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Trajectories of cognitive processing speed and physical disability over 11 years following initiation of a first multiple sclerosis disease-modulating therapy
Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden .
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
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2024 (English)In: Journal of Neurology, Neurosurgery and Psychiatry, ISSN 0022-3050, E-ISSN 1468-330X, Vol. 95, no 2, p. 134-141Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: We analysed the COMparison Between All immunoTherapies for Multiple Sclerosis (NCT03193866), a Swedish nationwide observational study in relapsing-remitting multiple sclerosis (RRMS), to identify trajectories of processing speed and physical disability after disease-modulating therapy (DMT) start.

METHODS: Using a group-modelling approach, we assessed trajectories of processing speed with oral Symbol Digit Modalities Test (SDMT) and physical disability with Expanded Disability Status Scale, from first DMT start among 1645 patients with RRMS followed during 2011-2022. We investigated predictors of trajectories using group membership as a multinomial outcome and calculated conditional probabilities linking membership across the trajectories.

RESULTS: We identified 5 stable trajectories of processing speed: low SDMT scores (mean starting values=29.9; 5.4% of population), low/medium (44.3; 25.3%), medium (52.6; 37.9%), medium/high (63.1; 25.8%) and high (72.4; 5.6%). We identified 3 physical disability trajectories: no disability/stable (0.8; 26.8%), minimal disability/stable (1.6; 58.1%) and moderate disability (3.2; 15.1%), which increased to severe disability. Older patients starting interferons were more likely than younger patients starting rituximab to be on low processing speed trajectories. Older patients starting teriflunomide, with more than one comorbidity, and a history of pain treatment were more likely to belong to the moderate/severe physical disability trajectory, relative to the no disability one. There was a strong association between processing speed and physical disability trajectories.

CONCLUSIONS: In this cohort of actively treated RRMS, patients' processing speed remained stable over the years following DMT start, whereas patients with moderate physical disability deteriorated in physical function. Nevertheless, there was a strong link between processing speed and disability after DMT start.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2024. Vol. 95, no 2, p. 134-141
Keywords [en]
Cognition, epidemiology, multiple sclerosis
National Category
Neurology
Identifiers
URN: urn:nbn:se:oru:diva-107525DOI: 10.1136/jnnp-2023-331784ISI: 001045834300001PubMedID: 37558400Scopus ID: 2-s2.0-85168293100OAI: oai:DiVA.org:oru-107525DiVA, id: diva2:1787082
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2020-0115Swedish Research Council, 2021-01418The Swedish Brain Foundation
Note

Funding agency:

Patient-Centered Outcomes Research Institute - PCORI MS- 1511-33196

Available from: 2023-08-11 Created: 2023-08-11 Last updated: 2024-01-12Bibliographically approved

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Gunnarsson, Martin

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