Dr. Fred Lublin, a renowned multiple sclerosis (MS) expert at Mount Sinai Medical Center, helped launch the Consortium of Multiple Sclerosis Centers (CMSC) 2016 Annual Meeting, June 1 – 4, in National Harbor, Md. with the John F. Kurtzke Memorial Lecture he titled “Do Relapses Really Matter?”
“How relapses influence disease worsening, and clinical outcomes in MS over the long-term, continues to be debated and accurate ways to determine what constitutes a relapse in MS and the severity of relapses have been lacking,” Lublin wrote in the CMSC 2016 program booklet.
His opening lecture provided insight about how, with emerging efficacy data, MS care professionals can begin to re-evaluate what is an ‘acceptable’ relapse rate.
Dr. Lublin began the presentation by defining relapse as the “essence of clinical diagnosis of MS”, and a “distinct event relatively easy to determine onset – not so easy to determine offset.”
There are several types of MS.
Relapsing-remitting MS (RRMS) is the most common form of the disease, occurring in 85% of MS cases. RRMS is characterized by clearly defined phases of relapse and progressive worsening of nerve functions with each attack. Normal conditions can be restored during occasional remission phases. Some people fully recover between attacks, while others only experience partial recovery.
Progressive MS, another type of the disease, is characterized by progressive neurological damage. According to Lublin, “many MS patients begin with a relapsing form and convert to a progressive form.”
Lubin posed several question during his lecture: “Is worsening from a relapse different from gradual progression?”, “What is the role of relapse in subsequent development of disability?”, “How much does it matter?”
“We have the potential to reduce relapse rates to very low levels” he stated. “We need therapies that address progressive disease . . . The earlier disability occurs, the longer one is in a more disabled state: this is a QOL (quality of life) issue.”
Dr. Lublin also discussed the term NEDA (no evidence of disease activity), which is defined as an activity free state of the disease in which there are “no relapses, no progression of disability, no gadolinium enhancement, no new or enlarging T2 lesions.”
NEDA is an emerging goal in multiple sclerosis treatment supported by the idea that an effective MS therapy should allow patients to reach NEDA, a point where the patient is free of visible and silent MS disease symptoms and activity. The concept of NEDA, applied to MS, is evolving and based on the fact that single variables such as relapse frequency, may not be a sufficient indicator of MS activity.
Multiple Sclerosis News Today previously conducted a telephone interview Lublin in which he discussed the importance of relapses in MS and its impact on clinical outcomes. For more information, please visit this link.