Defining secondary progressive multiple sclerosis

Johannes Lorscheider, Katherine Buzzard, Vilija Jokubaitis, Tim Spelman, Eva Havrdova, Dana Horakova, Maria Trojano, Guillermo Izquierdo, Marc Girard, Pierre Duquette, Alexandre Prat, Allessandra Lugaresi, Francois Grand'Maison, Pierre Grammond, Raymond Hupperts, Raed Alroughani, Patrizia Sola, Cavit Boz, Eugenio Pucci, Jeannette Lechner-ScottRoberto Bergamaschi, Celia Oreja-Guevara, Gerardo Iuliano, Vincent Van Pesch, Franco Granella, Cristina Ramo-Tello, Daniele Spitaleri, Thor Petersen, Mark Slee, Freek Verheul, Radek Ampapa, Maria Amato, Pamela McCombe, Steve Vucic, Jose Sanchez-Menoyo, Edgardo Christiano, Michael Barnett, Suzanne Hodgkinson, Javier Olascoaga, Maria Saladino, Orla Gray, Cameron Shaw, Fraser Moore, Helmut Butzkueven, Tomas Kalincik

    Research output: Contribution to journalArticlepeer-review

    258 Citations (Scopus)


    A number of studies have been conducted with the onset of secondary progressive multiple sclerosis as an inclusion criterion or an outcome of interest. However, a standardized objective definition of secondary progressive multiple sclerosis has been lacking. The aim of this work was to evaluate the accuracy and feasibility of an objective definition for secondary progressive multiple sclerosis, to enable comparability of future research studies. Using MSBase, a large, prospectively acquired, global cohort study, we analysed the accuracy of 576 data-derived onset definitions for secondary progressive multiple sclerosis and first compared these to a consensus opinion of three neurologists. All definitions were then evaluated against 5-year disease outcomes post-assignment of secondary progressive multiple sclerosis: sustained disability, subsequent sustained progression, positive disability trajectory, and accumulation of severe disability. The five best performing definitions were further investigated for their timeliness and overall disability burden. A total of 17 356 patients were analysed. The best definition included a 3-strata progression magnitude in the absence of a relapse, confirmed after 3 months within the leading Functional System and required an Expanded Disability Status Scale step ≥4 and pyramidal score ≥2. It reached an accuracy of 87% compared to the consensus diagnosis. Seventy-eight per cent of the identified patients showed a positive disability trajectory and 70% reached significant disability after 5 years. The time until half of all patients were diagnosed was 32.6 years (95% confidence interval 32-33.6) after disease onset compared with the physicians' diagnosis at 36 (35-39) years. The identified patients experienced a greater disease burden [median annualized area under the disability-time curve 4.7 (quartiles 3.6, 6.0)] versus non-progressive patients [1.8 (1.2, 1.9)]. This objective definition of secondary progressive multiple sclerosis based on the Expanded Disability Status Scale and information about preceding relapses provides a tool for a reproducible, accurate and timely diagnosis that requires a very short confirmation period. If applied broadly, the definition has the potential to strengthen the design and improve comparability of clinical trials and observational studies in secondary progressive multiple sclerosis.

    Original languageEnglish
    Pages (from-to)2395-2405
    Number of pages11
    Issue number9
    Publication statusPublished - 1 Sept 2016


    • definition
    • disability
    • MSBase
    • secondary progressive multiple sclerosis
    • study design


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