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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

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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