title: Clinical predictors of early second event in patients with clinically isolated syndrome.
abstract: This study aimed to determine the predictors of increased risk of a second demyelinating event within the first year of an initial demyelinating event (IDE) suggestive of early multiple sclerosis (MS). Patients with MS or clinically isolated syndrome (CIS) seen at the UCSF MS Center within one year of the IDE were studied. Univariate and multivariate Cox models were used to analyze predictors of having a second event within 1 year of the IDE. Of 330 patients with MS/CIS, 111 had a second event within 1 year. Non-white race/ethnicity (HR = 2.39, 95% CI [1.58, 3.60], p < 0.0001) and younger age (HR for each 10-year decrease in age = 1.51, 95% CI [1.28, 1.80], p < 0.0001) were strongly associated with an increased risk of having a second event within one year of onset. Having a lower number of functional systems affected by the IDE was also associated with an increased risk of early second event (HR for every one less FS involved = 1.31, 95% CI [1.06, 1.61], p = 0.011). These results were similar after adjusting for treatment of the IDE with steroids and disease-modifying therapy. Non-white race/ethnicity, younger age, and a lower number of FS affected by the IDE are associated with a substantially increased hazard ratio for a second demyelinating event within 1 year. Since early relapse is predictive of worse long-term outcome, identifying and treating such patients after the IDE may be of benefit to them.
authors.affiliation: Department of Neurology, Multiple Sclerosis Center, University of California, San Francisco, San Francisco, CA 94117, USA. ellen.mowry@ucsf.edu
authors.forename: Ellen M
authors.initials: EM
authors.lastname: Mowry
authors.forename: Mila
authors.initials: M
authors.lastname: Pesic
authors.forename: Barbara
authors.initials: B
authors.lastname: Grimes
authors.forename: Serina R
authors.initials: SR
authors.lastname: Deen
authors.forename: Peter
authors.initials: P
authors.lastname: Bacchetti
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Waubant
mesh_terms: D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D002490:Central Nervous System / Q000276:immunology / Q000473:pathology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000453:epidemiology* / Q000473:pathology* / Q000503:physiopathology; D011379:Prognosis; D016016:Proportional Hazards Models; D044469:Racial Groups; D012008:Recurrence; D012307:Risk Factors; D012720:Severity of Illness Index; D013256:Steroids / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D007155:Immunologic Factors; D013256:Steroids