![]() ![]() Those of Middle Eastern or North African ancestry had greater disability progression over time, despite evidence of inflammatory disease activity, based on clinical relapses and MRI lesions, that was similar to individuals of Northern European ancestry. 10 In a study from Toronto, Ontario, Canada, people with MS of Middle Eastern or North African ancestry had disease phenotypes that were different compared with an age- and sex-matched group of people with MS of Northern European ancestry. In a US-based study, Black and Hispanic/Latinx people with MS had more rapid disability accumulation than white people with MS, even after adjusting for age, gender, and insurance type. 3 Subsequent 10-year follow-up of these individuals, however, showed that male sex was no longer a significant predictor of developing CDMS. 2 Conversely, among people with RIS followed for 5 years, male sex was independently associated with a nearly twofold elevated risk of developing an initial clinical event. 9 Moreover, a large cohort study among people with CIS showed that both sexes studied had similar risks of developing CDMS and disability progression. 8Īlthough epidemiologic studies show female persons are more likely to develop MS, meta-analysis of 9 studies (n=1,116) in people with CIS over approximately 4 years showed no statistically significant increase in female persons for conversion to CDMS (odds ration, 1.2 95% CI, 0.98 to 1.46). 6 Conversely, another study demonstrated in multivariate analyses that sex was not a significant predictor of disability. 1,5-7 This association may be dependent on disease subtype, considering a study evaluating both relapsing-remitting MS (RRMS) and primary progressive MS (PPMS) found median times from disease onset to EDSS score of 6.0 were 18 and 22.7 years for male and female individuals, respectively but not significantly different between male and female persons with PPMS. Numerous studies have suggested that male sex negatively influences long-term disability outcomes and is associated with a shorter time to disability accrual in MS. 2 Similarly, among people with RIS, lower age at diagnosis was independently associated with a higher risk of developing a first clinical event consistent with MS at 5 and 10 years of follow-up. 1 Among people with CIS, lower age of onset was associated with an increased risk of conversion to clinically definite MS (CDMS). ![]() 1 Although lower age at onset is associated with a longer time to onset of disability milestone, individuals who present with MS earlier in life often acquire significant disability at an earlier age compared with individuals with onset later in life. In this review, we discuss potential prognostic factors in MS, including demographics, clinical characteristics, MRI measures, and laboratory tests that may have utility in clinical practice to predict conversion of clinically isolated syndrome (CIS) and radiologically isolated syndrome (RIS) to MS (Table 1) and disease activity and disability accumulation (Table 2).Īge at MS onset is known to impact MS disease course, and increasing age at onset correlates with decreased time to onset of specific disability milestones (eg, Expanded Disability Status Scale scores of 4.0, 6.0 and 7.0). With the broad and continually increasing armamentarium of MS disease-modifying treatments (DMTs), there is an opportunity to tailor treatment decisions on an individual level to optimize clinical outcomes. Owing to the clinical heterogeneity of MS, an awareness of key features that have predictive value to identify those with a higher likelihood of having highly active disease and developing rapid disability accumulation is crucial to optimizing clinical outcomes over time. Multiple sclerosis (MS) is a chronic, inflammatory, predominantly demyelinating condition of the central nervous system (CNS) that has a wide range of presentations, disease courses, and treatment responses. ![]()
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