title: Male Sex Is Independently Associated with Faster Disability Accumulation in Relapse-Onset MS but Not in Primary Progressive MS.
abstract: BACKGROUND
  Multiple Sclerosis is more common in women than men and females have more relapses than men. In a large international cohort we have evaluated the effect of gender on disability accumulation and disease progression to determine if male MS patients have a worse clinical outcome than females.
  
  
  METHODS
  Using the MSBase Registry, data from 15,826 MS patients from 25 countries was analysed. Changes in the severity of MS (EDSS) were compared between sexes using a repeated measures analysis in generalised linear mixed models. Kaplan-Meier analysis was used to test for sex difference in the time to reach EDSS milestones 3 and 6 and the secondary progressive MS.
  
  
  RESULTS
  In relapse onset MS patients (n = 14,453), males progressed significantly faster in their EDSS than females (0.133 vs 0.112 per year, P<0.001,). Females had a reduced risk of secondary progressive MS (HR (95% CI) = 0.77 (0.67 to 0.90) P = 0.001). In primary progressive MS (n = 1,373), there was a significant increase in EDSS over time in males and females (P<0.001) but there was no significant sex effect on the annualized rate of EDSS change.
  
  
  CONCLUSIONS
  Among registrants of MSBase, male relapse-onset patients accumulate disability faster than female patients. In contrast, the rate of disability accumulation between male and female patients with primary progressive MS is similar.
authors.affiliation: John Hunter Hospital, Newcastle, Australia.
authors.forename: Karen Ann
authors.initials: KA
authors.lastname: Ribbons
authors.affiliation: University of Newcastle, Newcastle, Australia.
authors.forename: Patrick
authors.initials: P
authors.lastname: McElduff
authors.affiliation: Karadeniz Technical University, Trabzon, Turkey.
authors.forename: Cavit
authors.initials: C
authors.lastname: Boz
authors.affiliation: University of Bari, Bari, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Trojano
authors.affiliation: Hospital Universitario, Sevilla, Spain.
authors.forename: Guillermo
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authors.lastname: Izquierdo
authors.affiliation: Hopital Notre Dame, Montreal, Canada.
authors.forename: Pierre
authors.initials: P
authors.lastname: Duquette
authors.affiliation: Hopital Notre Dame, Montreal, Canada.
authors.forename: Marc
authors.initials: M
authors.lastname: Girard
authors.affiliation: Neuro Rive-Sud, Quebec, Canada.
authors.forename: Francois
authors.initials: F
authors.lastname: Grand'Maison
authors.affiliation: Maaslandziekenhuis, Sittard, The Netherlands.
authors.forename: Raymond
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authors.lastname: Hupperts
authors.affiliation: Hotel-Dieu de Levis, Quebec, Canada.
authors.forename: Pierre
authors.initials: P
authors.lastname: Grammond
authors.affiliation: University Hospital La Paz, IdiPAZ, Madrid, Spain.
authors.forename: Celia
authors.initials: C
authors.lastname: Oreja-Guevara
authors.affiliation: Kommunehospitalet, Arhus C, Denmark.
authors.forename: Thor
authors.initials: T
authors.lastname: Petersen
authors.affiliation: Neurological Institute IRCCS Mondino, Pavia, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Bergamaschi
authors.affiliation: Ospedale di Macerata, Macerata, Italy.
authors.forename: Giorgio
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authors.lastname: Giuliani
authors.affiliation: Brain and Mind Research Institute, Sydney, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Barnett
authors.affiliation: Cliniques Universitaires Saint-Luc, Brussels, Belgium.
authors.forename: Vincent
authors.initials: V
authors.lastname: van Pesch
authors.affiliation: Department of Neurology, University of Florence, Florence, Italy.
authors.forename: Maria-Pia
authors.initials: MP
authors.lastname: Amato
authors.affiliation: Ospedali Riuniti di Salerno, Salerno, Italy.
authors.forename: Gerardo
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authors.lastname: Iuliano
authors.affiliation: FLENI, Buenos Aires, Argentina.
authors.forename: Marcela
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authors.lastname: Fiol
authors.affiliation: Flinders Medical Centre, Adelaide, Australia.
authors.forename: Mark
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authors.lastname: Slee
authors.affiliation: Groen Hart Ziekenhuis, Gouda, Netherlands.
authors.forename: Freek
authors.initials: F
authors.lastname: Verheul
authors.affiliation: Hospital Italiano, Buenos Aires, Argentina.
authors.forename: Edgardo
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authors.lastname: Cristiano
authors.affiliation: Hospital Universitario Virgen de Valme, Seville, Spain.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Fernandez-Bolanos
authors.affiliation: Craigavon Area Hospital, Craigavon, Northern Ireland.
authors.forename: Maria-Laura
authors.initials: ML
authors.lastname: Saladino
authors.affiliation: Hospital S. João, Porto, Portugal.
authors.forename: Maria Edite
authors.initials: ME
authors.lastname: Rio
authors.affiliation: Multiple Sclerosis Clinic, International Center of Neurological Restoration, Havana, Cuba.
authors.forename: Jose
authors.initials: J
authors.lastname: Cabrera-Gomez
authors.affiliation: Royal Melbourne Hospital, Melbourne, Australia.
authors.forename: Helmut
authors.initials: H
authors.lastname: Butzkueven
authors.affiliation: Jeroen Bosch Ziekenhuis, Den Bosch, Netherlands.
authors.forename: Erik
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authors.lastname: van Munster
authors.affiliation: Francicus Ziekenhuis, Roosendaal, Netherlands.
authors.forename: Leontien
authors.initials: L
authors.lastname: Den Braber-Moerland
authors.affiliation: AORN San Giuseppe Moscati, Avellino, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: La Spitaleri
authors.affiliation: Dept Neuroscience and Imaging-Univ "G. d'Annunzio", Chieti, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Lugaresi
authors.affiliation: Al-Zahara Hopsital, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Vahid
authors.initials: V
authors.lastname: Shaygannejad
authors.affiliation: Craigavon Area Hospital, Armagh, Northern Ireland.
authors.forename: Orla
authors.initials: O
authors.lastname: Gray
authors.affiliation: Hospital Fernandez, Capital Federal, Argentina.
authors.forename: Norma
authors.initials: N
authors.lastname: Deri
authors.affiliation: Amiri Hospital, Qurtoba, Kuwait.
authors.forename: Raed
authors.initials: R
authors.lastname: Alroughani
authors.affiliation: John Hunter Hospital, Newcastle, Australia.
authors.forename: Jeannette
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authors.lastname: Lechner-Scott
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D016208:Databases, Factual; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*; D016016:Proportional Hazards Models; D012008:Recurrence; D012042:Registries; D012720:Severity of Illness Index; D012737:Sex Factors
chemical_list: D007155:Immunologic Factors