{
  "abstract": "Background The main goal of treatment in relapsing-remitting multiple sclerosis (RRMS) is to reduce the occurrence of relapses. However, little is known about the natural history of relapse recovery.Methods We accessed data from DECIDE (n=1841), a phase 3 trial. We investigated factors associated with time to relapse recovery (defined as a return of the Expanded Disability Status Scale (EDSS) score to the pre-relapse level or lower), relapse severity (0.5, 1.0, or >1.0 EDSS score change) and the new concept of 'acute clinical events with stable MRI' (ACES). Variables used were age, sex, disease duration, treatment arm, pre-relapse EDSS, corticosteroid use, number of relapses prior to study enrolment, MRI activity, relapse severity and affected functional system (FS).Results We included 430 first relapses, of which 405 (94.2%) recovered during follow-up, 400 (93%) by 1 year (median time to recovery of 71 days, 95% CI 66 to 75 days). More severe relapses and relapses involving the bowel and bladder FS took a longer time to recover. Corticosteroids hastened the recovery of relapses but did not influence eventual relapse recovery. ACES occurred in 38% of relapses and was more frequent in older people and participants treated with daclizumab.Conclusions Most relapses (94.2%) recover, but the process of recovery can take up to 1 year and depends mostly on relapse severity. Our findings challenge the concept of 3-month and 6-month confirmed disability progression as reliable markers of permanent disability in RRMS trials. ACES occurs frequently and is associated with age.",
  "authors": [
    {
      "affiliations": [
        "Neurology, Rijnstate Hospital Arnhem, Arnhem, Netherlands"
      ],
      "name": "Jop Mostert"
    },
    {
      "affiliations": [
        "Neurology, Amsterdam UMC - Locatie VUMC, Amsterdam, Noord-Holland, Netherlands"
      ],
      "name": "Eva M Strijbis"
    },
    {
      "affiliations": [
        "Department of Neurology, Universitair Ziekenhuis Brussel, Brussels, Belgium"
      ],
      "name": "Miguel D’Haeseleer"
    },
    {
      "affiliations": [
        "Department of Neurology, Hospital Sant Joan Despí Moisès Broggi, Barcelona, Spain"
      ],
      "name": "Ester Moral"
    },
    {
      "affiliations": [
        "Neurology, Hospital Universitari Arnau de Vilanova, Lleida, Spain"
      ],
      "name": "Luis Brieva"
    },
    {
      "affiliations": [
        "Médecine, service de neurologie, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada",
        "Neurosciences, Université de Montréal, Montreal, Quebec, Canada"
      ],
      "name": "Jacynthe Comtois"
    },
    {
      "affiliations": [
        "Swedish Neuroscience Institute, Seattle, Washington, USA"
      ],
      "name": "Pavle Repovic"
    },
    {
      "affiliations": [
        "Swedish Neuroscience Institute, Seattle, Washington, USA"
      ],
      "name": "James D Bowen"
    },
    {
      "affiliations": [
        "UAB School of Public Health, Birmingham, Alabama, USA"
      ],
      "name": "Gary Cutter"
    },
    {
      "affiliations": [
        "Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada"
      ],
      "name": "Marcus Koch"
    }
  ],
  "title": "Extended window of relapse recovery in RRMS: an analysis of the DECIDE dataset",
  "uid": "fdd8c916-4ebf-5244-866d-4fd71ccb8ed6"
}