Relapses in patients with secondary progressive MS: a matter of disease duration or age?
ECTRIMS Online Library. Ahrweiller K. 10/27/17; 202556; 198
Kévin Ahrweiller
Kévin Ahrweiller

Abstract: 198

Type: Oral

Abstract Category: Clinical aspects of MS - 4 Natural course

Background: Studies describing the evolution of focal inflammation during the secondary progressive (SP) phase of multiple sclerosis (MS) are rare, but crucial for exploring potential disease-modifying treatments (DMT) for this phenotype. Our objectives were to i) describe relapses in an SPMS population during long-term follow-up, and ii) identify predictive factors for relapse occurrence during the SP phase of the disease.
Methods: We studied 506 patients with SPMS who had been included in the Rennes EDMUS database. The inclusion criteria were i) SP phenotype for at least 3 years, and ii) regular follow-up at Rennes University Hospital. Relapse occurrence during the SPMS phase was studied using Kaplan-Meier survival analysis. Factors associated with relapse were examined (age, disease duration, sex, disability scored on the EDSS). Annualized relapse rates (ARRs) were also calculated according to the patient's current age, disease duration, and phase of the disease. Analyses were repeated, excluding data on DMT.
Results: Mean follow-up duration was 24.4 ± 10.2 years from MS onset and 14.3 ± 7.3 years from SP onset. The proportion of time spent on a DMT during the SP phase was 31%. Out of 506 patients, 177 (35%) experienced at least one relapse during the SP phase. The probability of having at least one relapse following SP onset was 24% at 5 years and 34% at 10 years. The risk of relapse in the SP phase decreased with both disease duration (hazard ratio, HR = 0.85 [0.76; 0.96]) and age (HR = 0.84 [0.77; 0.92]). In the multivariate analysis, current age was the only significant parameter. ARRs were 0.11 for age 30‑40 years, 0.06 for 40‑50 years, 0.04 for 50‑60 years, and 0.01 after 60 years. The direction of findings did not differ when ARRs were calculated after removing DMT data.
Conclusion: Relapse occurrence decreases with patient age during the SP phase. Any therapy aimed at reducing focal inflammation would therefore be most justified in younger patients with SPMS.
Kevin Ahrweiller has nothing to disclose.
Dr Rousseau has nothing to disclose.
Dr Leray reports personal fees as speaker or consultant from Novartis and Sanofi Genzyme, and travel grants from Novartis and Roche SAS. Outside of the submitted work, other sources of funding in the past year included the French National Security Agency of Medicines and Health Products, the French ARSEP Foundation, the EDMUS Foundation, and donation from Roche SAS.
Dr Le Page reports honorarium as speaker or consultant from Biogen Idec, Sanofi Genzyme, Merck Serono, Novartis, Teva and Roche, and grants from the Programme Hospitalier de Recherche Clinique (PHRC), from La Ligue française contre la SEP, l'ARSEP and Teva, all outside the submitted work.
Dr Bajeux has nothing to disclose.
Dr Edan reports personal fees from Sanofi, and personal fees and grants from Bayer, Merck Serono, Teva Pharma, Biogenidec, and Novartis, all outside the submitted work.
Dr. Kerbrat reports personal fees and travels grants from Sanofi, Merck Serono, Teva Pharma, Biogenidec, Novartis and Roche all outside the submitted work.

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