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Updated: Aug 8, 2025
A Method of Trigonometric Modelling of Seasonal Variation Demonstrated with Multiple Sclerosis Relapse Data
Published on: December 9, 2015
Early non-disabling relapses are important predictors of disability accumulation in people with relapsing-remitting
Cyrus Daruwalla1, Vahid Shaygannejad2, Serkan Ozakbas3
1Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
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.
Insights
Early non-disabling relapses in relapsing-remitting multiple sclerosis (RRMS) increase disability risk, especially without high-efficacy disease-modifying therapies (DMTs). These relapses warrant consideration in treatment decisions for RRMS patients.
Area of Science:
- Neurology
- Clinical Research
- Multiple Sclerosis Studies
Background:
- The prognostic value of non-disabling relapses in relapsing-remitting multiple sclerosis (RRMS) remains uncertain.
- Understanding early relapse severity is crucial for predicting disease progression.
Purpose of the Study:
- To investigate if early non-disabling relapses in RRMS predict future disability accumulation.
- To analyze the impact of disease-modifying therapy (DMT) efficacy on this relationship.
Main Methods:
- Relapses in the MSBase registry were classified as 'non-disabling' (mild) or 'disabling' (moderate/severe).
- Mixed-effects Cox models compared disability accumulation (90-day confirmed events) in RRMS patients with early non-disabling relapses versus those with no early relapses or early disabling relapses.
- Analyses were stratified based on DMT efficacy during the follow-up period.
Main Results:
- Patients with early non-disabling relapses accumulated more disability than those with no early relapses when untreated (HR=1.29) or on platform DMTs (HR=1.33).
- This increased risk was not observed with high-efficacy DMTs (HR=0.90).
- Statistically significant differences in disability accumulation between early non-disabling and early disabling relapses were not found.
Conclusions:
- Early non-disabling relapses in RRMS are linked to a higher risk of disability accumulation compared to no early relapses.
- High-efficacy DMTs may mitigate the risk associated with early non-disabling relapses.
- Non-disabling relapses should be factored into treatment decisions for RRMS management.
