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. 2017 Aug 7;17(1):151.
doi: 10.1186/s12883-017-0927-x.

Outcome of MS relapses in the era of disease-modifying therapy

Muriel Stoppe  1   2 , Maria Busch  1 , Luise Krizek  1 , Florian Then Bergh  3   4
Affiliations

Outcome of MS relapses in the era of disease-modifying therapy

Muriel Stoppe et al. BMC Neurol. .

Abstract

Background: In multiple sclerosis (MS), neurological disability results from incomplete remission of relapses and from relapse-independent progression. Intravenous high dose methylprednisolone (IVMP) is the established standard treatment to accelerate clinical relapse remission, although some patients do not respond. Most studies of relapse treatment have been performed when few patients received disease-modifying treatment and may no longer apply today.

Methods: We prospectively assessed, over one year, the course of patients who presented with a clinically isolated syndrome (CIS) or MS relapse, documenting demographic, clinical, treatment and outcome data. A standardized follow-up examination was performed 10-14 days after end of relapse treatment.

Results: We documented 119 relapses in 108 patients (31 CIS, 77 MS). 114 relapses were treated with IVMP resulting in full remission (29.2%), partial remission (38.7%), no change (18.2%) or worsening (4.4%). In 27 relapses (22.7%), escalating relapse treatment was indicated, and performed in 24, using double-dose IVMP (n = 18), plasmapheresis (n = 2) or immunoadsorption (n = 4).

Conclusions: Standardised follow-up visits and outcome documentation in treated relapses led to escalating relapse treatment in every fifth relapse. We recommend incorporating scheduled follow-up visits into routine relapse management. Our data facilitate the design of prospective trials addressing methods and timelines of relapse treatment.

Keywords: Immunoadsorption; Methylprednisolone; Multiple Sclerosis; Plasmapheresis; Prospective study; Relapse; Relapse management; Relapse outcome; Relapse treatment.

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Conflict of interest statement

Authors’ information

MS holds a position as a resident physician (neurologist) at the Department of Neurology, University of Leipzig. She has several years of clinical experience in neuroimmunological disorders, from both inpatient and outpatient perspective. Her research has focused on multiple sclerosis, where she has initiated her own clinical projects employing electrophysiological and other surrogate markers. She has served as an investigator in the German Competence Network Multiple Sclerosis (KKNMS) prospective cohort study, in an investigator-initiated trial funded by the German Federal Ministry of Education and Research (BMBF) and in several multicenter clinical trials in multiple sclerosis, neuromyelitis optica and myasthenia gravis (phases I-III).

FTB is a professor of Neurology at the Department of Neurology, University of Leipzig. He is an associated partner of the German Competence Network Multiple Sclerosis (KKNMS), serving on the biosamples board. He has initiated several clinical studies in multiple sclerosis, partly funded by the German Federal Ministry of Education and Research (BMBF), the Deutsche Forschungsgemeinschaft (DFG) or by industry. He has been co-investigator, principal investigator or (national and international) lead investigator of several phase I to III trials in multiple sclerosis, neuromyelitis optica and myasthenia gravis. He has received funding from the Deutsche Forschungsgemeinschaft (DFG) for laboratory research in the field of neural stem cells.

Ethics approval and consent to participate

Since this was a retrospective single-centre observational study using data collected during routine care, obtaining informed consent from the subjects was not required, in accordance to national guidelines and the applicable state law (Saxonian Hospital Act, §34). According to this local regulatory practice, specific approval from the institutional review board was not required and therefore not granted.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow chart of the patients and documented relapses. CIS = clinically isolated syndrome. IA = immunoadsorption. MP = methylprednisolone. PLEX = plasma exchange. RRMS = relapse-remitting multiple sclerosis. SMPS = secondary-progressive multiple sclerosis
Fig. 2
Fig. 2
Allocation and effects of therapies. For primary (left), escalating (center) and second escalating (right) relapse treatment, the solid bar indicates the number of patients with indication for relapse treatment, the grey-shaded bar indicates applied treatment type, and the hatched bar indicates the effect of treatment, assessed clinically 10–14 days after treatment conclusion; the percentages of treatment response is given to the right of the hatched bar. IA, immunoadsorption; MP, methylprednisolone i.v.; PLEX, plasma exchange
See this image and copyright information in PMC

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