A SUPPLEMENT TO

How Can We Predict
Whose MS Will Worsen?

Two factors predict conversion to secondary progressive MS.

BOSTON—In older people with multiple sclerosis (MS), fatigue and limited lower leg function are more common in people with MS progression than in those without, according to a preliminary study presented at the 69th Annual Meeting of the American Academy of Neurology.

“Study participants with those symptoms were
more likely to progress from relapsing-remitting MS to
secondary progressive MS within ;ve years,” said study
author Bianca Weinstock-Guttman, MD, a Professor in
the Department of Neurology at the Jacobs School of
Medicine and Biomedical Sciences at the University of
Bu;alo in New York. “Better understanding of who is at
high risk of getting worse may eventually allow us to tai-
lor more speci;c treatments to these people.”
Older age at disease onset, high frequency of
relapses, and male sex have been found to be predictive
of higher risk of conversion to secondary progressive
MS. To further de;ne predictors of disease progression,
Dr. Weinstock-Guttman and colleagues investigated
patient-reported outcomes in an aging cohort of patients
with MS.

For the study, 155 people age 50 or older who had
had relapsing-remitting MS for at least 15 years were
evaluated for symptoms and level of disability at the
beginning of the study and ;ve years later, at which
point they had been living with MS for an average of 22
years. ;e study subjects were part of the New York State
MS Consortium.
In all, 30.3% of people in the study had progressed
to secondary progressive MS by the ;ve-year mark.
;ose who progressed to secondary progressive MS
were older at study enrollment (54.8 vs 52.1) and had a
higher Expanded Disability Status Scale score at base-
line (3.5 vs 2.6) and at year 5 (5.6 vs 3.0). ;ose who
progressed at year 5 were more likely to report lower
limb problems at baseline (53.2% vs 21.5%; odds ratio,
3.0) and were more likely to report fatigue (91.5% vs
68.2%; odds ratio, 4.2), compared with those whose dis-
ease did not progress. ;e results were the same after
researchers adjusted for other factors that could a;ect
disease progression, such as age, disease duration, and
disability severity.
“While more research needs to be done, this study
brings us closer to understanding which older adults
with MS may be at higher risk of getting worse,” said
Dr. Weinstock-Guttman. “With the aging population,
this information will be vital as people with MS, their
families, and policy makers make decisions about their
care.” ;e investigation was supported by the National
MS Society. ■
—Glenn S. Williams
Bianca
Weinstock-Guttman, MD