Thomas F Scott1,2, Daniel Diehl1, Wisam Elmalik1, Edward J Gettings3, Chris Hackett1, Carol J Schramke1,2. 1. Neurology and Neuroscience Institute, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA, USA. 2. Neurology, Drexel University College of Medicine, Philadelphia, PA, USA. 3. Department of Neurology, Temple University Hospitals, Philadelphia, PA, USA.
Abstract
BACKGROUND: Treatments affect both relapse-related disability and short-term disability change, but measurements of their impact on long-term outcomes remain a challenge. OBJECTIVE: To ascertain the contribution of relapse-associated disability to overall disability in relapse-onset multiple sclerosis (RMS) using long-term data collected in our clinic. MATERIALS AND METHODS: Retrospective study of a cohort of newly diagnosed patients with RMS, (n = 176) was undertaken, measuring all confirmed changes in disability up to 15 years after onset. Worsening was assessed yearly and in 5-year epochs and was attributed to either relapse (RW) or slow progression (PW). RESULTS: At data lock, 139/176 (81%) of patients were still actively followed, with Expanded Disability Status Scale (EDSS) available for 10 years post-onset in 145/176 (82%) patients and 15 years post-onset EDSS in 83 patients (mean follow-up entire group 12.7 years post-onset). RW accounted for a large amount of worsening seen in the first 15 years of RMS. RW was less frequent over time, but accounted for most EDSS changes in the first decade of MS (167/267, 63% of EDSS changes), and remained important even in years 11-15 (17/50, 34% of EDSS changes). Median change in disability due to RW vs PW was similar over the entire 15 years. CONCLUSIONS: Worsening of treated MS was associated with relapses in many RMS patients throughout the first 15 years after onset, suggesting an opportunity for long-term benefit through relapse reduction.
BACKGROUND: Treatments affect both relapse-related disability and short-term disability change, but measurements of their impact on long-term outcomes remain a challenge. OBJECTIVE: To ascertain the contribution of relapse-associated disability to overall disability in relapse-onset multiple sclerosis (RMS) using long-term data collected in our clinic. MATERIALS AND METHODS: Retrospective study of a cohort of newly diagnosed patients with RMS, (n = 176) was undertaken, measuring all confirmed changes in disability up to 15 years after onset. Worsening was assessed yearly and in 5-year epochs and was attributed to either relapse (RW) or slow progression (PW). RESULTS: At data lock, 139/176 (81%) of patients were still actively followed, with Expanded Disability Status Scale (EDSS) available for 10 years post-onset in 145/176 (82%) patients and 15 years post-onset EDSS in 83 patients (mean follow-up entire group 12.7 years post-onset). RW accounted for a large amount of worsening seen in the first 15 years of RMS. RW was less frequent over time, but accounted for most EDSS changes in the first decade of MS (167/267, 63% of EDSS changes), and remained important even in years 11-15 (17/50, 34% of EDSS changes). Median change in disability due to RW vs PW was similar over the entire 15 years. CONCLUSIONS: Worsening of treated MS was associated with relapses in many RMS patients throughout the first 15 years after onset, suggesting an opportunity for long-term benefit through relapse reduction.
Authors: Peter A Calabresi; Ludwig Kappos; Gavin Giovannoni; Tatiana Plavina; Irene Koulinska; Michael R Edwards; Bernd Kieseier; Carl de Moor; Elias S Sotirchos; Elizabeth Fisher; Richard A Rudick; Alfred Sandrock Journal: Ann Clin Transl Neurol Date: 2021-10-26 Impact factor: 4.511
Authors: Fred D Lublin; Dieter A Häring; Habib Ganjgahi; Alex Ocampo; Farhad Hatami; Jelena Čuklina; Piet Aarden; Frank Dahlke; Douglas L Arnold; Heinz Wiendl; Tanuja Chitnis; Thomas E Nichols; Bernd C Kieseier; Robert A Bermel Journal: Brain Date: 2022-09-14 Impact factor: 15.255