J Neurol Neurosurg Psychiatry 79:1368-1374 doi:10.1136/jnnp.2008.145805
  • Research paper

Relapses in multiple sclerosis are age- and time-dependent

  1. H Tremlett1,2,
  2. Y Zhao3,
  3. J Joseph2,
  4. V Devonshire1,
  5. the UBCMS Clinic Neurologists*
  1. 1
    Faculty of Medicine Neurology, University of British Columbia, Vancouver, Canada
  2. 2
    Faculty of Medicine, School of Public and Population Health, University of British Columbia, Vancouver, Canada
  3. 3
    Faculty of Medicine MS/MRI Research Group, University of British Columbia, Vancouver, Canada
  1. Helen Tremlett, PhD, Department of Medicine (Neurology), rm S178, 2211 Wesbrook Mall, University of British Columbia, Vancouver, BC V6T 2B5, Canada; tremlett{at}
  • Received 28 January 2008
  • Revised 5 May 2008
  • Accepted 12 May 2008
  • Published Online First 5 June 2008


Objectives: To examine the relative relapse-rate patterns over time in a relapsing multiple sclerosis (MS) cohort and to investigate potential predictors of relapse rates and periods of low-relapse activity.

Methods: This retrospective cohort study followed 2477 relapsing-remitting (RR) MS patients from onset to 1 July 2003. Annualised relapse rates were examined according to sex, age at onset, the patient’s current age and disease duration. The relationship between relapse rates and baseline characteristics (sex, onset age and onset symptoms) were examined using Poisson regression. Time to the first 5 years relapse-free was examined using Kaplan–Meier survival analysis.

Results: The mean follow-up time (from onset of MS symptoms) was 20.6 years, during which time 11,722 post-onset relapses were recorded. The relapse rate decreased by 17% every 5 years (between years 5 to 30 post-onset), but this decline increased in magnitude with increasing onset age. Women and those with onset sensory symptoms exhibited a higher relapse rate (p⩽0.001). More than three-quarters of patients (1692/2189) experienced a 5-year relapse-free period during the RR phase.

Conclusion: Relapse rates were age- and time-dependent. Our observations have clinical implications: 1) any drug able to modify relapse rates has the greatest potential for a population impact in patients <40 years old and within the first few demi-decades of disease; 2) continuation of drug beyond these times may be of limited value; 3) long-term follow-up studies must consider that relapse rates probably decline at different rates over time according to the patient’s onset age; 4) a relapse-quiescent period in MS is not uncommon.


  • *The UBC MS Clinic Neurologists (in alphabetical order): D Adams, D Craig, L Daly, S Hashimoto, O Hiebiceck, J Hooge, B Jones, L Kastrukoff, S Meckling, J Oger, D Parton, D Paty, P Rieckmann, P Smyth, W Shtybel, T Traboulsee.

  • Funding: This study was funded by a grant from the National MS Society (NMSS). HT is funded by: a ‘Don Paty Career Development Award’ from the MS Society of Canada, the Christopher Foundation and is a Michael Smith Foundation for Health Research Scholar. The BC-wide MS database was funded by an unrestricted grant from Don Paty and the MS/MRI research group.

  • Competing interests: The authors report no conflicts of interest or competing interests.

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