Relapsing and progressive MS: the sex-specific perspective

Paulus Stefan Rommer; David Ellenberger; Kerstin Hellwig; Judith Haas; Dieter Pöhlau; Alexander Stahmann; Uwe Klaus Zettl; Scientific Advisory Group of the German MS-Register by the German MS Society

doi:10.1177/1756286420956495

Relapsing and progressive MS: the sex-specific perspective

Ther Adv Neurol Disord. 2020 Sep 23:13:1756286420956495. doi: 10.1177/1756286420956495. eCollection 2020.

Authors

Paulus Stefan Rommer¹, David Ellenberger², Kerstin Hellwig³, Judith Haas⁴, Dieter Pöhlau⁵, Alexander Stahmann², Uwe Klaus Zettl⁶; Scientific Advisory Group of the German MS-Register by the German MS Society

Affiliations

¹ Department of Neurology, Neuroimmunological Section, University of Rostock, Gehlsheimer Straße 20, Rostock, 18147, Germany.
² German MS-Register by the German MS Society, MS Forschungs- und Projektentwicklungs-gGmbH, Hannover, Germany.
³ Department of Neurology, Katholisches Klinikum Bochum, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany.
⁴ Centre for Multiple Sclerosis, Jewish Hospital Berlin, Berlin, Germany.
⁵ Department of Neurology, German Red Cross-Kamillus-Clinic, Asbach, Germany.
⁶ Department of Neurology, Neuroimmunological Section, University of Rostock, Rostock, Germany.

Abstract

Background: Multiple sclerosis (MS) is an inflammatory and neurodegenerative disease whose aetiology is not fully understood. The female sex is clearly predominant, with a sex ratio between 2 and 3. In primary progressive MS the sex ratio almost balances out. Since the age at onset is higher for patients with progressive onset (POMS) than for relapsing onset (ROMS), it can be hypothesized that the age at onset is a decisive factor for the sex ratio.

Methods: To address this aspect, we compare clinical and demographic data between females and males for the different disease courses within the population of the German MS Register by the German MS Society. Only patients with complete details in mandatory data items and a follow-up visit since 01. Jan 2018 were included.

Results: A total of 18,728 patients were included in our analyses, revealing a female-to-male ratio of 2.6 (2.7 for patients with ROMS and 1.3 for POMS). The age at diagnosis is higher in patients with POMS (43.3 and 42.3 years for females and males versus 32.1 and 33.2 years, respectively). Females irrespective of disease course are statistically significantly more often affected by cognitive impairment (POMS: p = 0.013, ROMS: p = 0.001) and depression (POMS: p = 0.002, ROMS: 0.001) and suffer more often from pain (POMS and ROMS: p < 0.001). Fatigue is significantly more often seen in females with ROMS (p < 0.001) but not in POMS. Females with ROMS retire significantly (p < 0.001) earlier (42.8 versus 44.2 years) and to a greater extent than males (28 versus 24%). Disease progression was similar for women and men.

Conclusion: Our analysis shows that clinical and demographic data differ more between disease courses than between men and women. For pain, depression and cognitive impairment the female sex is the decisive factor. Whether these factors are responsible for the earlier retirement of females with ROMS is not clear. Appropriate measures for optimization of symptomatic treatment as well as to promote employment should be taken.

Keywords: age of onset; multiple sclerosis; progressive MS; relapsing MS; sex ratio.