Evidence map›Paper›PMID 38870471›Full record

ArticleNeurology2024

Association of Clinical Relapses With Disease Outcomes in Multiple Sclerosis Patients Older Than 50 Years.

Steffen Pfeuffer, Stephanie Wolff, Derya Aslan, Leoni Rolfes, Melanie Korsen, Marc Pawlitzki, Philipp Albrecht, Joachim Havla, Hagen B Huttner, Christoph Kleinschnitz and 3 more

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Article in Neurology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Steffen PfeufferFrom the Department of Neurology (S.P., S.W., H.B.H.), University Hospital Giessen, Justus-Liebig-University Giessen; Department of Neurology (D.A., C.K., R.P.), University Hospital Essen, University Duisburg-Essen; Department of Neurology (L.R., M.K., M.P., S.G.M., T.R.), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurology (P.A.), Medical Faculty, Heinrich Department of Neurology, Maria-Hilf-Clinic, Mönchengladbach; and Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig-Maximilians University Munich, Germany.ORCID 0000-0001-5171-4845
Stephanie WolffFrom the Department of Neurology (S.P., S.W., H.B.H.), University Hospital Giessen, Justus-Liebig-University Giessen; Department of Neurology (D.A., C.K., R.P.), University Hospital Essen, University Duisburg-Essen; Department of Neurology (L.R., M.K., M.P., S.G.M., T.R.), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurology (P.A.), Medical Faculty, Heinrich Department of Neurology, Maria-Hilf-Clinic, Mönchengladbach; and Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig-Maximilians University Munich, Germany.
Derya AslanFrom the Department of Neurology (S.P., S.W., H.B.H.), University Hospital Giessen, Justus-Liebig-University Giessen; Department of Neurology (D.A., C.K., R.P.), University Hospital Essen, University Duisburg-Essen; Department of Neurology (L.R., M.K., M.P., S.G.M., T.R.), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurology (P.A.), Medical Faculty, Heinrich Department of Neurology, Maria-Hilf-Clinic, Mönchengladbach; and Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig-Maximilians University Munich, Germany.
Leoni RolfesFrom the Department of Neurology (S.P., S.W., H.B.H.), University Hospital Giessen, Justus-Liebig-University Giessen; Department of Neurology (D.A., C.K., R.P.), University Hospital Essen, University Duisburg-Essen; Department of Neurology (L.R., M.K., M.P., S.G.M., T.R.), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurology (P.A.), Medical Faculty, Heinrich Department of Neurology, Maria-Hilf-Clinic, Mönchengladbach; and Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig-Maximilians University Munich, Germany.
Melanie KorsenFrom the Department of Neurology (S.P., S.W., H.B.H.), University Hospital Giessen, Justus-Liebig-University Giessen; Department of Neurology (D.A., C.K., R.P.), University Hospital Essen, University Duisburg-Essen; Department of Neurology (L.R., M.K., M.P., S.G.M., T.R.), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurology (P.A.), Medical Faculty, Heinrich Department of Neurology, Maria-Hilf-Clinic, Mönchengladbach; and Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig-Maximilians University Munich, Germany.
Marc PawlitzkiFrom the Department of Neurology (S.P., S.W., H.B.H.), University Hospital Giessen, Justus-Liebig-University Giessen; Department of Neurology (D.A., C.K., R.P.), University Hospital Essen, University Duisburg-Essen; Department of Neurology (L.R., M.K., M.P., S.G.M., T.R.), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurology (P.A.), Medical Faculty, Heinrich Department of Neurology, Maria-Hilf-Clinic, Mönchengladbach; and Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig-Maximilians University Munich, Germany.ORCID 0000-0003-3080-2277
Philipp AlbrechtFrom the Department of Neurology (S.P., S.W., H.B.H.), University Hospital Giessen, Justus-Liebig-University Giessen; Department of Neurology (D.A., C.K., R.P.), University Hospital Essen, University Duisburg-Essen; Department of Neurology (L.R., M.K., M.P., S.G.M., T.R.), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurology (P.A.), Medical Faculty, Heinrich Department of Neurology, Maria-Hilf-Clinic, Mönchengladbach; and Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig-Maximilians University Munich, Germany.ORCID 0000-0001-7987-658X
Joachim HavlaFrom the Department of Neurology (S.P., S.W., H.B.H.), University Hospital Giessen, Justus-Liebig-University Giessen; Department of Neurology (D.A., C.K., R.P.), University Hospital Essen, University Duisburg-Essen; Department of Neurology (L.R., M.K., M.P., S.G.M., T.R.), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurology (P.A.), Medical Faculty, Heinrich Department of Neurology, Maria-Hilf-Clinic, Mönchengladbach; and Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig-Maximilians University Munich, Germany.ORCID 0000-0002-4386-1340
Hagen B HuttnerFrom the Department of Neurology (S.P., S.W., H.B.H.), University Hospital Giessen, Justus-Liebig-University Giessen; Department of Neurology (D.A., C.K., R.P.), University Hospital Essen, University Duisburg-Essen; Department of Neurology (L.R., M.K., M.P., S.G.M., T.R.), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurology (P.A.), Medical Faculty, Heinrich Department of Neurology, Maria-Hilf-Clinic, Mönchengladbach; and Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig-Maximilians University Munich, Germany.
Christoph KleinschnitzFrom the Department of Neurology (S.P., S.W., H.B.H.), University Hospital Giessen, Justus-Liebig-University Giessen; Department of Neurology (D.A., C.K., R.P.), University Hospital Essen, University Duisburg-Essen; Department of Neurology (L.R., M.K., M.P., S.G.M., T.R.), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurology (P.A.), Medical Faculty, Heinrich Department of Neurology, Maria-Hilf-Clinic, Mönchengladbach; and Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig-Maximilians University Munich, Germany.ORCID 0000-0002-1650-8875
Sven G MeuthFrom the Department of Neurology (S.P., S.W., H.B.H.), University Hospital Giessen, Justus-Liebig-University Giessen; Department of Neurology (D.A., C.K., R.P.), University Hospital Essen, University Duisburg-Essen; Department of Neurology (L.R., M.K., M.P., S.G.M., T.R.), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurology (P.A.), Medical Faculty, Heinrich Department of Neurology, Maria-Hilf-Clinic, Mönchengladbach; and Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig-Maximilians University Munich, Germany.ORCID 0000-0003-2571-3501
Refik PulFrom the Department of Neurology (S.P., S.W., H.B.H.), University Hospital Giessen, Justus-Liebig-University Giessen; Department of Neurology (D.A., C.K., R.P.), University Hospital Essen, University Duisburg-Essen; Department of Neurology (L.R., M.K., M.P., S.G.M., T.R.), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurology (P.A.), Medical Faculty, Heinrich Department of Neurology, Maria-Hilf-Clinic, Mönchengladbach; and Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig-Maximilians University Munich, Germany.
Tobias RuckFrom the Department of Neurology (S.P., S.W., H.B.H.), University Hospital Giessen, Justus-Liebig-University Giessen; Department of Neurology (D.A., C.K., R.P.), University Hospital Essen, University Duisburg-Essen; Department of Neurology (L.R., M.K., M.P., S.G.M., T.R.), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurology (P.A.), Medical Faculty, Heinrich Department of Neurology, Maria-Hilf-Clinic, Mönchengladbach; and Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig-Maximilians University Munich, Germany.ORCID 0000-0001-6332-8650

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

BACKGROUND AND

objectivesRelapse and MRI activity usually decline with aging but are replaced by progression independent of relapse activity (PIRA) in patients with multiple sclerosis (PwMS). However, several older PwMS continue to experience clinical relapses, and the impact on their disease remains undetermined. We aimed to determine the impact of an index relapse on disease outcomes in patients older than 50 years and to identify risk factors of disadvantageous outcomes.

methodsWe performed a secondary analysis from 3 prospective cohorts in Germany. We evaluated all PwMS 50 years and older with a relapse ≤60 days before a baseline visit and at least 18 months of follow-up compared with a control cohort of PwMS without a relapse. Patients were stratified according to age ("50-54" vs "55-59" vs "60+") or disease outcomes ("stable" vs "active" vs "progressive," according to the Lublin criteria). We analyzed relapses, MRI activity, relapse-associated worsening, and PIRA. Regression analysis was performed to evaluate the association of specific baseline risk factors and treatment regimen changes with disease outcomes at month 18.

resultsA total of 681 patients were included in the "relapse cohort" (50+: 361; 55+: 220; 60+: 100). The "control cohort" comprised 232 patients (50+: 117; 55+: 71; 60+: 44). Baseline epidemiologic parameters were balanced among cohorts and subgroups. We observed increased abundance of inflammatory activity and relapse-independent disability progression in the "relapse" vs "control" cohort. In the "relapse" cohort, we identified 273 patients as "stable" (59.7%), 114 patients as "active" (24.9%), and 70 patients as "progressive" (15.3%) during follow-up. Cardiovascular risk factors (CVRFs) and older age at baseline were identified as risk factors of progressive, whereas disease-modifying treatment (DMT) administration at baseline favored stable disease. DMT during follow-up was associated with stable over active, but not over progressive disease. DISCUSSION: A relapse-suggesting underlying active disease-in PwMS older than 50 years was associated with continued disease activity and increased risk of PIRA. Presence of CVRF and absence of DMT at baseline appeared as risk factors of disadvantageous disease courses. An escalation of DMT switch was associated with stable over active but not progressive disease.

Indexed as

Disease ProgressionRecurrenceAgedAge FactorsCohort StudiesFemaleGermanyHumansMagnetic Resonance ImagingMaleMiddle AgedMultiple SclerosisMultiple Sclerosis, Relapsing-RemittingProspective StudiesRisk Factors

Identifiers

PMID38870471
PMCPMC11244741

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