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Sex As a Determinant of Relapse Incidence and Progressive Course of Multiple Sclerosis Publisher



Kalincik T1, 2, 47 ; Vivek V2 ; Jokubaitis V1 ; Lechnerscott J3 ; Trojano M4 ; Izquierdo G5 ; Lugaresi A6 ; Grandmaison F7 ; Hupperts R8 ; Orejaguevara C9 ; Bergamaschi R10 ; Iuliano G11 ; Alroughani R12 ; Van Pesch V13 Show All Authors
Authors
  1. Kalincik T1, 2, 47
  2. Vivek V2
  3. Jokubaitis V1
  4. Lechnerscott J3
  5. Trojano M4
  6. Izquierdo G5
  7. Lugaresi A6
  8. Grandmaison F7
  9. Hupperts R8
  10. Orejaguevara C9
  11. Bergamaschi R10
  12. Iuliano G11
  13. Alroughani R12
  14. Van Pesch V13
  15. Amato MP14
  16. Slee M15
  17. Verheul F16
  18. Fernandezbolanos R17
  19. Fiol M18
  20. Spitaleri DL19
  21. Cristiano E20
  22. Gray O21
  23. Cabreragomez JA22
  24. Shaygannejad V23
  25. Herbert J24
  26. Vucic S25
  27. Needham M26
  28. Petkovskaboskova T27
  29. Sirbu CA28
  30. Duquette P29
  31. Girard M29
  32. Grammond P30
  33. Boz C31
  34. Giuliani G32
  35. Rio ME33
  36. Barnett M34
  37. Flechter S35
  38. Moore F36
  39. Singhal B37
  40. Bacile EA38
  41. Saladino ML39
  42. Shaw C40
  43. Skromne E41
  44. Poehlau D42
  45. Vella N43
  46. Spelman T2
  47. Liew D44
  48. Kilpatrick TJ2, 45
  49. Butzkueven H1, 2, 46
Show Affiliations
Authors Affiliations
  1. 1. Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
  2. 2. Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia
  3. 3. John Hunter Hospital, Newcastle, NSW, Australia
  4. 4. Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Italy
  5. 5. Hospital Universitario Virgen Macarena, Sevilla, Spain
  6. 6. MS Centre, Department of Neuroscience and Imaging, University 'G. d'Annunzio', Chieti, Italy
  7. 7. Neuro Rive-Sud, Hopital Charles LeMoyne, QC, Canada
  8. 8. Orbis Medicle Center, Sittard, Netherlands
  9. 9. University Hospital San Carlos, IdISSC, Madrid, Spain
  10. 10. Neurological Institute IRCCS Mondino, Pavia, Italy
  11. 11. Ospedali Riuniti di Salerno, Salerno, Italy
  12. 12. Amiri Hospital, Kuwait City, Kuwait
  13. 13. Cliniques Universitaires Saint-Luc, Brussels, Belgium
  14. 14. Department NEUROFARBA, Section of Neurosciences, University of Florence, Florence, Italy
  15. 15. Flinders University and Medical Centre, Adelaide, SA, Australia
  16. 16. Groen Hart Ziekenhuis, Gouda, Netherlands
  17. 17. Hospital Universitario Virgen de Valme, Spain
  18. 18. FLENI, Buenos Aires, Argentina
  19. 19. AORN San Giuseppe Moscati, Avellino, Italy
  20. 20. Hospital Italiano, Buenos Aires, Argentina
  21. 21. Craigavon Area Hospital, Portadown, United Kingdom
  22. 22. Centro Internacional de Restauracion Neurologica, Havana, Cuba
  23. 23. Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
  24. 24. New York University Hospital for Joint Diseases, New York, NY, United States
  25. 25. Westmead Hospital, Sydney, NSW, Australia
  26. 26. Royal North Shore Hospital, Sydney, NSW, Australia
  27. 27. Clinic of Neurology Clinical Centre, Skopje, North Macedonia
  28. 28. Central Clinical Emergency Military Hospital, Bucharest, Romania
  29. 29. Hopital Notre Dame, Montreal, QC, Canada
  30. 30. Hotel-Dieu de Levis, QC, Canada
  31. 31. Karadeniz Technical University, Trabzon, Turkey
  32. 32. Ospedale di Macerata, Macerata, Italy
  33. 33. Hospital CUF, Porto, Portugal
  34. 34. Brain and Mind Research Institute, Sydney, NSW, Australia
  35. 35. Assaf Harofeh Medical Centre, Beer-Yaakov, Israel
  36. 36. Jewish General Hospital, Montreal, QC, Canada
  37. 37. Bombay Hospital Institute of Medical Sciences, Mumbai, India
  38. 38. Instituto de Neurociencias Cordoba, Cordoba, Argentina
  39. 39. INEBA, Buenos Aires, Argentina
  40. 40. Geelong Hospital, Geelong, VIC, Australia
  41. 41. Hospital Angeles Mexico, Lomas, Mexico
  42. 42. Multiple Sclerosis Centre Kamillus-Klinik, Asbach, Germany
  43. 43. Mater Dei Hospital, United States
  44. 44. Melbourne Epi Centre, University of Melbourne and Melbourne Health, Melbourne, VIC, Australia
  45. 45. Centre for Neuroscience Research, Melbourne Neuroscience Institute, University of Melbourne, Melbourne, VIC, Australia
  46. 46. Department of Neurology, Monash University, Box Hill, VIC, Australia
  47. 47. L4 Centre, Melbourne Brain Centre, Royal Melbourne Hospital, Grattan St, Parkville VIC 3050, Australia

Source: Brain Published:2013


Abstract

The aim of this work was to evaluate sex differences in the incidence of multiple sclerosis relapses; assess the relationship between sex and primary progressive disease course; and compare effects of age and disease duration on relapse incidence. Annualized relapse rates were calculated using the MSBase registry. Patients with incomplete data or <1 year of follow-up were excluded. Patients with primary progressive multiple sclerosis were only included in the sex ratio analysis. Relapse incidences over 40 years of multiple sclerosis or 70 years of age were compared between females and males with Andersen-Gill and Tweedie models. Female-to-male ratios stratified by annual relapse count were evaluated across disease duration and patient age and compared between relapse-onset and primary progressive multiple sclerosis. The study cohort consisted of 11 570 eligible patients with relapse-onset and 881 patients with primary progressive multiple sclerosis. Among the relapse-onset patients (82 552 patient-years), 48 362 relapses were recorded. Relapse frequency was 17.7% higher in females compared with males. Within the initial 5 years, the female-to-male ratio increased from 2.3:1 to 3.3:1 in patients with 0 versus ≥4 relapses per year, respectively. The magnitude of this sex effect increased at longer disease duration and older age (P < 10-12). However, the female-to-male ratio in patients with relapse-onset multiple sclerosis and zero relapses in any given year was double that of the patients with primary progressive multiple sclerosis. Patient age was a more important determinant of decline in relapse incidence than disease duration (P < 10-12). Females are predisposed to higher relapse activity than males. However, this difference does not explain the markedly lower female-to-male sex ratio in primary progressive multiple sclerosis. Decline in relapse activity over time is more closely related to patient age than disease duration. © The Author (2013).
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