Correlates and trajectories of relapses in relapsing–remitting multiple sclerosis
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Published:2023-11-17
Issue:
Volume:
Page:
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ISSN:1590-1874
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Container-title:Neurological Sciences
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language:en
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Short-container-title:Neurol Sci
Author:
Young Carolyn A.ORCID, Rog David J., Sharrack Basil, Tanasescu Radu, Kalra Seema, Harrower Timothy, Tennant Alan, Mills Roger J., Young Carolyn, Rog David, Sharrack Basil, Constantinescu Cris, Kalra Seema, Majeed Tahir, Santander Helen, Harrower Tim, Leach Oliver, Nicholas Richard, Ford Helen, Woolmore John, Kipps Chris, Johnston Clare, Thorpe John, Paling David, Falah Yasser, Ellis Cathy, Pinto Ashwin, Hanemann C. Oliver, Chandran Siddharthan, Malaspina Andrea, Kitley Jo, Palace Jacqueline, Fuller Tracy, Mottram Pat, Terrett Helen, Scalfari Antonio,
Abstract
Abstract
Background and aims
In people with relapsing–remitting multiple sclerosis (pwRRMS), data from studies on non-pharmacological factors which may influence relapse risk, other than age, are inconsistent. There is a reduced risk of relapses with increasing age, but little is known about other trajectories in real-world MS care.
Methods
We studied longitudinal questionnaire data from 3885 pwRRMS, covering smoking, comorbidities, disease-modifying therapy (DMT), and patient-reported outcome measures, as well as relapses during the past year. We undertook Rasch analysis, group-based trajectory modelling, and multilevel negative binomial regression.
Results
The regression cohort of 6285 data sets from pwRRMS over time showed that being a current smoker was associated with 43.9% greater relapse risk; having 3 or more comorbidities increased risk and increasing age reduced risk. Those diagnosed within the last 2 years showed two distinct trajectories, both reducing in relapse frequency but 25.8% started with a higher rate and took 4 years to reduce to the rate of the second group. In the cohort with at least three data points completed, there were three groups: 73.7% followed a low stable relapse rate, 21.6% started from a higher rate and decreased, and 4.7% had an increasing then decreasing pattern. These different trajectory groups showed significant differences in fatigue, neuropathic pain, disability, health status, quality of life, self-efficacy, and DMT use.
Conclusions
These results provide additional evidence for supporting pwRRMS to stop smoking and underline the importance of timely DMT decisions and treatment initiation soon after diagnosis with RRMS.
Funder
Multiple Sclerosis Society
Publisher
Springer Science and Business Media LLC
Subject
Psychiatry and Mental health,Neurology (clinical),Dermatology,General Medicine
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