MS Speaks

[S34.006] Early Relapse-Recovery Impacts Progressive Disease Course In Multiple Sclerosis

Martina Novotna,1Melih Tutuncu,2M. Paz Soldan,1Daniel Crusan,1Elizabeth Atkinson,1Orhun Kantarci1

1Rochester, MN, USA, 2Istanbul, Turkey

OBJECTIVE:

To evaluate the relationship between early relapse-recovery and onset of progressive multiple sclerosis.

BACKGROUND:

Frequency of early (within 5 years of MS onset) relapses correlates with poor prognosis in MS. Recovery from individual relapses inversely correlates with cumulative relapse-related disability. RRMS or CIS patients often develop secondary progression (bout-onset progressive MS - BOPMS). Poor relapse-recovery may also be associated with an earlier onset of progressive MS.

DESIGN/METHODS:

We studied a population-based MS cohort from Olmsted County MN (101 RRMS; 83 BOPMS), followed for ≥20 years. Early relapses were averaged for extent and duration of maximum recovery. Maximum recovery to baseline was assigned as ≥75 % vs 25-75% vs <25% based on patient reported and examination confirmed outcomes in the following year. Time to maximum recovery was grouped as <3 months vs ≥3 months based on patient reported outcome in the following clinical evaluations (not all patients were seen exactly at that time point). Time from fifth year of RRMS onset to progressive MS onset was studied using survival analyses, due to censoring (death or lost to follow-up).

RESULTS:

Early relapses recovered ≥75% in 143 patients (59% RRMS; 41% BOPMS) and <75% in 41 patients (39% RRMS; 61% BOPMS) (p=0.021). Early relapse-recovery was within 3 months in 169 patients (57% RRMS; 43%BOPMS) and ≥3 months in 15 patients (33% RRMS; 67% BOPMS) (p=0.08). Of 83 BOPMS patients 8 had the worst recovery metric (<25% and ≥3 months) while none of the RRMS patients had the worst recovery metric (p=0.001). Half of ≥75% recoverers developed progressive MS by 33 years while half of <75% recoverers developed progressive MS by 13 years (p=0.002).

CONCLUSIONS:

Patients with limited recovery in the first five year relapses will develop progressive MS more likely and earlier in the disease course than those with better recovery.

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Study Supported by:

Mayo Clinic Department of Neurology Internal Funds & The European Regional Development Fund - Project FNUSA-ICRC (No. CZ.1.05/1.1.00/02.0123).

Category - MS and CNS Inflammatory Disease: Clinical Science



S34: Platform Blitz: MS and CNS Inflammatory Disease: Risk Factors for Multiple Sclerosis Disease and Course