title: Assessing long-term prognosis improvement as a consequence of treatment pattern changes in MS.
abstract: OBJECTIVE
  To assess whether the age at which multiple sclerosis (MS) patients reach Expanded Disability Status Scale (EDSS) milestones changed as long as new drugs for the treatment of MS became available.
  
  
  METHODS
  We evaluated the long-term impact of therapies on disability progression assessing whether there is a detectable delay in the age at which patients reached EDSS milestones in more recent years. We used data collected over more than 30 years in the Center of Brescia, Italy. We compared the age at EDSS = 6 among patients diagnosed with relapsing-remitting MS in different time periods, adjusting for age at diagnosis and median interval among EDSS visits, by a multivariate Cox model.
  
  
  RESULTS
  A total of 1324 MS patients were included. Patients diagnosed in more recent periods reached EDSS = 6 at an older age: the rate at which patients reached EDSS = 6 in those diagnosed in 1991-1995 was similar to those diagnosed in 1980-1990 (hazard ratio ( HR) = 1.09, p = 0.68) and to those diagnosed in 1996-2000 ( HR = 0.85, p = 0.44), it was reduced by 37% in patients diagnosed in 2001-2005 ( HR = 0.63, p = 0.05), by 46% in patients diagnosed in 2006-2010 ( HR = 0.54, p < 0.02).
  
  
  CONCLUSIONS
  A clear modification of MS course is observed after 2000; among other causes, this can be associated to the changes in the treatment patterns experienced in those years.
authors.affiliation: Multiple Sclerosis Center, Spedali Civili di Brescia, Montichiari Hospital, Montichiari, Italy/University of Genoa, Genoa, Italy.
authors.forename: Ruggero
authors.initials: R
authors.lastname: Capra
authors.affiliation: Multiple Sclerosis Center, Spedali Civili di Brescia, Montichiari Hospital, Montichiari, Italy/University of Genoa, Genoa, Italy.
authors.forename: Cinzia
authors.initials: C
authors.lastname: Cordioli
authors.affiliation: Multiple Sclerosis Center, Spedali Civili di Brescia, Montichiari Hospital, Montichiari, Italy/University of Genoa, Genoa, Italy.
authors.forename: Sarah
authors.initials: S
authors.lastname: Rasia
authors.affiliation: Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Gallo
authors.affiliation: Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.
authors.forename: Alessio
authors.initials: A
authors.lastname: Signori
authors.affiliation: Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.
authors.forename: Maria Pia
authors.initials: MP
authors.lastname: Sormani
mesh_terms: D000328:Adult; D000367:Age Factors; D018450:Disease Progression; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000453:epidemiology* / Q000503:physiopathology* / Q000628:therapy*; D011379:Prognosis; D012720:Severity of Illness Index; D013997:Time Factors
keywords: Multiple sclerosis; long-term treatment effect; real life