Relapses and disability accumulation in progressive multiple sclerosis

M. Mateo Paz Soldán, Martina Novotna, Nuhad Abou Zeid, Nilufer Kale, Melih Tutuncu, Daniel J. Crusan, Elizabeth J. Atkinson, Aksel Siva, B. Mark Keegan, Istvan Pirko, Sean J. Pittock, Claudia F. Lucchinetti, Brian G. Weinshenker, Moses Rodriguez, Orhun H. Kantarci

Research output: Contribution to journalArticle

51 Scopus citations

Abstract

Objective: We examined the effect of relapses-before and after progression onset-on the rate of postprogression disability accrual in a progressive multiple sclerosis (MS) cohort. Methods: We studied patients with primary progressive MS (n = 322) and bout-onset progressive MS (BOPMS) including single-attack progressive MS (n = 112) and secondary progressive MS (n = 421). The effect of relapses on time to Expanded Disability Status Scale (EDSS) score of 6 was studied using multivariate Cox regression analysis (sex, age at progression, and immunomodulation modeled as covariates). Kaplan-Meier analysis was performed using EDSS 6 as endpoint. Results: Preprogression relapses (hazard ratio [HR]: 1.63; 95% confidence interval [CI]: 1.34- 1.98), postprogression relapses (HR: 1.37; 95% CI: 1.11-1.70), female sex (HR: 1.19; 95% CI: 1.00-1.43), and progression onset after age 50 years (HR: 1.47; 95% CI: 1.21-1.78) were associated with shorter time to EDSS 6. Postprogression relapses occurred in 29.5% of secondary progressive MS, 10.7% of single-attack progressive MS, and 3.1% of primary progressive MS. Most occurred within 5 years (91.6%) after progressive disease onset and/or before age 55 (95.2%). Immunomodulation after onset of progressive disease course (HR: 0.64; 95% CI: 0.52-0.78) seemingly lengthened time to EDSS 6 (for BOPMS with ongoing relapses) when analyzed as a dichotomous variable, but not as a time-dependent variable. Conclusions: Pre- and postprogression relapses accelerate time to severe disability in progressive MS. Continuing immunomodulation for 5 years after the onset of progressive disease or until 55 years of age may be reasonable to consider in patients with BOPMS who have ongoing relapses.

Original languageEnglish (US)
Pages (from-to)81-88
Number of pages8
JournalNeurology
Volume84
Issue number1
DOIs
StatePublished - 2015

ASJC Scopus subject areas

  • Clinical Neurology

Fingerprint Dive into the research topics of 'Relapses and disability accumulation in progressive multiple sclerosis'. Together they form a unique fingerprint.

  • Cite this

    Soldán, M. M. P., Novotna, M., Zeid, N. A., Kale, N., Tutuncu, M., Crusan, D. J., Atkinson, E. J., Siva, A., Keegan, B. M., Pirko, I., Pittock, S. J., Lucchinetti, C. F., Weinshenker, B. G., Rodriguez, M., & Kantarci, O. H. (2015). Relapses and disability accumulation in progressive multiple sclerosis. Neurology, 84(1), 81-88. https://doi.org/10.1212/WNL.0000000000001094