BOSTON—Along with baseline characteristics, clinical and MRI changes during the first year after diagnosis of clinically isolated syndrome (CIS) can improve neurologists’ estimation of a patient’s prognosis, according to research presented at the 2014 Joint ACTRIMS–ECTRIMS Meeting. The presence of MRI lesions at baseline and the emergence of new T2 lesions during the first year after CIS diagnosis predict the occurrence of a second attack, said Mar Tintoré, MD. Treatment after the first attack, however, may protect against further attacks.
The presence of oligoclonal bands, the emergence of new T2 lesions during the first year after CIS diagnosis, and incomplete recovery from the first attack are independent predictors of the accumulation of disability, said Dr. Tintoré, Professor of Neurology and Neuroimmunology at Vall d’Hebron University Hospital in Barcelona.
A Prospective Study of Patients With CIS
In a previous prospective study of patients with CIS, Dr. Tintoré and colleagues concluded that baseline MRI was of great value in predicting future attacks and accumulation of disability. The presence of oligoclonal bands at baseline is a medium-impact prognostic factor for these outcomes, and demographic characteristics and topography of CIS are low-impact prognostic factors, the investigators concluded.
The researchers next decided to investigate the added value of clinical and brain MRI changes during the first year after a diagnosis of CIS for predicting conversion to multiple sclerosis (MS) or disability accumulation. For this investigation, Dr. Tintoré’s group began prospectively following patients with CIS in 1995. Eligible patients were younger than 50. During regular clinical follow-up, neurologists monitored patients for a second attack and disability accumulation. Participants also underwent regular MRI monitoring.
Age, gender, topography of CIS, date of disease-modifying therapy initiation (if applicable), number of T2 lesions, presence of gadolinium-enhancing lesions, and presence of oligoclonal bands were the baseline variables that the investigators examined. First-year variables included the presence of a second attack and recovery from the first attack, which was measured as Expanded Disability Status Scale (EDSS) score at year one. Incomplete recovery was defined as an EDSS score of 2 or higher. The investigators also looked at the number of new T2 lesions and the presence of gadolinium-enhancing lesions at 12 months.
The total cohort included 1,058 participants, but the investigators excluded 43 people who were ineligible. The researchers have more than 12 months of follow-up data for 887 patients. Approximately 68% of participants were female, and the cohort’s mean age was 31. Oligoclonal bands were performed for about 82% of patients, and the mean follow-up duration was 7.7 years.
New T2 Lesions at One Year Were Common
At baseline, approximately one-third of patients had a normal MRI, and 41.4% had 10 or more T2 lesions. In addition, 23% of participants had gadolinium-enhancing lesions at baseline.
During the first year after CIS diagnosis, 17% of patients had a relapse, and 24% of participants had incomplete recovery from the first attack. Approximately 43% of patients had new T2 lesions at 12 months, and approximately 20% had gadolinium-enhancing lesions at 12 months.
Multivariate analysis indicated that gender and topography did not affect the risk of having a second attack. Younger age, however, was associated with a higher risk of having a second attack. The presence of T2 lesions on baseline MRI was a strong predictor of new relapses, as was the presence of new T2 lesions at 12 months.
A separate multivariate analysis suggested that gender and age did not predict the accumulation of disability, which was defined as a confirmed EDSS score of 3. Oligoclonal bands, however, increased the risk of disability accumulation. Incomplete recovery from the first attack also was “a clear predictor of disability in the long term,” said Dr. Tintoré.
—Erik Greb