Disease progression and prognostic factors in multiple system atrophy: A prospective cohort study
Neurobiology of Disease. 2020-06-01; 139: 104813
DOI: 10.1016/j.nbd.2020.104813
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Foubert-Samier A(1), Pavy-Le Traon A(2), Guillet F(3), Le-Goff M(3), Helmer C(4), Tison F(5), Rascol O(6), Proust-Lima C(4), Meissner WG(7).
Author information:
(1)French Reference Centre for MSA, University Hospital Bordeaux, Bordeaux, France; Inserm, UMR1219, Bordeaux Population Health Research Center, univ. Bordeaux, ISPED, F33000 Bordeaux, France; Institut des Maladies Neurodégénératives, CNRS, UMR 5293, Bordeaux University, Bordeaux, France. Electronic address:
(2)French Reference Centre for MSA, University Hospital Toulouse, Toulouse, France; Institut des Maladies Métaboliques et Cardiovasculaires, Inserm U 1048, Toulouse University, Toulouse, France.
(3)Inserm, UMR1219, Bordeaux Population Health Research Center, univ. Bordeaux, ISPED, F33000 Bordeaux, France.
(4)Inserm, UMR1219, Bordeaux Population Health Research Center, univ. Bordeaux, ISPED, F33000 Bordeaux, France; Inserm, CIC 1401 Bordeaux, Clinical Epidemiology Unit, F-33000 Bordeaux, France.
(5)French Reference Centre for MSA, University Hospital Bordeaux, Bordeaux, France; Institut des Maladies Neurodégénératives, CNRS, UMR 5293, Bordeaux University, Bordeaux, France.
(6)French Reference Centre for MSA, University Hospital Toulouse, Toulouse, France; Inserm, Toulouse University and CHU Toulouse, Clinical Investigation Center CIC 1436 and Departments of Neurosciences and Clinical Pharmacology, Toulouse, France.
(7)French Reference Centre for MSA, University Hospital Bordeaux, Bordeaux, France; Institut des Maladies Neurodégénératives, CNRS, UMR 5293, Bordeaux University, Bordeaux, France; Dept. Medicine, University of Otago, Christchurch, and New Zealand Brain Research Institute, Christchurch, New Zealand.
Multiple system atrophy (MSA) is a rare neurodegenerative disease, with limited understanding of disease progression and prognostic factors. We leveraged the data of a large prospective cohort of MSA to study both clinical progression and survival and assess their determinants. All consecutive patients seen at the French Reference Centre for MSA since 2007 were included in a prospective cohort
with an annual follow-up including the Unified MSA Rating Scale (UMSARS). We used joint models to evaluate the risk of death, the mean trajectory of each UMSARS subscale and to determine the potential factors. Investigated factors included gender, age at baseline, MSA subtype, diagnosis certainty, type of first symptoms and the duration between symptom onset and the first visit. Among the 261 MSA
patients included in our cohort, the median duration of clinical follow-up was 2.1 years (up to 10.3 years) and the median survival was 4.0 years since the first visit. Main factors for poor survival were the progression over time of UMSARS score (I + II and IV) and the severity of orthostatic hypotension. MSA subtype had no effect on progression or survival. The UMSARS I + II score progressed faster over time in subjects with autonomic dysfunction as the initial feature and in women. Despite a faster progression, women and men had similar
survival. From this large MSA cohort, we confirm the rapid progression and poor prognosis of MSA. We provide additional evidence for a negative impact of early autonomic dysfunction and the severity of orthostatic hypotension on both disease progression and survival.