title: Prognostic factors associated with long-term disability and secondary progression in patients with Multiple Sclerosis.
abstract: BACKGROUND
  Predicting the long-term prognosis of patients with multiple sclerosis (MS) remains an uncertain and difficult task, with most data having been obtained exclusively from Caucasian cohorts.
  
  
  OBJECTIVE
  To investigate clinical prognostic factors in a Brazilian mixed-race cohort.
  
  
  METHODS
  Demographic, clinical and therapeutic factors were investigated in 303 patients with relapsing-remitting MS in relation to the following outcomes: time until reaching Expanded Disability Status Scale (EDSS) 3 and EDSS 6, and until secondary progression.
  
  
  RESULTS
  Benign course was significantly more frequent among Caucasians when compared to Afrodescendants. Patients with a malignant course had more than one relapse in the first year of the disease and reached EDSS 3 faster if treatment was not started. In the multivariate analysis, the following factors were associated with a significantly shorter time until the established outcomes: male gender, being of African descent, non-recovery after the first relapse, two or more relapses during the first year, a short interval between initial relapses, initial polysymptomatic presentation of pyramidal and cerebellar dysfunction and no treatment prior to reaching EDSS 3.
  
  
  CONCLUSIONS
  Being of African descent was found to be an unfavorable factor for all outcomes, reinforcing the need to take ethnicity into consideration when defining treatment, particularly in mixed MS populations.
authors.affiliation: Universidade Federal do Estado do Rio de Janeiro, Rua Mariz e Barros 775, Departamento de Neurologia, Tijuca, Rio de Janeiro CEP: 20270-901, Brazil. Electronic address: cfvas@hotmail.com.
authors.forename: Claudia Cristina Ferreira
authors.initials: CC
authors.lastname: Vasconcelos
authors.affiliation: Universidade Federal do Estado do Rio de Janeiro, Rua Mariz e Barros 775, Departamento de Neurologia, Tijuca, Rio de Janeiro CEP: 20270-901, Brazil. Electronic address: julianacka@hotmail.com.
authors.forename: Juliana Calvet Kallenbach
authors.initials: JC
authors.lastname: Aurenção
authors.affiliation: Universidade Federal do Estado do Rio de Janeiro and Instituto Nacional de Câncer, Rua André Cavalcanti, 37 - Centro, Rio de Janeiro, RJ CEP 20231050, Brazil. Electronic address: lthuler@inca.gov.br.
authors.forename: Luiz Claudio Santos
authors.initials: LC
authors.lastname: Thuler
authors.affiliation: Hospital Federal da Lagoa - Departamento de Neurologia, Rua Jardim Botânico, 501, Rio de Janeiro, Brazil. Electronic address: solangecamargo@ig.com.br.
authors.forename: Solange
authors.initials: S
authors.lastname: Camargo
authors.affiliation: Hospital Federal da Lagoa - Departamento de Neurologia, Rua Jardim Botânico, 501, Rio de Janeiro, Brazil. Electronic address: marcospalvarenga@hotmail.com.
authors.forename: Marcos Papais
authors.initials: MP
authors.lastname: Alvarenga
authors.affiliation: Universidade Federal do Estado do Rio de Janeiro and Hospital Federal da Lagoa, Rua Mariz e Barros 775, Departamento de Neurologia, Tijuca, Rio de Janeiro CEP: 20270-901, Brazil. Electronic address: regina_alvarenga2004@hotmail.com.
authors.forename: Regina Maria Papais
authors.initials: RM
authors.lastname: Alvarenga
mesh_terms: D000328:Adult; D017668:Age of Onset; D044383:Black People; D001938:Brazil / Q000453:epidemiology; D015331:Cohort Studies; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009103:Multiple Sclerosis / Q000175:diagnosis* / Q000453:epidemiology*; D015999:Multivariate Analysis; D011379:Prognosis; D012737:Sex Factors; D044465:White People
keywords: African Ancestry; Disability; Multiple Sclerosis; Prognostic factors; Risk factors; Secondary progression