Age, Number of Relapses Predict Increasing Disability in Multiple Sclerosis

girl sitting on scanner bed
girl sitting on scanner bed
Investigators examine identifiers to predict disability in patients with relapsing-onset multiple sclerosis.

For patients with relapsing multiple sclerosis (MS), age and the number of relapses can predict the risk for increasing disability, according to results published in the Multiple Sclerosis Journal.

A high number of relapses among patients with disease activity adds to the risk for increasing disability, and age >45 years can amplify the risk for increasing disability even without disease activity.

The study included participants with relapsing MS, Expanded Disability Status Scale (EDSS) score of 3.0 to 4.0, and follow-up of ≥2 years. The researchers analyzed demographic, clinical, and MRI data for each participant. They defined increasing disability as achieving an EDSS of 6.0, and they defined relapses and/or MRI results as disease activity.

Of 542 participants, 63.5% (n=344) reached EDSS ≥6.0; 64.0% (n=220) of these participants also had disease activity.

Of the participants with disease activity, the number of relapses before reaching EDSS 3.0 to 4.0 was associated with increasing disability (hazard ratio 1.53; P =.009). Without disease activity, participants who were age >45 years at baseline had an added risk for increasing disability (hazard ratio 1.65; P =.04). When the researchers combined age and number of relapses, they found a further increased risk for EDSS score of 6.0 and a shorter duration of time to EDSS score of 6.0.

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“Quantifying the individual risk of disability attainment and describing the profile of clinical worsening can aid the development of personalized approaches to MS treatment,” the researchers wrote.


Tomassini V, Fanelli F, Prosperini L Cerqua R, Cavalla P, Pozzilli C. Predicting the profile of increasing disability in multiple sclerosis [published online August 3, 2018]. Mult Scler. doi:10.1177/1352458518790397