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

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 re...

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Bibliographic Details
Published in:	BMC neurology Vol. 17; no. 1; p. 151
Main Authors:	Stoppe, Muriel, Busch, Maria, Krizek, Luise, Then Bergh, Florian
Format:	Journal Article
Language:	English
Published:	England BioMed Central Ltd 07-08-2017 BioMed Central BMC
Subjects:	Adult Antirheumatic agents Apheresis Care and treatment Clinical outcomes Clinical trials Disease Progression Dosage and administration Drug therapy Female Follow-Up Studies Humans Interferon Intravenous administration Male Methylprednisolone Methylprednisolone - therapeutic use Multiple Sclerosis Multiple Sclerosis - drug therapy Neurological complications Neurology Patients Plasma Plasmapheresis Plasmapheresis - methods Prospective Studies Recurrence Relapse Relapse management Relapse outcome Relapse treatment Remission Risk factors Studies Treatment Outcome Multiple Sclerosis Relapse outcome Relapse treatment Relapse Immunoadsorption Relapse management Methylprednisolone Prospective study Plasmapheresis
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Summary:	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. 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. 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). 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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1471-2377 1471-2377
DOI:	10.1186/s12883-017-0927-x