Early non-disabling relapses are important predictors of disability accumulation in people with relapsing-remitting multiple sclerosis. (June 2023)

• Record Type: Journal Article
• Authors: Daruwalla, Cyrus; Shaygannejad, Vahid; Ozakbas, Serkan; Havrdova, Eva Kubala; Horakova, Dana; Alroughani, Raed; Boz, Cavit; Patti, Francesco; Onofrj, Marco; Lugaresi, Alessandra; Eichau, Sara; Girard, Marc; Prat, Alexandre; Duquette, Pierre; Yamout, Bassem; Khoury, Samia J; Sajedi, Seyed Aidin; Turkoglu, Recai; Altintas, Ayse; Skibina, Olga; Buzzard, Katherine; Grammond, Pierre; Karabudak, Rana; van der Walt, Anneke; Butzkueven, Helmut; Maimone, Davide; Lechner-Scott, Jeannette; Soysal, Aysun; John, Nevin; Prevost, Julie; Spitaleri, Daniele; Ramo-Tello, Cristina; Gerlach, Oliver; Iuliano, Gerardo; Foschi, Matteo; Ampapa, Radek; van Pesch, Vincent; Barnett, Michael; Shalaby, Nevin; D'hooghe, Marie; Kuhle, Jens; Sa, Maria Jose; Fabis-Pedrini, Marzena; Kermode, Allan; Mrabet, Saloua; Gouider, Riadh; Hodgkinson, Suzanne; Laureys, Guy; Van Hijfte, Liesbeth; Macdonell, Richard; Oreja-Guevara, Celia; Cristiano, Edgardo; McCombe, Pamela; Sanchez-Menoyo, Jose Luis; Singhal, Bhim; Blanco, Yolanda; Hughes, Stella; Garber, Justin; Solaro, Claudio; McGuigan, Chris; Taylor, Bruce; de Gans, Koen; Habek, Mario; Al-Asmi, Abdullah; Mihaela, Simu; Castillo Triviño, Tamara; Al-Harbi, Talal; Rojas, Juan Ignacio; Gray, Orla; Khurana, Dheeraj; Van Wijmeersch, Bart; Grigoriadis, Nikolaos; Inshasi, Jihad; Oh, Jiwon; Aguera-Morales, Eduardo; Fragoso, Yara; Moore, Fraser; Shaw, Cameron; Baghbanian, Seyed Mohammad; Shuey, Neil; Willekens, Barbara; Hardy, Todd A; Decoo, Danny; sempere, Angel Perez; Field, Deborah; Wynford-Thomas, Ray; Cunniffe, Nick G; Roos, Izanne; Malpas, Charles B; Coles, Alasdair J; Kalincik, Tomas; Brown, J William L;
• Is Part Of: Multiple sclerosis. Volume 29:Number 7(2023)
• Page Start: 875
• Page End: 883
• Publication Date: 2023-06
• Subjects: Multiple sclerosis -- prognosis; Central nervous system -- Diseases -- Periodicals; Myelin sheath -- Diseases -- Periodicals; Inflammation -- Periodicals; Multiple sclerosis -- Periodicals; Central Nervous System Diseases -- Periodicals; Demyelinating Diseases -- Periodicals; Inflammation -- Periodicals; Multiple Sclerosis -- Periodicals; Système nerveux central -- Maladies -- Périodiques; Gaine de myéline -- Maladies -- Périodiques; Inflammation (Pathologie) -- Périodiques; Sclérose en plaques -- Périodiques; Electronic journals; 616.834005
• DOI: 10.1177/13524585231151951
• Languages: English
• ISSNs: 1352-4585

Abstract

Background: The prognostic significance of non-disabling relapses in people with relapsing-remitting multiple sclerosis (RRMS) is unclear. Objective: To determine whether early non-disabling relapses predict disability accumulation in RRMS. Methods: We redefined mild relapses in MSBase as 'non-disabling', and moderate or severe relapses as 'disabling'. We used mixed-effects Cox models to compare 90-day confirmed disability accumulation events in people with exclusively non-disabling relapses within 2 years of RRMS diagnosis to those with no early relapses; and any early disabling relapses. Analyses were stratified by disease-modifying therapy (DMT) efficacy during follow-up. Results: People who experienced non-disabling relapses within 2 years of RRMS diagnosis accumulated more disability than those with no early relapses if they were untreated ( n = 285 vs 4717; hazard ratio (HR) = 1.29, 95% confidence interval (CI) = 1.00–1.68) or given platform DMTs ( n = 1074 vs 7262; HR = 1.33, 95% CI = 1.15–1.54), but not if given high-efficacy DMTs ( n = 572 vs 3534; HR = 0.90, 95% CI = 0.71–1.13) during follow-up. Differences in disability accumulation between those with early non-disabling relapses and those with early disabling relapses were not confirmed statistically. Conclusion: This study suggests that early non-disabling relapses are associated with a higher risk of disability accumulation than no early relapses in RRMS. This risk may be mitigated by high-efficacy DMTs. Therefore, non-disabling relapses should be considered when making treatment decisions.