Multiple sclerosis relapse incomplete recovery and associated factors - a systematic review and meta-analysis

Abstract

Objectives: We conducted a meta-analysis to assess the frequency of incomplete recovery from multiple sclerosis (MS) relapses and a systematic review to evaluate the influence of six factors on incomplete recovery: relapse severity, age, sex, disease duration, disease-modifying treatment use, and the presence of contrast-enhancing lesions at relapse.

Methods: We searched Scientific databases to identify suitable publications. Our outcome was MS relapse incomplete recovery, defined as a post-relapse EDSS measured at least 6 months after the event higher than the pre-relapse EDSS. We synthesized the rate of incomplete recovery using meta-analysis (random effect model). and summarized the effect estimates (or HR) for demographic and clinical factors.

Results: We included 13 studies (with a total of 19,920 patients and 27672 relapses having at least six month of follow up) . The pooled rate of incomplete recovery was 0.42 (95 % confidence interval 0.31 to 0.54). The subgroup systematic review identified that relapse severity was the most consistent and strongest predictor of incomplete recovery, with odds ratios ranging from 2.4 to 17.2. Other factors were less consistently associated with relapse recovery.

Conclusion: This systematic review indicates that relapse recovery is often incomplete, with relapse severity being the strongest and most consistent predictor of incomplete recovery.

Keywords: Disability; Multiple sclerosis; Relapse associated disability (RAW); Relapse recovery.