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Outcome of MS relapses in the era of disease-modifying therapy
BACKGROUND: In multiple sclerosis (MS), neurological disability results from incomplete remission of relapses and from relapse-independent progression. Intravenous high dose methylprednisolone (IVMP) is the established standard treatment to accelerate clinical relapse remission, although some patien...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5547454/ https://www.ncbi.nlm.nih.gov/pubmed/28784102 http://dx.doi.org/10.1186/s12883-017-0927-x |
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author | Stoppe, Muriel Busch, Maria Krizek, Luise Then Bergh, Florian |
author_facet | Stoppe, Muriel Busch, Maria Krizek, Luise Then Bergh, Florian |
author_sort | Stoppe, Muriel |
collection | PubMed |
description | BACKGROUND: In multiple sclerosis (MS), neurological disability results from incomplete remission of relapses and from relapse-independent progression. Intravenous high dose methylprednisolone (IVMP) is the established standard treatment to accelerate clinical relapse remission, although some patients do not respond. Most studies of relapse treatment have been performed when few patients received disease-modifying treatment and may no longer apply today. METHODS: We prospectively assessed, over one year, the course of patients who presented with a clinically isolated syndrome (CIS) or MS relapse, documenting demographic, clinical, treatment and outcome data. A standardized follow-up examination was performed 10–14 days after end of relapse treatment. RESULTS: We documented 119 relapses in 108 patients (31 CIS, 77 MS). 114 relapses were treated with IVMP resulting in full remission (29.2%), partial remission (38.7%), no change (18.2%) or worsening (4.4%). In 27 relapses (22.7%), escalating relapse treatment was indicated, and performed in 24, using double-dose IVMP (n = 18), plasmapheresis (n = 2) or immunoadsorption (n = 4). CONCLUSIONS: Standardised follow-up visits and outcome documentation in treated relapses led to escalating relapse treatment in every fifth relapse. We recommend incorporating scheduled follow-up visits into routine relapse management. Our data facilitate the design of prospective trials addressing methods and timelines of relapse treatment. |
format | Online Article Text |
id | pubmed-5547454 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-55474542017-08-09 Outcome of MS relapses in the era of disease-modifying therapy Stoppe, Muriel Busch, Maria Krizek, Luise Then Bergh, Florian BMC Neurol Research Article BACKGROUND: In multiple sclerosis (MS), neurological disability results from incomplete remission of relapses and from relapse-independent progression. Intravenous high dose methylprednisolone (IVMP) is the established standard treatment to accelerate clinical relapse remission, although some patients do not respond. Most studies of relapse treatment have been performed when few patients received disease-modifying treatment and may no longer apply today. METHODS: We prospectively assessed, over one year, the course of patients who presented with a clinically isolated syndrome (CIS) or MS relapse, documenting demographic, clinical, treatment and outcome data. A standardized follow-up examination was performed 10–14 days after end of relapse treatment. RESULTS: We documented 119 relapses in 108 patients (31 CIS, 77 MS). 114 relapses were treated with IVMP resulting in full remission (29.2%), partial remission (38.7%), no change (18.2%) or worsening (4.4%). In 27 relapses (22.7%), escalating relapse treatment was indicated, and performed in 24, using double-dose IVMP (n = 18), plasmapheresis (n = 2) or immunoadsorption (n = 4). CONCLUSIONS: Standardised follow-up visits and outcome documentation in treated relapses led to escalating relapse treatment in every fifth relapse. We recommend incorporating scheduled follow-up visits into routine relapse management. Our data facilitate the design of prospective trials addressing methods and timelines of relapse treatment. BioMed Central 2017-08-07 /pmc/articles/PMC5547454/ /pubmed/28784102 http://dx.doi.org/10.1186/s12883-017-0927-x Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Stoppe, Muriel Busch, Maria Krizek, Luise Then Bergh, Florian Outcome of MS relapses in the era of disease-modifying therapy |
title | Outcome of MS relapses in the era of disease-modifying therapy |
title_full | Outcome of MS relapses in the era of disease-modifying therapy |
title_fullStr | Outcome of MS relapses in the era of disease-modifying therapy |
title_full_unstemmed | Outcome of MS relapses in the era of disease-modifying therapy |
title_short | Outcome of MS relapses in the era of disease-modifying therapy |
title_sort | outcome of ms relapses in the era of disease-modifying therapy |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5547454/ https://www.ncbi.nlm.nih.gov/pubmed/28784102 http://dx.doi.org/10.1186/s12883-017-0927-x |
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