{
  "abstract": "Background Corticosteroid treatment of multiple sclerosis (MS) relapses is assumed to improve the speed of relapse recovery, without modifying long-term disability risk. We aimed to re-evaluate this assumption in a large cohort of individuals with MS.Methods Individuals with clinically definite MS and ≥3 Expanded Disability Status Scale (EDSS) measurements over ≥12 months were identified within the international neuroimmunology registry MSBase. Individuals were required to have ≥1 relapse, with complete information on relapse treatment, phenotype and severity for all documented relapses. The primary outcome was disability worsening confirmed over 12 months. The association of the cumulative number of steroid-treated and untreated relapses (as a time-varying exposure) with disability worsening was evaluated with Cox proportional hazards.Results In total, 3673 individuals met the inclusion criteria (71% female, mean age 38 years, mean disability EDSS step 2); 5809 relapses (4671 treated/1138 untreated) were captured (annualised relapse rate 0.19). Over the study period (total 30 175 person-years), 32.7% reached the outcome of confirmed disability worsening (median survival time 5.2 years). Non-treated relapses were associated with a higher risk of disability worsening (HR 1.72, 95% CI 1.57 to 1.88) than steroid-treated relapses (HR 1.50, 95% CI 1.43 to 1.57). This association was modified by the efficacy of disease-modifying therapy at the time of relapse.Conclusions Our results suggest that a lack of steroid treatment of MS relapses is associated with a higher risk of future disability worsening. Hence, corticosteroid treatment of MS relapses may impact not only the speed of recovery but also the severity of residual structural damage.",
  "authors": [
    {
      "affiliations": [
        "Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada",
        "CORe, Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia"
      ],
      "name": "Jodie I Roberts"
    },
    {
      "affiliations": [
        "CORe, Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia",
        "Neuroimmunology Centre, Department of Neurology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia"
      ],
      "name": "Sifat Sharmin"
    },
    {
      "affiliations": [
        "Department of Neurology and Center of Clinical Neuroscience, Charles University First Faculty of Medicine, Prague, Czech Republic"
      ],
      "name": "Dana Horakova"
    },
    {
      "affiliations": [
        "Department of Neurology and Center of Clinical Neuroscience, Charles University First Faculty of Medicine, Prague, Czech Republic"
      ],
      "name": "Eva Kubala Havrdova"
    },
    {
      "affiliations": [
        "Medical Point Hospital, Izmir University of Economics, Konak/Izmir, Turkey"
      ],
      "name": "Serkan Ozakbas,"
    },
    {
      "affiliations": [
        "Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy",
        "IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy"
      ],
      "name": "Alessandra Lugaresi"
    },
    {
      "affiliations": [
        "Institute for Advanced Biomedical Technologies (ITAB) and Centre for Rehabilitation, Disability and Sport Medicine (CARES), Department of Neurosciences, Imaging and Clinical Sciences, Gabriele d’Annunzio University of Chieti and Pescara, Chieti, Italy",
        "Clinical Neurology, SS Annunziata Hospital, Chieti, Italy"
      ],
      "name": "Valentina Tomassini"
    },
    {
      "affiliations": [
        "Division of Neurology, Department of Medicine, Al-Amiri Hospital, Sharq, Kuwait"
      ],
      "name": "Raed Alroughani"
    },
    {
      "affiliations": [
        "Eastern Health Clinical School, Monash University, Box Hill Hospital, Melbourne, Victoria, Australia"
      ],
      "name": "Katherine Buzzard"
    },
    {
      "affiliations": [
        "Eastern Health Clinical School, Monash University, Box Hill Hospital, Melbourne, Victoria, Australia",
        "Department of Neurology, The Alfred, Melbourne, Victoria, Australia"
      ],
      "name": "Olga Skibina"
    },
    {
      "affiliations": [
        "Department of Neurology, Farabi Hospital, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey"
      ],
      "name": "Cavit Boz"
    },
    {
      "affiliations": [
        "Istsanbul Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey"
      ],
      "name": "Recai Turkoglu"
    },
    {
      "affiliations": [
        "Centro Sclerosi Multipla, UOC Neurologia, Azienda Ospedaliera Cannizzaro, Catania, Italy"
      ],
      "name": "Davide Maimone"
    },
    {
      "affiliations": [
        "Neurology Institute, Harley Street Medical Center, Abu Dhabi, UAE"
      ],
      "name": "Bassem Yamout"
    },
    {
      "affiliations": [
        "Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon"
      ],
      "name": "Samia Joseph Khoury"
    },
    {
      "affiliations": [
        "Azienda Ospedaliera di Rilievo Nazionale e di Alta Specialita San Giuseppe Moscati, Avellino, Italy"
      ],
      "name": "Daniele Spitaleri"
    },
    {
      "affiliations": [
        "Hunter Medical Research Institute, The University of Newcastle, Newcastle, New South Wales, Australia",
        "Hunter New England Health, John Hunter Hospital, Newcastle, New South Wales, Australia"
      ],
      "name": "Jeannette Lechner-Scott"
    },
    {
      "affiliations": [
        "CRCHUM, CHUM MS Center and Department of Neurosciences, Universite de Montreal Faculte de Medecine, Montreal, Québec, Canada"
      ],
      "name": "Marc Girard"
    },
    {
      "affiliations": [
        "CRCHUM, CHUM MS Center and Department of Neurosciences, Universite de Montreal Faculte de Medecine, Montreal, Québec, Canada"
      ],
      "name": "Pierre Duquette"
    },
    {
      "affiliations": [
        "College of Medicine & Health Sciences, Sultan Qaboos University, Al-Khodh, Oman"
      ],
      "name": "Abdullah Al-Asmi"
    },
    {
      "affiliations": [
        "Nemocnice Jihlava, Jihlava, Czech Republic"
      ],
      "name": "Radek Ampapa"
    },
    {
      "affiliations": [
        "Department of Neuroscience, MS Center, Neurology Unit, Ospedale Santa Maria delle Croci, Ravenna, Italy",
        "Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L’Aquila, L’Aquila, Italy"
      ],
      "name": "Matteo Foschi"
    },
    {
      "affiliations": [
        "Department of Neuroscience, MS Center, Neurology Unit, Ospedale Santa Maria delle Croci, Ravenna, Italy"
      ],
      "name": "Andrea Surcinelli"
    },
    {
      "affiliations": [
        "University of Catania Department of Surgical and Medical Sciences and Advanced Technologies 'G.F. Ingrassia’, Catania, Italy",
        "Multiple Sclerosis Unit, Azienda Ospedaliero Universitaria Policlinico G Rodolico San Marco, Catania, Italy"
      ],
      "name": "Francesco Patti"
    },
    {
      "affiliations": [
        "Department of Neurology, Cliniques Universitaires Saint-Luc, Brussels, Belgium",
        "UCLouvain, Brussels, Belgium"
      ],
      "name": "Vincent Van Pesch"
    },
    {
      "affiliations": [
        "Department of Neuroscience, Hospital Germans Trias i Pujol, Badalona, Spain"
      ],
      "name": "Cristina Ramo-Tello"
    },
    {
      "affiliations": [
        "Department of Neurology, Hospital de Galdakao-Usansolo, Galdakao, Spain",
        "Biocruces-Bizkaia Health Research Institute, Barakaldo, Spain"
      ],
      "name": "José Luis Sánchez-Menoyo"
    },
    {
      "affiliations": [
        "Department of Neurology, School of Medicine and Koc University Research Center for Translational Medicine (KUTTAM), Koç University, Istanbul, Turkey"
      ],
      "name": "Ayse Altintas"
    },
    {
      "affiliations": [
        "CISSS de Chaudiere-Appalaches, Levis, Quebec, Canada"
      ],
      "name": "Pierre Grammond"
    },
    {
      "affiliations": [
        "Neurology Unit, P O Unico Macerata, AST Macerata, Macerata, Italy"
      ],
      "name": "Elisabetta Cartechini"
    },
    {
      "affiliations": [
        "Department of Neurology, University of Debrecen Faculty of Medicine, Debrecen, Hungary"
      ],
      "name": "Tunde Csepany"
    },
    {
      "affiliations": [
        "Department of Neurology, University Hospital Ghent, Ghent, Belgium"
      ],
      "name": "Guy Laureys"
    },
    {
      "affiliations": [
        "Department of Neurology, Antwerp University Hospital and Translational Neurosciences Research Group, University of Antwerp Faculty of Medicine and Health Sciences, Antwerp, Belgium"
      ],
      "name": "Barbara Willekens"
    },
    {
      "affiliations": [
        "CORe, Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia",
        "Neuroimmunology Centre, Department of Neurology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia"
      ],
      "name": "Izanne Roos"
    },
    {
      "affiliations": [
        "CORe, Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia",
        "Neuroimmunology Centre, Department of Neurology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia"
      ],
      "name": "Tomas Kalincik"
    },
    {
      "affiliations": [
        "The Alfred, Melbourne, Victoria, Australia"
      ],
      "name": "MSBase Study Group"
    }
  ],
  "title": "Corticosteroid treatment of multiple sclerosis relapses is associated with lower disability worsening over 5 years",
  "uid": "fcd730e5-4179-5304-b5ae-d5bb296b4553"
}