Recovery from relapses an important factor to consider
Medical studies of people with multiple sclerosis typically look at the frequency and/or severity of relapses. A relapse is defined as new or worsening symptoms that persist for at least a day or two (and aren’t caused by an infection or heat exposure). These relapses typically reflect an inflammatory flare-up in the brain and provide some indication of how active MS is.
However, a factor that is often overlooked is relapse recovery – important not only as a window into MS but as something to consider when deciding on treatment.
Early in the disease process, people often have a full recovery from their relapse. Symptoms go away with no residual effects. “Full recovery”, as defined in a recent study, means that within a month after the relapse, the person’s level of disability goes back to what it was before the relapse occurred. Later in the course of disease, full recovery is less common, and the person is often left with residual problems. These problems typically become more severe or extensive as the number of relapses accumulates.
How well a person recovers from a relapse is largely a matter of how much tissue damage was caused by the relapse and how well the person is able to heal that damage. The disease-modifying therapies (DMTs) used in MS are meant to prevent inflammatory flare-ups or to limit the effects of a relapse. A person’s genetics likely determine how well a person heals after a relapse, but little is known about the healing process or why disability is worse in some people.
The issue of how relapse recovery affects long-term outcomes was recently examined in a study of people with early MS (Kantarci and colleagues. Neurol Neuroimmunol Neuroinflamm 2019;7:pii:e653). The researchers used data from the CHAMPS and CHAMPIONS trials, which looked at the use of Avonex over a 10-year period in 328 people with early MS. What the researchers wanted to know was if two key factors – relapse recovery and early treatment – can affect long-term disability.
They found that people who with good relapse recovery who immediately started treatment with a DMT had a 65% chance of having minimal disability by age 45. People who either had good relapse recovery or started treatment right away had a 50% chance of minimal disability. The people who were worse off were those with poor relapse recovery and who didn’t start treatment right away: they had only a 20% chance of minimal disability by age 45. These results likely overestimate the benefits of early treatment since most people dropped out of the study in the first five years. However, it’s also important to note that this study looked at Avonex, and people with a disabling relapse would be likely to receive a DMT that might be more effective in slowing disability.
The researchers concluded that a person’s relapse recovery should be considered when making treatment decisions. It’s especially important to start treatment if the person doesn’t fully recover from a relapse. This general principle may also apply to people with poor relapse recovery while on treatment – it may be a sign that a more effective therapy is needed.
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