Key result
Primary progressive MS was associated with more nervous system-related encounters than relapsing-remitting MS in the 5 years before onset (adjusted rate ratio 3.00; 95% CI 1.06-8.49).
Why the study?
The multiple sclerosis prodrome remains poorly understood, motivating an examination of the prodrome in people with relapsing remitting multiple sclerosis and primary progressive multiple sclerosis.
Are there differences in the prodromal phase (physician encounters in the 5 years before symptom onset) between relapsing-remitting and primary progressive multiple sclerosis?
Cohort (n=11,895)
Yes
Are there differences in the prodromal phase (physician encounters in the 5 years before symptom onset) between relapsing-remitting and primary progressive multiple sclerosis?
Relative Risk: 3 (95% CI 1.06–8.49)
Both relapsing-remitting and primary progressive multiple sclerosis have a prodromal phase, but PPMS patients have significantly more nervous system-related physician encounters prior to symptom onset.
Suggests distinct prodromal patterns in PPMS; hypothesis-generating and should not yet change practice.
BACKGROUND AND PURPOSE: The multiple sclerosis prodrome remains poorly understood. We aimed to examine the prodrome in people with relapsing remitting multiple sclerosis at onset (RMS) and primary progressive multiple sclerosis (PPMS). METHODS: We conducted a matched cohort study using clinical and linked health administrative data in two Canadian provinces. We identified people with RMS, PPMS and age- sex- and geographically-matched population controls, and compared the number of physician encounters (total number, per International Classification of Diseases chapter, and per physician speciality) in the five years before symptom onset. Negative binomial regression models were sex, age, socioeconomic status and calendar year adjusted. RESULTS: We identified 1887 RMS, 171 PPMS cases, and 9837 matched population controls. No difference existed in the total number of encounters in the five years before index between RMS and PPMS, or between the phenotypes and their respective controls. Compared to RMS cases, PPMS cases had more nervous system-related encounters (adjusted rate ratio, 3.00; 95% confidence interval, 1.06-8.49) and fewer encounters with dermatologists (adjusted rate ratio 0.53; 95% confidence interval, 0.30-0.96). CONCLUSION: Findings suggest that people with RMS and PPMS may both experience a prodrome, although aspects may differ.
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Wijnands et al. (2019) conducted a cohort in Multiple sclerosis (RMS and PPMS) (n=11,895). Primary progressive multiple sclerosis (PPMS) vs. Relapsing remitting multiple sclerosis (RMS) was evaluated on Nervous system-related physician encounters in the five years before symptom onset (adjusted rate ratio 3.00, 95% CI 1.06-8.49). Primary progressive MS was associated with more nervous system-related encounters than relapsing-remitting MS in the 5 years before onset (adjusted rate ratio 3.00; 95% CI 1.06-8.49).
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