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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.

Neurology
|November 16, 2014
PubMed
Abstract

Insights

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.

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.

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