The impact of changing diagnostic criteria on disability in a Brazilian multiple sclerosis cohort

Abstract

Background

Updating multiple sclerosis (MS) diagnostic criteria over recent decades may have impacted disability progression.

Objective

To assess the effects of the passage of time and changes in diagnostic criteria on disability.

Methods

A retrospective study of Brazilian people with relapsing-remitting MS from 1994 to 2019. Descriptive analysis compared three periods based on admission: Epoch 1 (1994–2001), 2 (2002–2010), and 3 (2011–2019). Cox regressions were performed for the outcomes of the expanded disability status scale (EDSS) 6.0 and conversion to secondary progressive MS (SPMS). We compared the three Epochs in sequence, the Poser with all McDonald criteria combined, and Poser versus each McDonald criteria (2001, 2005, 2010, and 2017). A multivariate logistic regression assessed the impact of diagnostic criteria on patients reaching EDSS 6.0.

Results

Time to diagnosis and treatment decreased across Epochs. For reaching EDSS 6.0, the Cox regression indicated a hazard ratio (HR) 63% lower for Epoch 3 compared with 1, an HR 50% lower for the McDonald criteria combined, and an HR 65% lower for McDonald 2010 compared with Poser. Regarding the conversion to SPMS, the HR was 53% lower for Epoch 3, 48% lower for the McDonald criteria combined, and 64% lower for McDonald 2010. The multivariate logistic regression demonstrated that incomplete recovery of initial symptoms was the main prognostic factor for reaching EDSS 6.0. However, transitioning diagnostic criteria from Poser to McDonald 2001 and 2005 decreased these odds by 54%.

Conclusion

Newer diagnostic criteria have reduced the likelihood of reaching EDSS 6.0 and converting to SPMS over the past 25 years.

Keywords

Multiple Sclerosis - Multiple Sclerosis, Relapsing-Remitting - Prognosis - Disease Progression - Diagnosis

Authors' Contributions

Conceptualization: FTLM, EMLO; Data curation: FTLM, ABL, LSA, RPH, FTA, NPAB, LSFV, NAS, DBB, EMLO; Formal analysis: FTLM, EMLO; Investigation: FTLM, EMLO; Methodology: FTLM, EMLO; Project administration: FTLM, EMLO; Supervision: EMLO; Writing – original draft: FTLM; Writing – review & editing: FTLM, EMLO.

Data Availability Statement

Any data not published within this article are available at Universidade Federal de São Paulo. Patient-related data will be shared upon reasonable request by any qualified investigator, preserving the anonymity of the individual patients.

Editor-in-Chief: Hélio A. G. Teive https://orcid.org/0000-0003-2305-1073.

Associate Editor: Tarso Adoni https://orcid.org/0000-0002-5008-2783.

Publication History

Received: 27 August 2024

Accepted: 27 March 2025

Article published online:
25 June 2025

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