title: Long Term Clinical Prognostic Factors in Relapsing-Remitting Multiple Sclerosis: Insights from a 10-Year Observational Study.
abstract: BACKGROUND
  Multiple sclerosis (MS) has a highly heterogenic course making prediction of long term outcome very difficult.
  
  
  OBJECTIVE
  The objective was to evaluate current and identify additional clinical factors that are linked to long term outcome of relapsing-remitting MS assessed by disability status 10 years after disease onset.
  
  
  METHODS
  This observational study included 793 patients with relapsing-remitting MS. Clinical factors hypothesized to influence long term outcome measured by EDSS scores 10 years after disease onset were analysed by Kaplan-Meier-estimates. Multinomial logistic regression models regarding mild (EDSS ≤2.5), moderate (EDSS 3.0-5.5) or severe (EDSS ≥6.0) disability were calculated to correct for confounders.
  
  
  RESULTS
  Secondary progression was the strongest predictor of severe disability (Hazard ratio [HR] 503.8, 95% confidence interval [CI] 160.0-1580.1); p<0.001). Complete remission of neurological symptoms at onset reduced the risk of moderate disability (HR 0.42; CI 0.23-0.77; p = 0.005), while depression (HR 3.59; CI 1.14-11.24; p = 0.028) and cognitive dysfunction (HR 4.64; CI 1.11-19.50; p = 0.036) 10 years after disease onset were associated with severe disability. Oligoclonal bands and pregnancy were not correlated with disability.
  
  
  CONCLUSIONS
  We were able to identify clinically apparent chronic depression and cognitive dysfunction to be associated with adverse long term outcome in MS and to confirm that pregnancy has no negative impact. Additionally, we emphasize the positive predictive value of complete remission of initial symptoms.
authors.affiliation: Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: Gabriel
authors.identifier: http://orcid.org/0000-0002-0825-0851
authors.initials: G
authors.lastname: Bsteh
authors.affiliation: Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: Rainer
authors.initials: R
authors.lastname: Ehling
authors.affiliation: Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.|Department of Neurology, University Hospital Zurich & University of Zurich, Zurich, Switzerland.
authors.forename: Andreas
authors.initials: A
authors.lastname: Lutterotti
authors.affiliation: Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: Harald
authors.initials: H
authors.lastname: Hegen
authors.affiliation: Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: Franziska
authors.initials: F
authors.lastname: Di Pauli
authors.affiliation: Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: Michael
authors.initials: M
authors.lastname: Auer
authors.affiliation: Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: Florian
authors.initials: F
authors.lastname: Deisenhammer
authors.affiliation: Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: Markus
authors.initials: M
authors.lastname: Reindl
authors.affiliation: Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: Thomas
authors.initials: T
authors.lastname: Berger
mesh_terms: D000328:Adult; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D009103:Multiple Sclerosis / Q000401:mortality* / Q000628:therapy; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality* / Q000628:therapy; D012008:Recurrence