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Excess Mortality in Patients with Multiple Sclerosis Starts at 20 Years from Clinical Onset: Data from a Large-Scale French Observational Study.

Leray E, Vukusic S, Debouverie M, Clanet M, Brochet B, de Sèze J, Zéphir H, Defer G, Lebrun-Frenay C, Moreau T, Clavelou P, Pelletier J, Berger E, Cabre P, Camdessanché JP, Kalson-Ray S, Confavreux C, Edan G - PLoS ONE (2015)

Bottom Line: Death rates were significantly higher in men, patients with later clinical onset, and in progressive MS.Overall excess mortality compared with the general population was moderate (Standardized Mortality Ratio 1.48, 95% confidence interval [1.41-1.55]), but increased considerably after 20 years of disease (2.20 [2.10-2.31]).This study revealed a moderate decrease in life expectancy in MS patients, and showed that the risk of dying is strongly correlated to disease duration and disability, highlighting the need for early actions that can slow disability progression.

View Article: PubMed Central - PubMed

Affiliation: Department of Epidemiology, EHESP Rennes, Sorbonne Paris Cité; CIC-P 1414, CHU Rennes, West Neuroscience Network of Excellence (WENNE), Rennes, France.

ABSTRACT

Background: Recent studies in multiple sclerosis (MS) showed longer survival times from clinical onset than older hospital-based series. However estimated median time ranges widely, from 24 to 45 years, which makes huge difference for patients as this neurological disease mainly starts around age 20 to 40. Precise and up-to-date reference data about mortality in MS are crucial for patients and neurologists, but unavailable yet in France.

Objectives: Estimate survival in MS patients and compare mortality with that of the French general population.

Methods: We conducted a multicenter observational study involving clinical longitudinal data from 30,413 eligible patients, linked to the national deaths register. Inclusion criteria were definite MS diagnosis and clinical onset prior to January, 1st 2009 in order to get a minimum of 1-year disease duration.

Results: After removing between-center duplicates and applying inclusion criteria, the final population comprised 27,603 MS patients (F/M sex ratio 2.5, mean age at onset 33.0 years, 85.5% relapsing onset). During the follow-up period (mean 15.2 +/- 10.3 years), 1569 deaths (5.7%) were identified; half related to MS. Death rates were significantly higher in men, patients with later clinical onset, and in progressive MS. Overall excess mortality compared with the general population was moderate (Standardized Mortality Ratio 1.48, 95% confidence interval [1.41-1.55]), but increased considerably after 20 years of disease (2.20 [2.10-2.31]).

Conclusions: This study revealed a moderate decrease in life expectancy in MS patients, and showed that the risk of dying is strongly correlated to disease duration and disability, highlighting the need for early actions that can slow disability progression.

No MeSH data available.


Related in: MedlinePlus

Flowchart of the study population.These patients had the classic characteristics of MS populations: F/M sex ratio 2.47 (19,656/7,947); mean age at MS clinical onset 32.8 ± 10.6 years; and 85.5% relapsing-onset MS (23,438/27,408; 195 missing values). As expected, mean age at onset was significantly higher and F/M sex ratio lower for progressive onset MS than for relapsing-onset MS (41.8 ± 10.8 vs. 31.2 ± 9.7 years, t test, p < 10−4, and 1.40 vs. 2.76, Fisher’s exact test, p < 10−4, respectively). MS = Multiple Sclerosis.
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pone.0132033.g001: Flowchart of the study population.These patients had the classic characteristics of MS populations: F/M sex ratio 2.47 (19,656/7,947); mean age at MS clinical onset 32.8 ± 10.6 years; and 85.5% relapsing-onset MS (23,438/27,408; 195 missing values). As expected, mean age at onset was significantly higher and F/M sex ratio lower for progressive onset MS than for relapsing-onset MS (41.8 ± 10.8 vs. 31.2 ± 9.7 years, t test, p < 10−4, and 1.40 vs. 2.76, Fisher’s exact test, p < 10−4, respectively). MS = Multiple Sclerosis.

Mentions: At study launch, 30,413 MS files were received from the 15 participating centers, equivalent to 29,430 MS patients after removal of between-centers duplicates. Then, 1,164 patients were excluded for “possible MS” diagnosis and a further 663 because MS onset occurred after 2009. The final study population size was 27,603 MS patients (Fig 1).


Excess Mortality in Patients with Multiple Sclerosis Starts at 20 Years from Clinical Onset: Data from a Large-Scale French Observational Study.

Leray E, Vukusic S, Debouverie M, Clanet M, Brochet B, de Sèze J, Zéphir H, Defer G, Lebrun-Frenay C, Moreau T, Clavelou P, Pelletier J, Berger E, Cabre P, Camdessanché JP, Kalson-Ray S, Confavreux C, Edan G - PLoS ONE (2015)

Flowchart of the study population.These patients had the classic characteristics of MS populations: F/M sex ratio 2.47 (19,656/7,947); mean age at MS clinical onset 32.8 ± 10.6 years; and 85.5% relapsing-onset MS (23,438/27,408; 195 missing values). As expected, mean age at onset was significantly higher and F/M sex ratio lower for progressive onset MS than for relapsing-onset MS (41.8 ± 10.8 vs. 31.2 ± 9.7 years, t test, p < 10−4, and 1.40 vs. 2.76, Fisher’s exact test, p < 10−4, respectively). MS = Multiple Sclerosis.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4492994&req=5

pone.0132033.g001: Flowchart of the study population.These patients had the classic characteristics of MS populations: F/M sex ratio 2.47 (19,656/7,947); mean age at MS clinical onset 32.8 ± 10.6 years; and 85.5% relapsing-onset MS (23,438/27,408; 195 missing values). As expected, mean age at onset was significantly higher and F/M sex ratio lower for progressive onset MS than for relapsing-onset MS (41.8 ± 10.8 vs. 31.2 ± 9.7 years, t test, p < 10−4, and 1.40 vs. 2.76, Fisher’s exact test, p < 10−4, respectively). MS = Multiple Sclerosis.
Mentions: At study launch, 30,413 MS files were received from the 15 participating centers, equivalent to 29,430 MS patients after removal of between-centers duplicates. Then, 1,164 patients were excluded for “possible MS” diagnosis and a further 663 because MS onset occurred after 2009. The final study population size was 27,603 MS patients (Fig 1).

Bottom Line: Death rates were significantly higher in men, patients with later clinical onset, and in progressive MS.Overall excess mortality compared with the general population was moderate (Standardized Mortality Ratio 1.48, 95% confidence interval [1.41-1.55]), but increased considerably after 20 years of disease (2.20 [2.10-2.31]).This study revealed a moderate decrease in life expectancy in MS patients, and showed that the risk of dying is strongly correlated to disease duration and disability, highlighting the need for early actions that can slow disability progression.

View Article: PubMed Central - PubMed

Affiliation: Department of Epidemiology, EHESP Rennes, Sorbonne Paris Cité; CIC-P 1414, CHU Rennes, West Neuroscience Network of Excellence (WENNE), Rennes, France.

ABSTRACT

Background: Recent studies in multiple sclerosis (MS) showed longer survival times from clinical onset than older hospital-based series. However estimated median time ranges widely, from 24 to 45 years, which makes huge difference for patients as this neurological disease mainly starts around age 20 to 40. Precise and up-to-date reference data about mortality in MS are crucial for patients and neurologists, but unavailable yet in France.

Objectives: Estimate survival in MS patients and compare mortality with that of the French general population.

Methods: We conducted a multicenter observational study involving clinical longitudinal data from 30,413 eligible patients, linked to the national deaths register. Inclusion criteria were definite MS diagnosis and clinical onset prior to January, 1st 2009 in order to get a minimum of 1-year disease duration.

Results: After removing between-center duplicates and applying inclusion criteria, the final population comprised 27,603 MS patients (F/M sex ratio 2.5, mean age at onset 33.0 years, 85.5% relapsing onset). During the follow-up period (mean 15.2 +/- 10.3 years), 1569 deaths (5.7%) were identified; half related to MS. Death rates were significantly higher in men, patients with later clinical onset, and in progressive MS. Overall excess mortality compared with the general population was moderate (Standardized Mortality Ratio 1.48, 95% confidence interval [1.41-1.55]), but increased considerably after 20 years of disease (2.20 [2.10-2.31]).

Conclusions: This study revealed a moderate decrease in life expectancy in MS patients, and showed that the risk of dying is strongly correlated to disease duration and disability, highlighting the need for early actions that can slow disability progression.

No MeSH data available.


Related in: MedlinePlus