Limits...
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

Comparison of the survival in MS patients with the survival of the French general population.Kaplan-Meier survival estimates according to time from MS clinical onset (years). MS = Multiple Sclerosis.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4492994&req=5

pone.0132033.g002: Comparison of the survival in MS patients with the survival of the French general population.Kaplan-Meier survival estimates according to time from MS clinical onset (years). MS = Multiple Sclerosis.

Mentions: The overall SMR was 1.48 (95% CI [1.41-1.55]), resulting in 48% excess mortality in MS patients compared with the French general population. The survival curves (Fig 2) show that survival in MS patients was similar to that of the general population for the first 20 years of the disease. The two curves then begin to diverge, and the resulting gap can be estimated at around 7 years. Indeed, the observed median survival time was estimated to be around 53–54 years from MS onset, while the expected one in the French general population would have been about 61 years. Similarly, respectively 60% and 70% of patients were still alive after 49 and 43–44 years of MS duration, while these figures would have been observed in the French general population after 56–57 and 51 years.


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)

Comparison of the survival in MS patients with the survival of the French general population.Kaplan-Meier survival estimates according to time from MS clinical onset (years). MS = Multiple Sclerosis.
© Copyright Policy
Related In: Results  -  Collection

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

pone.0132033.g002: Comparison of the survival in MS patients with the survival of the French general population.Kaplan-Meier survival estimates according to time from MS clinical onset (years). MS = Multiple Sclerosis.
Mentions: The overall SMR was 1.48 (95% CI [1.41-1.55]), resulting in 48% excess mortality in MS patients compared with the French general population. The survival curves (Fig 2) show that survival in MS patients was similar to that of the general population for the first 20 years of the disease. The two curves then begin to diverge, and the resulting gap can be estimated at around 7 years. Indeed, the observed median survival time was estimated to be around 53–54 years from MS onset, while the expected one in the French general population would have been about 61 years. Similarly, respectively 60% and 70% of patients were still alive after 49 and 43–44 years of MS duration, while these figures would have been observed in the French general population after 56–57 and 51 years.

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