Predicting the End of Symptomatic Relapses and Disease Modifying Treatment Use Decisions in Progressive Multiple Sclerosis

Objective: To define the overlapping period in late relapsing-remitting and early progressive phase of multiple sclerosis (MS) to guide disease modifying treatment initiation or discontinuation decisions.Background: Relapses may continue after the onset of progressive phase in 14[percnt] of patients with MS. Even in patients with primary progressive MS, post-progression relapses can occur. Since ongoing relapses add to the disability burden of progressive MS patients, disease modifying treatments can be continued or initiated during the overlapping period.Methods: We studied age at first relapse, age at progressive MS onset and age at last relapse (before or after progressive MS onset) in 964 patients from clinic- and population-based MS cohorts. Overlapping age range for relapsing-remitting and progressive phases of MS, as well as absolute lifetime risk of relapses after progressive MS onset were calculated.Results: Median age at first relapse was 32.6 (range 10-67), median age at progressive MS onset was 45.9 (range 17-76) and median age at last relapse was 42.0 years (range 16-76). Overlap age range (95[percnt]) was 27-47 years. After grouping patients according to the age at progressive MS onset based on mean ± SD of 45.4 ± 9.5 into 55 years, the absolute lifetime risk of relapses after progressive MS onset were; 18[percnt], 17[percnt], 13[percnt] and 5[percnt], respectively. The last expected relapse for these groups was at ages 50, 65, 70 and 70 years, respectively.Conclusions: Overall, there is a notable chance of relapses to occur the first time or continue in patients between ages 27-47, regardless of being in the progressive phase of MS: absolute lifelong risk of further relapses which is 18[percnt] before age 35 drops to 5[percnt] after 55. These age limits can be utilized to guide decision to initiate or continue disease-modifying treatments after progressive MS onset. Disclosure: Dr. Novotna has received personal compensation for activities with the European Regional Development Fund, European Social Fund and the State Budget of the Czech Republic. Dr. Conway has nothing to disclose. Dr. Zeydan has nothing to disclose. Dr. Paz Soldan has nothing to disclose. Dr. Abou Zeid has nothing to disclose. Dr. Kale has nothing to disclose. Dr. Tutuncu has nothing to disclose. Dr. Kantarci has nothing to disclose.