard.2016.07.003
Meyniel C, Spelman T, Jokubaitis VG, Trojano M, Izquierdo, Grand’Maison F, et al. Country, sex, EDSS change and therapy choice independently predict treatment discontinuation in Multiple Sclerosis and Clinically Isolated Syndrome. Plos one. 2012; 7(6):e3866, 1-8. https://doi.org/10.1371/journal.pone.0038661
Tilbery CP, Fazzito MM, Jordy SS, Thomaz RB, Fernandes IR. Side effects of immunomodulatory drugs in the treatment of Multiple Sclerosis - experience in 118 cases. Rev. Neurociênc. 2009; 17(3):220-225.
Alves BC, Angeloni RV, Azalis LA, Pereira EC, Perazzo FF, Rosa PC, et al. Multiple sclerosis: a review of main treatments. Saúde Meio Ambient.. 2014; 3(2):19-34. https://doi.org/10.24302/sma.v3i2.542
Brazil, Ministerio da Saúde. Relatório de Recomendação: Protocolo Clínico e Diretrizes Terapêuticas Esclerose Múltipla. CONITEC, 2019; 20.
Nali LH; Moraes L, Fink MC, Callegaro D, Romano CM, Oliveira AC. Natalizumab treatment for multiple sclerosis: updates and considerations for safer treatment in JCV positive patients. Arq. Neuro-Psiquiatr. 2014 Dec; 72(12):960-965. https://doi.org/10.1590/0004-282X20140142
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