Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 May;45(5):2181-2189.
doi: 10.1007/s10072-023-07155-3. Epub 2023 Nov 17.

Correlates and trajectories of relapses in relapsing-remitting multiple sclerosis

Carolyn A Young  1 , David J Rog  2 , Basil Sharrack  3 , Radu Tanasescu  4 , Seema Kalra  5 , Timothy Harrower  6 , Alan Tennant  7 , Roger J Mills  8 ; Trajectories of Outcome in Neurological Conditions-MS Study Group
Collaborators, Affiliations

Correlates and trajectories of relapses in relapsing-remitting multiple sclerosis

Carolyn A Young et al. Neurol Sci. 2024 May.

Abstract

Background and aims: In people with relapsing-remitting multiple sclerosis (pwRRMS), data from studies on non-pharmacological factors which may influence relapse risk, other than age, are inconsistent. There is a reduced risk of relapses with increasing age, but little is known about other trajectories in real-world MS care.

Methods: We studied longitudinal questionnaire data from 3885 pwRRMS, covering smoking, comorbidities, disease-modifying therapy (DMT), and patient-reported outcome measures, as well as relapses during the past year. We undertook Rasch analysis, group-based trajectory modelling, and multilevel negative binomial regression.

Results: The regression cohort of 6285 data sets from pwRRMS over time showed that being a current smoker was associated with 43.9% greater relapse risk; having 3 or more comorbidities increased risk and increasing age reduced risk. Those diagnosed within the last 2 years showed two distinct trajectories, both reducing in relapse frequency but 25.8% started with a higher rate and took 4 years to reduce to the rate of the second group. In the cohort with at least three data points completed, there were three groups: 73.7% followed a low stable relapse rate, 21.6% started from a higher rate and decreased, and 4.7% had an increasing then decreasing pattern. These different trajectory groups showed significant differences in fatigue, neuropathic pain, disability, health status, quality of life, self-efficacy, and DMT use.

Conclusions: These results provide additional evidence for supporting pwRRMS to stop smoking and underline the importance of timely DMT decisions and treatment initiation soon after diagnosis with RRMS.

Keywords: Multiple sclerosis; Patient-reported outcome measure; Rasch; Relapse; Trajectories of Outcome in Neurological Conditions-MS.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Relapse trajectories for the inception cohort. n = 666. Fine dashed lines indicate 95% confidence limits
Fig. 2
Fig. 2
Relapse trajectories for trilogy cohort. n = 695. Fine dashed lines indicate 95% confidence limits
See this image and copyright information in PMC

References

    1. McDonald WI, Compston A, Edan G, Goodkin D, Hartung H-P, Lublin FD, McFarland HF, Paty DW, Polman CH, Reingold SC, Sandberg-Wollheim M, Sibley W, Thompson A, Van Den Noort S, Weinshenker BY, Wolinsky JS. Recommended diagnostic criteria for multiple sclerosis: guidelines from the international panel on the diagnosis of multiple sclerosis. Ann Neurol. 2001;50:121–127. doi: 10.1002/ana.1032. - DOI - PubMed
    1. Simbrich A, Thibaut J, Khil L, Berger K, Riedel O, Schmedt N. Drug-use patterns and severe adverse events with disease-modifying drugs in patients with multiple sclerosis: a cohort study based on German claims data. Neuropsychiatr Dis Treat. 2019;15:1439–1457. doi: 10.2147/ndt.S200930. - DOI - PMC - PubMed
    1. Nazareth TA, Rava AR, Polyakov JL, Banfe EN, Waltrip Ii RW, Zerkowski KB, Herbert LB. Relapse prevalence, symptoms, and health care engagement: patient insights from the multiple sclerosis in America 2017 survey. Mult Scler Relat Disord. 2018;26:219–234. doi: 10.1016/j.msard.2018.09.002. - DOI - PubMed
    1. Tremlett H, Zhao Y, Joseph J, Devonshire V. Relapses in multiple sclerosis are age- and time-dependent. J Neurol Neurosurg Psychiatry. 2008;79(12):1368–1374. doi: 10.1136/jnnp.2008.145805. - DOI - PubMed
    1. Miller DH. Biomarkers and surrogate outcomes in neurodegenerative disease: lessons from multiple sclerosis. NeuroRx: J Amer Soc Exp NeuroTher. 2004;1(2):284–294. doi: 10.1602/neurorx.1.2.284. - DOI - PMC - PubMed