Early non-disabling relapses are important predictors of disability accumulation in people with relapsing-remitting multiple sclerosis
Por:
Daruwalla, C, Shaygannejad, V, Ozakbas, S, Havrdova, EK, Horakova, D, Alroughani, R, Boz, C, Patti, F, Onofrj, M, Lugaresi, A, Eichau, S, Girard, M, Prat, A, Duquette, P, Yamout, B, Khoury, SJ, Sajedi, SA, Turkoglu, R, Altintas, A, Skibina, O, Buzzard, K, Grammond, P, Karabudak, R, van der Walt, A, Butzkueven, H, Maimone, D, Lechner-Scott, J, Soysal, A, John, N, Prevost, J, Spitaleri, D, Ramo-Tello, C, Gerlach, O, Iuliano, G, Foschi, M, Ampapa, R, van Pesch, V, Barnett, M, Shalaby, N, D'hooghe, M, Kuhle, J, Sa, MJ, Fabis-Pedrini, M, Kermode, A, Mrabet, S, Gouider, R, Hodgkinson, S, Laureys, G, Van Hijfte, L, Macdonell, R, Oreja-Guevara, C, Cristiano, E, McCombe, P, Sanchez-Menoyo, JL, Singhal, B, Blanco, Y, Hughes, S, Garber, J, Solaro, C, McGuigan, C, Taylor, B, de Gans, K, Habek, M, Al-Asmi, A, Mihaela, S, Trivino, TC, Al-Harbi, T, Rojas, JI, Gray, O, Khurana, D, Van Wijmeersch, B, Grigoriadis, N, Inshasi, J, Oh, J, Aguera-Morales, E, Fragoso, Y, Moore, F, Shaw, C, Baghbanian, SM, Shuey, N, Willekens, B, Hardy, TA, Decoo, D, Sempere, AP, Field, D, Wynford-Thomas, R, Cunniffe, NG, Roos, I, Malpas, CB, Coles, AJ, Kalincik, T, Brown, JWL and MSBase Study Grp
Publicada:
1 jun 2023
Ahead of Print:
1 feb 2023
Resumen:
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.
Filiaciones:
Univ G DAnnunzio, Dept Neurosci Imaging & Clin Sci, Chieti, Italy
Univ Bologna, Dipartimento Sci Biomed & Neuromotorie, Bologna, Italy
IRCCS Ist Sci Neurol Bologna, Bologna, Italy
Hosp Univ Virgen Macarena, Seville, Spain
CHUM, Montreal, PQ, Canada
Univ Montreal, Montreal, PQ, Canada
Amer Univ Beirut Med Ctr, Nehme & Therese Tohme Multiple Sclerosis Ctr, Beirut, Lebanon
Golestan Univ Med Sci, Neurosci Res Ctr, Dept Neurol, Gorgan, Iran
Haydarpasa Numune Training & Res Hosp, Istanbul, Turkiye
Koc Univ, Sch Med, Dept Neurol, Istanbul, Turkiye
Koc Univ, Koc Univ Res Ctr Translat Med KUTTAM, Istanbul, Turkiye
Box Hill Hosp, Dept Neurol, Melbourne, Vic, Australia
Monash Univ, Cent Clin Sch, Dept Neurosci, Melbourne, Vic, Australia
Alfred Hosp, Dept Neurol, Melbourne, Vic, Australia
Royal Melbourne Hosp, MS Ctr, Melbourne, Vic, Australia
CISSS ChaudiEre Appalache, Levis, PQ, Canada
Hacettepe Univ, Ankara, Turkiye
ARNAS Garibaldi, Ctr Sclerosi Multipla, UOC Neurol, Catania, Italy
Univ Newcastle, Sch Med & Publ Hlth, Newcastle, NSW, Australia
John Hunter Hosp, Dept Neurol, Hunter New England Hlth, Newcastle, NSW, Australia
Bakirkoy Educ & Res Hosp Psychiat & Neurol Dis, Istanbul, Turkiye
Monash Med Ctr, Melbourne, Vic, Australia
Monash Univ, Sch Clin Sci, Dept Med, Melbourne, Vic, Australia
CSSS St Jerome, St Jerome, PQ, Canada
Azienda Osped Rilievo Nazl San Giuseppe Moscati Av, Avellino, Italy
Hosp Germans Trias I Pujol, Badalona, Spain
Zuyderland Med Ctr, Acad MS Ctr Zuyderland, Dept Neurol, Sittard Geleen, Netherlands
Maastricht Univ, Sch Mental Hlth & Neurosci, Maastricht, Netherlands
Osped Riuniti Salerno, Salerno, Italy
S Maria delle Croci Hosp Ravenna, Dept Neurosci, Neurol Unit, AUSL Romagna, Ravenna, Italy
Nemocnice Jihlava, Jihlava, Czech Republic
Clin Univ St Luc, Brussels, Belgium
Catholic Univ Louvain, Ottignies Louvain La Neuv, Belgium
Brain & Mind Ctr, Sydney, NSW, Australia
Kasr Al Ainy MS Res Unit KAMSU, Neurol, Cairo, Egypt
Natl MS Ctr, Dept Neurol, Melsbroek, Belgium
Univ Basel, Univ Hosp Basel, MS Ctr, Dept Head Spine & Neuromed, Basel, Switzerland
Univ Basel, Univ Hosp Basel, MS Ctr, Dept Biomed, Basel, Switzerland
Univ Basel, Univ Hosp Basel, MS Ctr, Dept Clin Res, Basel, Switzerland
Univ Basel, Univ Hosp Basel, Res Ctr Clin Neuroimmunol & Neurosci Basel RC2NB, Dept Head Spine & Neuromed, Basel, Switzerland
Univ Basel, Univ Hosp Basel, Res Ctr Clin Neuroimmunol & Neurosci Basel RC2NB, Dept Biomed, Basel, Switzerland
Univ Basel, Univ Hosp Basel, Res Ctr Clin Neuroimmunol & Neurosci Basel RC2NB, Dept Clin Res, Basel, Switzerland
Ctr Hosp Univ Sao Joao, Dept Neurol, Porto, Portugal
Univ Fernando Pessoa, Fac Hlth Sci, Porto, Portugal
Univ Western Australia, Perron Inst Neurol & Translat Sci, Nedlands, WA, Australia
Murdoch Univ, Australia Ctr Mol Med & Innovat Therapeut, Perth, WA, Australia
Murdoch Univ, Inst Immunol & Infect Dis, Perth, WA, Australia
Sir Charles Gairdner Hosp, Nedlands, WA, Australia
Univ Hosp Razi Manouba, Dept Neurol, Tunis, Tunisia
Univ Tunis El Manar, Fac Med Tunis, Tunis, Tunisia
Univ New South Wales UNSW, Ingham Inst, Immune Tolerance Lab, Sydney, NSW, Australia
Univ New South Wales UNSW, Dept Med, Sydney, NSW, Australia
Univ Hosp Ghent, Dept Neurol, Ghent, Belgium
Austin Hlth, Melbourne, Vic, Australia
Hosp Clin San Carlos, Dept Neurol, Madrid, Spain
hybrid, Green Published, Green Accepted
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