Assessment of definitions of sustained disease progression in relapsing-remitting multiple sclerosis.
Assessment of definitions of sustained disease progression in relapsing-remitting multiple sclerosis.
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DOI：
10.1155/2013/189624
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发表时间：
2013
影响因子：
2.5
通讯作者：
Chitnis T
中科院分区：
文献类型：
--
作者：
Healy BC;Engler D;Glanz B;Musallam A;Chitnis T
扩展残疾状态量表（EDSS）的持续进展是MS临床研究中疾病进展的常见结局指标。不幸的是，该结局可能无法准确衡量长期和不可逆的疾病进展。为了评估持续进展定义的性能，我们的研究纳入了复发缓解型MS（RRMS）或临床孤立综合征（脑MRI显示病变证据）患者。使用EDSS和功能系统（FS）量表对15个持续进展的定义进行了研究。还评估了复发和提供者变更对维持进展概率的影响。尽管在随访期间，对EDSS评分的提供者有时会发生变化，但提供者可以访问以前的EDSS评分。根据使用EDSS作为结局的定义，15.8%至42.2%的患者经历了持续进展，但这些患者中近50%未能在随访期间维持持续进展。当使用FS量表时，进展最常见于锥体和感觉量表。不幸的是，特定FS量表的进展未能对不可逆残疾更敏感。复发或供应商的变化并不能解释这些措施的表现不佳。EDSS或FS评分的短期变化可能不是RRMS不可逆变化的准确标志。
Sustained progression on the expanded disability status scale (EDSS) is a common outcome measure of disease progression in clinical studies of MS. Unfortunately, this outcome may not accurately measure long-term and irreversible disease progression. To assess the performance of definitions of sustained progression, patients with relapsing-remitting MS (RRMS) or a clinically isolated syndrome with evidence of lesions on a brain MRI were included in our study. Fifteen definitions of sustained progression using both the EDSS and the functional system (FS) scales were investigated. The impact of both relapses and changes in provider on the probability of maintaining progression was also evaluated. Although the provider scoring the EDSS sometimes changed during followup, the provider had access to previous EDSS scores. Between 15.8% and 42.2% of patients experienced sustained progression based on the definitions using EDSS as the outcome, but nearly 50% of these patients failed to maintain sustained progression for the duration of followup. When FS scales were used, progression was most common on the pyramidal and sensory scales. Unfortunately, progression on specific FS scales failed to be more sensitive to irreversible disability. Relapses or changes in provider did not explain the poor performance of the measures. Short-term changes in the EDSS or FS scores may not be an accurate marker of irreversible change in RRMS.