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Relapses and disability accumulation in progressive multiple sclerosis.

M Mateo Paz Soldán1, Martina Novotna1, Nuhad Abou Zeid1

  • 1From the Mayo Clinic Center for Multiple Sclerosis and CNS Demyelinating Diseases, Department of Neurology (M.M.P.S., M.N., B.M.K., I.P., S.J.P., C.F.L., B.G.W., M.R., O.H.K.), and Division of Biomedical Statistics & Informatics (D.J.C., E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; International Clinical Research Center (M.N.), St. Anne's University Hospital Brno, Czech Republic; Department of Neurology (N.A.Z.), American University of Beirut Medical Center, Lebanon; Department of Neurology (N.K.), Bakirkoy State Hospital, Istanbul; and Department of Neurology (M.T., A.S.), Cerrahpasa School of Medicine, Istanbul University, Turkey. N.A.Z., N.K., and M.T. were previous fellows of the Department of Neurology, Mayo Clinic College of Medicine.

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Summary
This summary is machine-generated.

Relapses before and after disease progression significantly speed up severe disability in multiple sclerosis (MS). Continuing immunomodulation for up to 5 years post-progression may benefit certain MS patients with ongoing relapses.

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Area of Science:

  • Neurology
  • Clinical Research
  • Disease Progression Studies

Background:

  • Progressive multiple sclerosis (MS) is characterized by accumulating disability.
  • The impact of relapses on disability accrual in progressive MS requires further clarification.

Purpose of the Study:

  • To investigate the effect of relapses occurring before and after disease progression onset on the rate of disability accumulation in a progressive MS cohort.
  • To identify factors associated with a faster time to severe disability (Expanded Disability Status Scale [EDSS] score of 6).

Main Methods:

  • Analysis of a progressive MS cohort including primary progressive MS (PPMS) and bout-onset progressive MS (BOPMS) (n=855).
  • Multivariate Cox regression and Kaplan-Meier analyses were used to assess the time to EDSS 6, considering relapses, sex, age at progression, and immunomodulation.
  • Subgroup analysis of postprogression relapse rates in PPMS, single-attack progressive MS (SAPMS), and secondary progressive MS (SPMS).

Main Results:

  • Both preprogression and postprogression relapses were significantly associated with a shorter time to EDSS 6 (HR: 1.63 and 1.37, respectively).
  • Female sex and progression onset after age 50 were also linked to faster disability accrual.
  • Postprogression relapses were most common in SPMS (29.5%) and typically occurred within 5 years of progression onset or before age 55.

Conclusions:

  • Relapses occurring at any stage of progressive multiple sclerosis accelerate the time to severe disability.
  • Consideration of continuing immunomodulation for 5 years post-progression or until age 55 may be beneficial for BOPMS patients experiencing ongoing relapses.