Conversion from clinically isolated syndrome to multiple sclerosis: A large multicentre study.

J Kuhle, G Disanto, R Dobson, R Adiutori, L Bianchi, J Topping, J P Bestwick, U-C Meier, M Marta, G Dalla Costa, T Runia, E Evdoshenko, N Lazareva, E Thouvenot, P Iaffaldano, V Direnzo, M Khademi, F Piehl, M Comabella, M Sombekke, J Killestein, H Hegen, S Rauch, S D'Alfonso, J C Alvarez-Cermeño, P Kleinová, D Horáková, R Roesler, F Lauda, S Llufriu, T Avsar, U Uygunoglu, A Altintas, S Saip, T Menge, C Rajda, R Bergamaschi, N Moll, M Khalil, R Marignier, I Dujmovic, H Larsson, C Malmestrom, E Scarpini, C Fenoglio, S Wergeland, A Laroni, V Annibali, S Romano, A D Martínez, A Carra, M Salvetti, A Uccelli, Ø Torkildsen, K M Myhr, D Galimberti, K Rejdak, J Lycke, J L Frederiksen, J Drulovic, C Confavreux, D Brassat, C Enzinger, S Fuchs, I Bosca, J Pelletier, C Picard, E Colombo, D Franciotta, T Derfuss, Rlp Lindberg, Ö Yaldizli, L Vécsei, B C Kieseier, H P Hartung, P Villoslada, A Siva, A Saiz, H Tumani, E Havrdová, L M Villar, M Leone, N Barizzone, F Deisenhammer, C Teunissen, X Montalban, M Tintoré, T Olsson, M Trojano, S Lehmann, G Castelnovo, S Lapin, R Hintzen, L Kappos, R Furlan, V Martinelli, G Comi, S V Ramagopalan, G Giovannoni

Journal: Multiple sclerosis (Houndmills, Basingstoke, England) 2016;21(8):1013-24

PMID: 25680984

Abstract

BACKGROUND AND OBJECTIVE

We explored which clinical and biochemical variables predict conversion from clinically isolated syndrome (CIS) to clinically definite multiple sclerosis (CDMS) in a large international cohort.

METHODS

Thirty-three centres provided serum samples from 1047 CIS cases with at least two years' follow-up. Age, sex, clinical presentation, T2-hyperintense lesions, cerebrospinal fluid (CSF) oligoclonal bands (OCBs), CSF IgG index, CSF cell count, serum 25-hydroxyvitamin D3 (25-OH-D), cotinine and IgG titres against Epstein-Barr nuclear antigen 1 (EBNA-1) and cytomegalovirus were tested for association with risk of CDMS.

RESULTS

At median follow-up of 4.31 years, 623 CIS cases converted to CDMS. Predictors of conversion in multivariable analyses were OCB (HR = 2.18, 95% CI = 1.71-2.77, p < 0.001), number of T2 lesions (two to nine lesions vs 0/1 lesions: HR = 1.97, 95% CI = 1.52-2.55, p < 0.001; >9 lesions vs 0/1 lesions: HR = 2.74, 95% CI = 2.04-3.68, p < 0.001) and age at CIS (HR per year inversely increase = 0.98, 95% CI = 0.98-0.99, p < 0.001). Lower 25-OH-D levels were associated with CDMS in univariable analysis, but this was attenuated in the multivariable model. OCB positivity was associated with higher EBNA-1 IgG titres.

CONCLUSIONS

We validated MRI lesion load, OCB and age at CIS as the strongest independent predictors of conversion to CDMS in this multicentre setting. A role for vitamin D is suggested but requires further investigation.

© The Author(s), 2015.

Address: Blizard Institute, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, UK/ Departments of Neurology and Biomedicine, University Hospital Basel, University of Basel, Switzerland.; Blizard Institute, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, UK.; Wolfson Institute of Preventive Medicine, Queen Mary University of London, Barts and the London School for Medicine and Dentistry, UK.; Department of Neurology and INSPE, Vita-Salute San Raffaele University, Scientific Institute San Raffaele, Italy.; Department of Neurology, Erasmus MC University Medical Center, The Netherlands.; Centre of Multiple Sclerosis, City Clinical Hospital#31, Russia.; Institut de Génomique Fonctionelle, CNRS UMR5203, INSERM U661, Université Montpellier 1, Université Montpellier, France, and Hôpital Carémeau, France.; Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Italy.; Neuroimmunology Unit, Department of Clinical Neuroscience, Karolinska Institutet, Sweden.; Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Receca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain.; Departments of Neurology and Clinical Chemistry, MS Center, Neurocampus Amsterdam, VU University Medical Centre Amsterdam, The Netherlands and BioMS-eu network.; Department of Neurology, Innsbruck Medical University, Austria.; Department of Radiology, Innsbruck Medical University, Austria.; Department of Health Sciences and IRCAD, Eastern Piedmont University, Italy.; Department of Neurology and Immunology, Hospital Ramón y Cajal, Spain.; Department of Neurology, Charles University in Prague, Czech Republic.; Department of Neurology, CSF Laboratory and MS Outpatient Unit, University of Ulm, Germany.; Center for Neuroimmunology and Department of Neurology. Institut d'investigacions Biomèdiques August Pi Sunyer (IDIBAPS) - Hospital Clinic of Barcelona, Spain.; Dr Orhan Öcalgiray Molecular Biology-Biotechnology and Genetics Research Centre, Istanbul Technical University, Turkey.; Department of Neurology, Istanbul University, Turkey.; Department of Neurology, Medical Faculty, Heinrich-Heine-University, Germany.; Department of Neurology, University of Szeged, Hungary.; C. Mondino National Neurological Institute, Italy.; Pôle de Neurosciences Cliniques, Service de Neurologie, Centre de Résonance Magnétique Biologique et Médicale, Centre Hospitalier Universitaire Timone, Laboratoire d'histocompatibilité, Etablissement Français du Sang Alpes Méditerrannée, Aix Marseille Université, France.; Department of Neurology, Medical University of Graz, Austria.; Department of Neurology, Université de Lyon, Université Claude Bernard-Lyon 1, France.; Clinic of Neurology, Belgrade University School of Medicine, Serbia.; Unit of Functional Imaging, Glostrup Hospital, University of Copenhagen, Denmark.; Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Sweden.; Neurology Unit, Dept. of Pathophysiology and Transplantation, University of Milan, Fondazione Cà Granda, IRCCS Policlinico.; KG Jebsen Centre for MS-Research, Department of Clinical Medicine, Haukeland University Hospital, University of Bergen, Norway.; Department of Neurology, University of Genoa, Italy.; Centre for Experimental Neurological Therapies, S. Andrea Hospital-site, Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Italy.; Department of Neurology of Hospital Británico of Buenos Aires, Argentina.; Department of Neurology, Medical University of Lublin, Poland.; Department of Neurology, Glostrup Hospital, University of Copenhagen, Denmark.; Department of Neurology, University of Toulouse, France.; MS Unit, Neurology Department, La Fe University and Polytechnic Hospital, Instituto de investigación Sanitaria La Fe, Spain.; Departments of Neurology and Biomedicine, University Hospital Basel, University of Basel, Switzerland.; MS Centre, SCDU Neurology, Head and Neck Department, AOU Maggiore della Carità, Italy.; Department of Physiology, Anatomy and Genetics and Medical Research Council Functional Genomics Unit, University of Oxford, UK.; Blizard Institute, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, UK [email protected].

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