title: The multiple sclerosis relapse experience: patient-reported outcomes from the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry.
abstract: BACKGROUND
  Among patients with relapsing-remitting multiple sclerosis, relapses are associated with increased disability and decreased quality of life. Relapses are commonly treated with corticosteroids or left untreated. We aimed to better understand patient perceptions of the adequacy of corticosteroids in resolving relapse symptoms.
  
  
  METHODS
  We examined self-reported data from 4482 participants in the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry regarding evaluation, treatment, and recovery from relapses. Pearson's chi-square test was used to analyze categorical variables, while logistic regression was used to assess factors associated with patients' perceptions.
  
  
  RESULTS
  Forty percent (1775/4482) of respondents were simply observed for disease worsening, whereas 25% (1133/4482) were treated with intravenous methylprednisolone (IVMP) and 20% (923/4482) with oral corticosteroids; additional treatments included adrenocorticotropic hormone, plasmapheresis, intravenous immunoglobulin, and others. Among patients who responded to questions about their most recent relapse, 32% (363/1123) of IVMP-treated and 34% (301/895) of oral corticosteroid-treated patients indicated their symptoms were worse one month after treatment than pre-relapse, as did 39% (612/1574) of observation-only patients; 30% (335/1122) of IVMP-treated patients indicated their treatment made relapse symptoms worse (13% [145/1122]) or had no effect (17% [190/1122]), as did 38% (340/894) of oral corticosteroid-treated patients (worse, 13% [116/894]; no effect, 25% [224/894]) and 76% (1162/1514) of observation-only patients (worse, 17% [264/1514]; no change, 59% [898/1514]).
  
  
  CONCLUSIONS
  Overall, patients with relapsing multiple sclerosis who receive treatment report better outcomes than those who are simply observed. However, a sizeable percentage of patients feel that their symptoms following corticosteroid treatment are worse than pre-relapse symptoms and that treatment had no effect or worsened symptoms. Patient perceptions of relapse treatment deserve more attention, and more effective treatment options are needed.
authors.affiliation: Questcor Pharmaceuticals, Inc, 26118 Research Road, Hayward, CA 94545, USA. molly.nickerson@questcor.com.
authors.forename: Molly
authors.initials: M
authors.lastname: Nickerson
authors.forename: Ruth Ann
authors.initials: RA
authors.lastname: Marrie
mesh_terms: D016009:Chi-Square Distribution; D004333:Drug Administration Routes; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D009103:Multiple Sclerosis / Q000188:drug therapy / Q000503:physiopathology / Q000523:psychology; D009656:North America; D017063:Outcome Assessment, Health Care; D012042:Registries; D012189:Retrospective Studies; D055502:Secondary Prevention; D013256:Steroids / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D013256:Steroids
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