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Contribution of different relapse phenotypes to disability in multiple sclerosis


Stewart, T and Spelman, T and Havrdova, E and Horakova, D and Trojano, M and Izquierdo, G and Duquette, P and Girard, M and Prat, A and Lugaresi, A and Grand'Maison, F and Grammond, P and Sola, P and Shaygannejad, V and Hupperts, R and Alroughani, R and Oreja-Guevara, C and Pucci, E and Boz, C and Lechner-Scott, J and Bergamaschi, R and Van Pesch, V and Iuliano, G and Ramo, C and Taylor, B and Slee, M and Spitaleri, D and Granella, F and Verheul, F and McCombe, P and Hodgkinson, S and Amato, MP and Vucic, S and Gray, O and Cristiano, E and Barnett, M and Sanchez Menoyo, JL and van Munster, E and Saladino, ML and Olascoaga, J and Prevost, J and Deri, N and Shaw, C and Singhal, B and Moore, F and Rozsa, C and Shuey, N and Skibina, O and Kister, I and Petkovska-Boskova, T and Ampapa, R and Kermode, A and Butzkueven, H and Jokubaitis, V and Kalincik, T, on behalf of the MSBase Study Group, Contribution of different relapse phenotypes to disability in multiple sclerosis, Multiple Sclerosis Journal, 23, (2) pp. 266-276. ISSN 1352-4585 (2017) [Refereed Article]

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Copyright 2016 the Author

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DOI: doi:10.1177/1352458516643392


OBJECTIVE: This study evaluated the effect of relapse phenotype on disability accumulation in multiple sclerosis.

METHODS: Analysis of prospectively collected data was conducted in 19,504 patients with relapse-onset multiple sclerosis and minimum 1-year prospective follow-up from the MSBase cohort study. Multivariable linear regression models assessed associations between relapse incidence, phenotype and changes in disability (quantified with Expanded Disability Status Scale and its Functional System scores). Sensitivity analyses were conducted.

RESULTS: In 34,858 relapses recorded during 136,462 patient-years (median follow-up 5.9 years), higher relapse incidence was associated with greater disability accumulation (β = 0.16, p < 0.001). Relapses of all phenotypes promoted disability accumulation, with the most pronounced increase associated with pyramidal (β = 0.27 (0.25-0.29)), cerebellar (β = 0.35 (0.30-0.39)) and bowel/bladder (β = 0.42 (0.35-0.49)) phenotypes (mean (95% confidence interval)). Higher incidence of each relapse phenotype was associated with an increase in disability in the corresponding neurological domain, as well as anatomically related domains.

CONCLUSION: Relapses are associated with accumulation of neurological disability. Relapses in pyramidal, cerebellar and bowel/bladder systems have the greatest association with disability change. Therefore, prevention of these relapses is an important objective of disease-modifying therapy. The differential impact of relapse phenotypes on disability outcomes could influence management of treatment failure in multiple sclerosis.

Item Details

Item Type:Refereed Article
Keywords:Prognosis, cohort studies, multiple sclerosis, observational study, outcome research, relapse phenotype
Research Division:Biomedical and Clinical Sciences
Research Group:Neurosciences
Research Field:Central nervous system
Objective Division:Health
Objective Group:Clinical health
Objective Field:Clinical health not elsewhere classified
UTAS Author:Taylor, B (Professor Bruce Taylor)
ID Code:108522
Year Published:2017 (online first 2016)
Web of Science® Times Cited:23
Deposited By:Menzies Institute for Medical Research
Deposited On:2016-04-21
Last Modified:2017-11-06

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