VANCOUVER, British Columbia — Regardless of whether the disease was in the progressive phase or not, patients with multiple sclerosis (MS) were likely to experience relapses for the first time or relapse continuation between the ages of 27 and 47 years.
“These age limits can be utilized to guide [the] decision to initiate or continue disease-modifying treatments after progressive MS onset,” Martina Novotna, MD, of the Mayo Clinic in Rochester, Minnesota, and fellow researchers wrote in an abstract presented at the 2016 annual meeting of the American Academy of Neurology (AAN).
Dr Novotna and colleagues noted that relapses may continue after the onset of the progressive phase in 14% of patients with MS, and that even in patients with primary progressive MS, postprogression relapses can occur.
“Since ongoing relapses add to the disability burden of progressive MS patients, disease-modifying treatments can be continued or initiated during the overlapping period,” they wrote.
The researchers conducted the present study examining the overlapping period in late relapsing-remitting and early progressive phase of MS with the goal of guiding disease-modifying treatment initiation or discontinuation decisions.
The study included 964 patients from clinic- and population-based MS cohorts who were evaluated for age at first relapse, age at progressive MS onset, and age at last relapse (before or after progressive MS onset). Researchers determined the overlapping age range for relapsing-remitting and progressive phases of MS, along with the absolute lifetime risk of relapses after progressive MS onset.
Median ages were as follows: at first relapse, 32.6 years; at progressive MS onset, 45.9 years; and at last relapse, 42 years.
Results indicated that the overlap age range was 27 to 47 years.
In additional analysis, patients were grouped according to age at progressive MS onset based on mean ± standard deviation of 45.4 ± 9.5 into 55 years. The absolute lifetime risk for relapse after progressive MS onset was 18%, 17%, 13%, and 5%, respectively, with the last expected relapse for these groups occurring at ages 50, 65, 70, and 70 years, respectively.
“Overall, there is a notable chance of relapses to occur the first time or continue in patients between ages 27 [and] 47, regardless of being in the progressive phase of MS: absolute lifelong risk of further relapses, which is 18% before age 35, drops to 5% after 55,” Dr Novotna and colleagues concluded.
Novotna M, Conway B, Zeydan B, et al. Predicting the end of symptomatic relapses and disease modifying treatment use decisions in progressive multiple sclerosis. Presented at: The 68th Annual Meeting of the American Academy of Neurology; April 15-21, 2016; Vancouver, British Columbia, Canada. Abstract S24.001.