Identifying Predictors of Worsening Disease Activity in Patients With Relapsing-Remitting Multiple Sclerosis

Younger age and baseline relapses were among several predictors of worsening disease activity in patients with relapsing-remitting multiple sclerosis (MS). Researchers published their findings in Neurology Clinical Practice.

“Disease course in MS is highly variable, and predicting disease activity would improve patient care through choosing appropriate disease-modifying therapies (DMTs) and knowing when to change therapy,” study authors said.

Using data from the CombiRx trial, investigators analyzed a cohort of 1008 patients to determine whether variables such as baseline demographics, MRI metrics, clinical history, and treatments were associated with worsening disease over 7 years of follow-up.

They found the risk of relapse was higher in patients who were younger than 38 years (hazard ratio [HR] range 1.36-1.43), as well as those who had gadolinium+ lesions (HR 1.38, [95% confidence interval, CI 1.14, 1.67]) and Expanded Disability Status Scale scores of 3.5 or more (HR range 1.63-1.67) at baseline.

A higher risk of new MRI activity was also associated with younger age (HR range 1.58-1.84) and the baseline presence of gadolinium+ lesions (HR 1.75, [95% CI 1.49, 2.06]). Additionally, new MRI activity was higher in those with more preexisting lesions than the cohort’s median (≥71 T2 hyperintense lesions vs <71; HR 1.50, [95% CI 1.27, 1.77]) and those with higher baseline T2 lesion volume (HR 1.02 for every unit increase in baseline volume, [95% CI 1.01, 1.03]).

Per the analysis, the risk of new MRI activity was lower in patients who were treated with combination therapy, as opposed to those who received only glatiramer acetate (HR range 0.67-0.68) or interferon beta-1a (HR range 0.68-0.70).

Patients with higher T2 volume (HR for 1 unit increase in volume 1.01, 95% CI 1.004, 1.03) and baseline Expanded Disability Status Scale scores of at least 2 (HR range 2.79-2.96) were at greater risk for disease worsening.

“There were no associations between sex, race, and disease duration on relapse, MRI activity, or disease worsening in the multivariable analysis,” researchers noted.

Younger patients with MS who had a high rate of relapses and more lesions at baseline faced the greatest risk of subsequent disease activity, investigators concluded.

Reference:
Zhang Y, Cofield S, Cutter G, Krieger S, Wolinsky JS, Lublin F. Predictors of disease activity and worsening in relapsing-remitting multiple sclerosis. Neurol Clin Pract. 2022;12(4):e58-e65. doi:10.1212/CPJ.0000000000001177