Relapse Recovery and Outcomes in MS

Jeffrey M. Kaplan, MD: At the ACTRIMS 2020 meeting [The Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) Forum 2020], you were discussing the contribution of relapse recovery to long-term outcomes in multiple sclerosis [MS]. What are your thoughts about that study?

Matthew J. Baker, MD: I think your approach to treating relapses is excellent. You’re bringing the patient back, and you’re evaluating how they have improved or not improved and then driving home that recovery. And you’re getting them treated and then getting them into rehab and minimizing disability.

And so, we’ve looked at sort of these clinical demographic, paraclinical predictors of long-term disability. One of those, at least early on in the disease course, is within those first 3 years, relapses and lack of recovery, or incomplete recovery back to baseline.

So as part of the longitudinal study at Brigham and Women’s Hospital, the CLIMB study evaluated this. They looked at patients who had relapsed within the first 3 years of disease onset and classified them into a group of complete recovery. So, EDSS [Expanded Disability Status Scale] change 6 months later of 0, or incomplete recovery. So, greater than 0. And what that showed was that in those patients who had an incomplete recovery there was an association with higher EDSS. So those had complete, lower EDSS. And also, age of onset.

We know the older we are, the less able our nervous system is to heal and compensate. So the take-home point is it’s important to treat relapse. Identify it and maximize recovery as much as possible. And, don’t get old.

Jeffrey M. Kaplan, MD: Yes, so that concerns me because I’m 59. You know, I read about immunosenescence. They talk about age 55. That absolutely hits home hard for me.

Matthew J. Baker, MD: Is it 45 or 55, because I heard 45 and I’m 49. I’ve been thinking about immunosenescence for the last 4 years.

Jeffrey M. Kaplan, MD: I thought it was 55, but either way…

Matthew J. Baker, MD: I’ll take 55.

Jeffrey M. Kaplan, MD: Yes, I think, Matt, you should definitely go with my definition.