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Early non-disabling relapses are important predictors of disability accumulation in people with relapsing-remitting multiple sclerosis
journal contribution
posted on 2023-07-31, 03:04 authored by C Daruwalla, V Shaygannejad, S Ozakbas, EK Havrdova, D Horakova, R Alroughani, C Boz, F Patti, M Onofrj, A Lugaresi, S Eichau, M Girard, A Prat, P Duquette, B Yamout, SJ Khoury, SA Sajedi, R Turkoglu, A Altintas, O Skibina, K Buzzard, P Grammond, R Karabudak, A van der Walt, H Butzkueven, D Maimone, J Lechner-Scott, A Soysal, N John, J Prevost, D Spitaleri, C Ramo-Tello, O Gerlach, G Iuliano, M Foschi, R Ampapa, V van Pesch, M Barnett, N Shalaby, M D'hooghe, J Kuhle, MJ Sa, M Fabis-Pedrini, A Kermode, S Mrabet, R Gouider, S Hodgkinson, G Laureys, L Van Hijfte, R Macdonell, C Oreja-Guevara, E Cristiano, P McCombe, JL Sanchez-Menoyo, B Singhal, Y Blanco, S Hughes, J Garber, C Solaro, C McGuigan, B Taylor, K de Gans, M Habek, A Al-Asmi, S Mihaela, T Castillo Triviño, T Al-Harbi, JI Rojas, O Gray, D Khurana, B Van Wijmeersch, N Grigoriadis, J Inshasi, J Oh, E Aguera-Morales, Y Fragoso, F Moore, Cameron ShawCameron Shaw, SM Baghbanian, N Shuey, B Willekens, TA Hardy, D Decoo, AP Sempere, D Field, R Wynford-Thomas, NG Cunniffe, I Roos, CB Malpas, AJ Coles, T Kalincik, JWL BrownBackground: 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.
