Abstract Details

Title Early clinical and MRI predictors of long-term disability in pediatric multiple sclerosis patients

Topic Multiple Sclerosis

Presentation(s) S28 - Clinical Decision Making in MS (2:40 PM-2:48 PM)

Poster/Presentation
Number 005

Background The main clinical and MRI features driving therapeutic choices are not as clear for pediatric multiple sclerosis (MS) patients as for adults.

Objective

We aimed at assessing early predictors of long-term clinically-relevant outcomes in a large cohort of pediatric multiple sclerosis (MS) patients.

Design/Methods Clinical and MRI assessments of 123 pediatric MS patients were obtained at disease onset and after 1, 2 and 3 years. A 9-year clinical follow-up was evaluated for long-term outcomes. Cox proportional hazard and multivariable regression models were respectively used to assess independent predictors of time to first relapse and long-term outcomes.

Results

Optic nerve lesions predicted shorter time to first relapse (hazard ratio=1.9, p=0.03). Predictors of annualized relapse rate were: at baseline, presence of cerebellar (b=-0.16, p<0.001) and of cervical cord lesions (b=0.14, p=0.01); over the short-term, the same baseline variables together with time to first relapse (2-year: b=-0.12, p=0.01; 3-year: b=-0.08, p<0.001) and number of relapses (1-year: b=0.14, p<0.001; 2-year: b=0.06, p=0.02). Predictors of 9-year disability worsening were: at baseline, presence of optic nerve lesions [odds ratio (OR)=6.45, p=0.01]; over the short-term, Expanded Disability Status Scale (EDSS) changes (1-year: OR=26.05, p<0.001; 2-year: OR=16.38, p=0.02) and detection of ≥2 new T2-lesions in 2 years (2-year: OR=4.91, p=0.02; 3-year: OR=5.49, p=0.09). Predictors of higher 9-year EDSS score were: at baseline, EDSS score (b=0.58, p<0.001), presence of brainstem (b=0.31, p=0.04) and number of cervical cord lesions (b=0.22, p=0.05); over the short-term, EDSS changes (1-year: b=0.82, p<0.001; 2-year: b=0.79, p<0.001, 3-year: b=0.27, p=0.04 ), together with detection of ≥2 new T2-lesions (1-year: b=0.28, p=0.03; 2-year: b=0.35, p=0.01).

Conclusions

A complete baseline MRI assessment and an accurate clinical and MRI monitoring during the first 2 years of disease have proven to represent powerful tools to predict pediatric multiple sclerosis patients’ long-term prognosis.

Authors/Disclosures
Ermelinda De Meo (San Raffaele, Vita-Salute University, Milan) PRESENTER	Ms. De Meo has nothing to disclose.
	No disclosure on file
Lucia Moiola, MD, PhD (Fondazione Centro San Raffaele)	Dr. Moiola has nothing to disclose.
Francesca Sangalli	No disclosure on file
Bruno Colombo	Bruno Colombo has nothing to disclose.
	No disclosure on file
Vittorio Martinelli (S. Raffaele Hospital)	Dr. Martinelli has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis, Biogen, Sanofi Genzyme, TEVA and Merck. Dr. Martinelli has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck .
Maria A. Rocca (Neuroimaging Research Unit)	Maria Assunta Rocca has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen, Bristol Myers Squibb, Eli Lilly, Janssen, Roche. Maria Assunta Rocca has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for AstraZaneca, Biogen, Bristol Myers Squibb, Bromatech, Celgene, Genzyme, Horizon Therapeutics Italy, Merck Serono SpA, Novartis, Roche, Sanofi and Teva. The institution of Maria Assunta Rocca has received research support from MS Society of Canada, the Italian Ministry of Health, the Italian Ministry of University and Research, and Fondazione Italiana Sclerosi Multipla.
Maria P. Amato, PhD (Ospedale Di Careggi)	Dr. Amato has received personal compensation for serving as an employee of AOUCareggi. Dr. Amato has received personal compensation for serving as an employee of AOUCareggi. Dr. Amato has received personal compensation for serving as an employee of AOUCareggi. Dr. Amato has received personal compensation for serving as an employee of AOU Careggi. Dr. Amato has received personal compensation for serving as an employee of AOUCareggi. Dr. Amato has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. Amato has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Amato has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sanofi Genzyme. Dr. Amato has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Amato has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Amato has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck. Dr. Amato has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Amato has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Amato has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi genzyme. The institution of Dr. Amato has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Celgene BMS. The institution of Dr. Amato has received research support from Merck. The institution of Dr. Amato has received research support from Biogen. The institution of Dr. Amato has received research support from Roche.
Massimo Filippi, MD, FAAN (Ospedale San Raffaele, Neuroimaging Research Unit)	Dr. Filippi has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Alexion, Almirall, Biogen, Merck, Novartis, Roche, Sanofi. Dr. Filippi has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion, Biogen, Bristol-Myers Squibb, Merck, Novartis, Roche, Sanofi, Sanofi-Aventis, Sanofi-Genzyme, Takeda. Dr. Filippi has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Bayer, Biogen, Celgene, Chiesi Italia SpA, Eli Lilly, Genzyme, Janssen, Merck-Serono, Neopharmed Gentili, Novartis, Novo Nordisk, Roche, Sanofi, Takeda, and TEVA. Dr. Filippi has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Springer Nature. The institution of Dr. Filippi has received research support from Biogen Idec, Merck-Serono, Novartis, Roche, the Italian Ministry of Health, the Italian Ministry of University and Research, and Fondazione Italiana Sclerosi Multipla.

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