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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

Longinetti, Elisa ; Englund, Simon ; Burman, Joachim ; Fink, Katharina ; Fogdell-Hahn, Anna ; Gunnarsson, Martin ; Hillert, Jan ; Langer-Gould, Annette Magdalene ; Lycke, Jan and Nilsson, Petra LU , et al. (2023) In Journal of Neurology, Neurosurgery and Psychiatry
Abstract

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... (More)

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.

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organization
publishing date
type
Contribution to journal
publication status
epub
subject
keywords
cognition, epidemiology, multiple sclerosis
in
Journal of Neurology, Neurosurgery and Psychiatry
publisher
BMJ Publishing Group
external identifiers
  • pmid:37558400
  • scopus:85168293100
ISSN
0022-3050
DOI
10.1136/jnnp-2023-331784
language
English
LU publication?
yes
id
cff447b2-7113-4a75-8422-92c237cf4bfb
date added to LUP
2023-11-13 13:08:16
date last changed
2024-04-25 04:25:43
@article{cff447b2-7113-4a75-8422-92c237cf4bfb,
  abstract     = {{<p>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.</p>}},
  author       = {{Longinetti, Elisa and Englund, Simon and Burman, Joachim and Fink, Katharina and Fogdell-Hahn, Anna and Gunnarsson, Martin and Hillert, Jan and Langer-Gould, Annette Magdalene and Lycke, Jan and Nilsson, Petra and Salzer, Jonatan and Svenningsson, Anders and Mellergård, Johan and Olsson, Tomas and Piehl, Fredrik and Frisell, Thomas}},
  issn         = {{0022-3050}},
  keywords     = {{cognition; epidemiology; multiple sclerosis}},
  language     = {{eng}},
  publisher    = {{BMJ Publishing Group}},
  series       = {{Journal of Neurology, Neurosurgery and Psychiatry}},
  title        = {{Trajectories of cognitive processing speed and physical disability over 11 years following initiation of a first multiple sclerosis disease-modulating therapy}},
  url          = {{http://dx.doi.org/10.1136/jnnp-2023-331784}},
  doi          = {{10.1136/jnnp-2023-331784}},
  year         = {{2023}},
}