The Evolution of a Multiple Sclerosis Relapse: Analysis of Clinical & Patient-reported Outcome Measures
Justin Abbatemarco1, Carol Swetlik2, Daniel Ontaneda2, Robert Bermel2, Sarah Planchon Pope2, Scott Husak2, Brittany Lapin2, Li Yadi2, Deborah Miller1
1Cleveland Clinic Foundation, 2Cleveland Clinic
Objective:
To investigate changes in functional and patient-reported outcome measures (PROMs) following a multiple sclerosis (MS) relapse.
Background:
Improved understanding of the recovery process after a relapse may guide interventions to promote recovery and limit the sequalae of an incomplete recovery
Design/Methods:
This retrospective study identified MS patients with a provider-reported relapse from May 2016 - June 2022. Baseline characteristics were defined 12 months prior to the relapse and compared at 12-month post-relapse. Controls were MS patients without a relapse and had follow-up data available over 24 months. Changes in Quality of Life in Neurological Disorders Questionnaire (Neuro-QoL) and MS Performance Test (MSPT) measures were compared between the relapsing and non-relapsing cohort using multivariable linear regression models adjusted for age, sex, race, disease modifying use, MS phenotype, and Patient Determined Disease Steps (PDDS). Acute treatment information was not available.
Results:
1617 MS patients were included: 180 (11.1%) in the relapsing cohort (age 42.2 ± 10.8, 78.3% female, 80.6% white, baseline PDDS 1.0 [0.0, 3.0]) compared to 1,437 (88.9%) in the non-relapsing cohort (age 49.8 ± 12.5, 71.6% female, 83.9% white, baseline PDDS 2.0 [0.0, 4.0]). A total of 56 (32.2%) in the relapsing cohort had at least a 1-point increase in PDDS compared to 341 (24.2%) in the non-relapsing cohort (p = 0.02) at follow-up. After adjustment, the relapsing cohort had a clinically significant decline in Neuro-QoL (≥ 5 T-score change) on all functional and symptomatic domains except positive affect compared to the non-relapsing cohort. There was no difference between the two groups in MSPT including manual dexterity, processing speed, and walking speed tests (p > 0.05).
Conclusions:
MS patients with a recent relapse demonstrate similar performance outcomes but poorer PROMs compared to those without relapse. These findings highlight the range of symptoms that are impacted following a relapse.