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Published on: June 30, 2014
Specific clinical phenotypes in relapsing multiple sclerosis: The impact of relapses on long-term outcomes
Thomas F Scott1, Edward J Gettings2, Christopher T Hackett3
1Allegheny General Hospital, Department of Neurology, Pittsburgh, USA; Drexel University College of Medicine, Department of Neurology, Pittsburgh, USA.
Objective:
The impact of relapses on the disease course of relapsing MS remains to be determined. This study aims to identify and characterize clinical phenotypes of relapse onset MS in a longitudinally studied cohort.
Methods:
We recorded the clinical course of MS during the first decade of disease, using five-year epochs. Patients were stratified as: no worsening due to relapse or secondary progression (type A), relapse with worsening seen without secondary progression (type B), secondary progression with no worsening due to relapse (type C), worsening due to relapses mixed with secondary progression (type D).
Results:
Of 176 patients followed from diagnosis for 12.62 ± 4.18 years, 93.2% (164/176) had increased disability in their first 5-year epoch of MS and 52.2% (72/138) in the next. The phenotypes significantly differed by EDSS change during each epoch (p<0.001), final confirmed MSSS (p ≤ 0.002) and relapse rate (p<0.001). Type D fared worse than others by change in EDSS and MSSS.
Conclusion:
We identified multiple specific phenotypes of MS and temporal shifts between phenotypes according to relapse type and progression.
Insights
Relapsing multiple sclerosis (MS) has distinct clinical phenotypes. Understanding these relapse-driven disease courses can inform patient management and prognosis.
Area of Science:
- Neurology
- Immunology
- Clinical Research
Background:
- The long-term impact of relapses on the disease trajectory of relapsing multiple sclerosis (MS) requires further elucidation.
- Identifying distinct clinical phenotypes associated with relapse onset is crucial for understanding disease progression.
Purpose of the Study:
- To identify and characterize clinical phenotypes in patients with relapse-onset MS.
- To analyze the impact of relapses on the disease course over a decade.
Main Methods:
- Longitudinal study of 176 patients with MS over approximately 12.6 years.
- Disease course analysis in five-year epochs.
- Stratification of patients into four phenotypes (A, B, C, D) based on relapse and progression patterns.
Main Results:
- Over 93% of patients showed increased disability in the first 5 years, and over 52% in the next 5 years.
- Identified phenotypes significantly differed in Expanded Disability Status Scale (EDSS) change, Multiple Sclerosis Severity Score (MSSS), and relapse rate (p<0.001).
- Phenotype D (worsening due to relapses mixed with secondary progression) exhibited worse outcomes.
Conclusions:
- Multiple distinct phenotypes of MS were identified.
- Temporal shifts between phenotypes were observed, influenced by relapse type and disease progression.
- Characterizing these phenotypes offers insights into MS heterogeneity and progression patterns.
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