Corticosteroid treatment of multiple sclerosis relapses is associated with lower disability worsening over 5 years

Jodie I. Roberts; Sifat Sharmin; Dana Horakova; Eva Kubala Havrdova; Serkan Ozakbas; Alessandra Lugaresi; Valentina Tomassini; Raed Alroughani; Katherine Buzzard; Olga Skibina; Cavit Boz; Recai Turkoglu; Davide Maimone; Bassem Yamout; Samia Joseph Khoury; Daniele Spitaleri; Jeannette Lechner-Scott; Marc Girard; Pierre Duquette; Abdullah Al-Asmi; Radek Ampapa; Matteo Foschi; Andrea Surcinelli; Francesco Patti; Vincent Van Pesch; Cristina Ramo-Tello; José Luis Sánchez-Menoyo; Ayse Altintas; Pierre Grammond; Elisabetta Cartechini; Tunde Csepany; Guy Laureys; Barbara Willekens; Izanne Roos; Tomas Kalincik; MSBase Study Group; Mark Slee

doi:10.1136/jnnp-2025-336343

Corticosteroid treatment of multiple sclerosis relapses is associated with lower disability worsening over 5 years

Jodie I. Roberts
, Sifat Sharmin
, Dana Horakova
, Eva Kubala Havrdova
, Serkan Ozakbas
, Alessandra Lugaresi
, Valentina Tomassini
, Raed Alroughani
, Katherine Buzzard
, Olga Skibina
, Cavit Boz
, Recai Turkoglu
, Davide Maimone
, Bassem Yamout
, Samia Joseph Khoury
, Daniele Spitaleri
, Jeannette Lechner-Scott
, Marc Girard
, Pierre Duquette
, Abdullah Al-Asmi

Radek Ampapa, Matteo Foschi, Andrea Surcinelli, Francesco Patti, Vincent Van Pesch, Cristina Ramo-Tello, José Luis Sánchez-Menoyo, Ayse Altintas, Pierre Grammond, Elisabetta Cartechini, Tunde Csepany, Guy Laureys, Barbara Willekens, Izanne Roos, Tomas Kalincik, MSBase Study Group, Mark Slee

College of Medicine and Public Health

Research output: Contribution to journal › Article › peer-review

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.

Original language	English
Pages (from-to)	1185–1193
Number of pages	9
Journal	Journal of Neurology, Neurosurgery and Psychiatry
Volume	96
Issue number	12
DOIs	https://doi.org/10.1136/jnnp-2025-336343
Publication status	Published - Dec 2025

Keywords

CLINICAL NEUROLOGY
DEMYELINATING DISEASES
EVIDENCE-BASED NEUROLOGY
MULTIPLE SCLEROSIS

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Roberts, J. I., Sharmin, S., Horakova, D., Kubala Havrdova, E., Ozakbas, S., Lugaresi, A., Tomassini, V., Alroughani, R., Buzzard, K., Skibina, O., Boz, C., Turkoglu, R., Maimone, D., Yamout, B., Khoury, S. J., Spitaleri, D., Lechner-Scott, J., Girard, M., Duquette, P., ... Slee, M. (2025). Corticosteroid treatment of multiple sclerosis relapses is associated with lower disability worsening over 5 years. Journal of Neurology, Neurosurgery and Psychiatry, 96(12), 1185–1193. https://doi.org/10.1136/jnnp-2025-336343

@article{d104b5f39d6b4533961c1c54337d5da9,

title = "Corticosteroid treatment of multiple sclerosis relapses is associated with lower disability worsening over 5 years",

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.",

keywords = "CLINICAL NEUROLOGY, DEMYELINATING DISEASES, EVIDENCE-BASED NEUROLOGY, MULTIPLE SCLEROSIS",

author = "Roberts, \{Jodie I.\} and Sifat Sharmin and Dana Horakova and \{Kubala Havrdova\}, Eva and Serkan Ozakbas and Alessandra Lugaresi and Valentina Tomassini and Raed Alroughani and Katherine Buzzard and Olga Skibina and Cavit Boz and Recai Turkoglu and Davide Maimone and Bassem Yamout and Khoury, \{Samia Joseph\} and Daniele Spitaleri and Jeannette Lechner-Scott and Marc Girard and Pierre Duquette and Abdullah Al-Asmi and Radek Ampapa and Matteo Foschi and Andrea Surcinelli and Francesco Patti and \{Van Pesch\}, Vincent and Cristina Ramo-Tello and S{\'a}nchez-Menoyo, \{Jos{\'e} Luis\} and Ayse Altintas and Pierre Grammond and Elisabetta Cartechini and Tunde Csepany and Guy Laureys and Barbara Willekens and Izanne Roos and Tomas Kalincik and \{MSBase Study Group\} and Francois Grand'maison and Cabrera-Gomez, \{Jose Antonio\} and Etienne Roullet and Jamie Campbell and Cees Zwanikken and Braber-Moerland, \{Leontien Den\} and Jihad Inshasi and Norma Deri and Alfredo Firstenfeld and Saladino, \{Maria Laura\} and Edgardo Cristiano and Rojas, \{Juan Ingacio\} and Carlos Vrech and Cameron Shaw and Neil Shuey and Nevin John and Suzanne Hodgkinson and Justin Garber and Mark Slee and Pamela Mccombe and Mike Boggild and Bruce Taylor and Walt, \{Anneke van der\} and Helmut Butzkueven and Richard Macdonell and Todd Hardy and Steve Vucic and Pamela Mccombe and Danny Decoo and Wijmeersch, \{Bart Van\} and Claudia Vasconcelos and Julie Prevost and Fraser Moore and Emmanuelle Lapointe and Jiwon Oh and Magd Zakaria and Nevin Shalaby and Javier Olascoaga and Celia Oreja-Guevara and Sara Eichau and Dominguez, \{Jose Andres\} and Yolanda Blanco and Orla Gray and Nikolaos Grigoriadis and Imre Piroska and Magdolna Simo and Cecilia Rajda and Chris Mcguigan and Bhim Singhal and Dheeraj Khurana and Vahid Shaygannejad and Amato, \{Maria Pia\} and Gregorio, \{Maria Di\} and Claudio Solaro and Tatjana Petkovska-Boskova and Marija Cauchi and Oliver Gerlach and Raymond Hupperts and Gans, \{Koen de\} and Freek Verheul and Sinnige, \{L. G.F.\} and Deborah Mason and Jan Schepel and Jabir Alkhaboori and Sa, \{Maria Jose\} and Simu Mihaela and Talal Al-Harbi and Riadh Gouider and Saloua Mrabet and Rana Karabudak and Mark Marriott and Trevor Kilpatrick and John King and Nguyen, \{Ai Lan\} and Chris Dwyer and Mastura Monif and Lisa Taylor and Josephine Baker and Catherine Larochelle and Clara Chisari and Emanuele D'amico and Salvatore, \{Lo Fermo\} and Matteo Diamanti and Charlotte Sartori and Pamela Farr and Rein Moore and Dusko Stupar and Cynthia Tang and Sonya Smirnova",

year = "2025",

month = dec,

doi = "10.1136/jnnp-2025-336343",

language = "English",

volume = "96",

pages = "1185–1193",

journal = "Journal of Neurology, Neurosurgery and Psychiatry",

issn = "0022-3050",

publisher = "BMJ Publishing Group",

number = "12",

}

Roberts, JI, Sharmin, S, Horakova, D, Kubala Havrdova, E, Ozakbas, S, Lugaresi, A, Tomassini, V, Alroughani, R, Buzzard, K, Skibina, O, Boz, C, Turkoglu, R, Maimone, D, Yamout, B, Khoury, SJ, Spitaleri, D, Lechner-Scott, J, Girard, M, Duquette, P, Al-Asmi, A, Ampapa, R, Foschi, M, Surcinelli, A, Patti, F, Van Pesch, V, Ramo-Tello, C, Sánchez-Menoyo, JL, Altintas, A, Grammond, P, Cartechini, E, Csepany, T, Laureys, G, Willekens, B, Roos, I, Kalincik, T, MSBase Study Group & Slee, M 2025, 'Corticosteroid treatment of multiple sclerosis relapses is associated with lower disability worsening over 5 years', Journal of Neurology, Neurosurgery and Psychiatry, vol. 96, no. 12, pp. 1185–1193. https://doi.org/10.1136/jnnp-2025-336343

TY - JOUR

T1 - Corticosteroid treatment of multiple sclerosis relapses is associated with lower disability worsening over 5 years

AU - Roberts, Jodie I.

AU - Sharmin, Sifat

AU - Horakova, Dana

AU - Kubala Havrdova, Eva

AU - Ozakbas, Serkan

AU - Lugaresi, Alessandra

AU - Tomassini, Valentina

AU - Alroughani, Raed

AU - Buzzard, Katherine

AU - Skibina, Olga

AU - Boz, Cavit

AU - Turkoglu, Recai

AU - Maimone, Davide

AU - Yamout, Bassem

AU - Khoury, Samia Joseph

AU - Spitaleri, Daniele

AU - Lechner-Scott, Jeannette

AU - Girard, Marc

AU - Duquette, Pierre

AU - Al-Asmi, Abdullah

AU - Ampapa, Radek

AU - Foschi, Matteo

AU - Surcinelli, Andrea

AU - Patti, Francesco

AU - Van Pesch, Vincent

AU - Ramo-Tello, Cristina

AU - Sánchez-Menoyo, José Luis

AU - Altintas, Ayse

AU - Grammond, Pierre

AU - Cartechini, Elisabetta

AU - Csepany, Tunde

AU - Laureys, Guy

AU - Willekens, Barbara

AU - Roos, Izanne

AU - Kalincik, Tomas

AU - MSBase Study Group

AU - Grand'maison, Francois

AU - Cabrera-Gomez, Jose Antonio

AU - Roullet, Etienne

AU - Campbell, Jamie

AU - Zwanikken, Cees

AU - Braber-Moerland, Leontien Den

AU - Inshasi, Jihad

AU - Deri, Norma

AU - Firstenfeld, Alfredo

AU - Saladino, Maria Laura

AU - Cristiano, Edgardo

AU - Rojas, Juan Ingacio

AU - Vrech, Carlos

AU - Shaw, Cameron

AU - Shuey, Neil

AU - John, Nevin

AU - Hodgkinson, Suzanne

AU - Garber, Justin

AU - Slee, Mark

AU - Mccombe, Pamela

AU - Boggild, Mike

AU - Taylor, Bruce

AU - Walt, Anneke van der

AU - Butzkueven, Helmut

AU - Macdonell, Richard

AU - Hardy, Todd

AU - Vucic, Steve

AU - Mccombe, Pamela

AU - Decoo, Danny

AU - Wijmeersch, Bart Van

AU - Vasconcelos, Claudia

AU - Prevost, Julie

AU - Moore, Fraser

AU - Lapointe, Emmanuelle

AU - Oh, Jiwon

AU - Zakaria, Magd

AU - Shalaby, Nevin

AU - Olascoaga, Javier

AU - Oreja-Guevara, Celia

AU - Eichau, Sara

AU - Dominguez, Jose Andres

AU - Blanco, Yolanda

AU - Gray, Orla

AU - Grigoriadis, Nikolaos

AU - Piroska, Imre

AU - Simo, Magdolna

AU - Rajda, Cecilia

AU - Mcguigan, Chris

AU - Singhal, Bhim

AU - Khurana, Dheeraj

AU - Shaygannejad, Vahid

AU - Amato, Maria Pia

AU - Gregorio, Maria Di

AU - Solaro, Claudio

AU - Petkovska-Boskova, Tatjana

AU - Cauchi, Marija

AU - Gerlach, Oliver

AU - Hupperts, Raymond

AU - Gans, Koen de

AU - Verheul, Freek

AU - Sinnige, L. G.F.

AU - Mason, Deborah

AU - Schepel, Jan

AU - Alkhaboori, Jabir

AU - Sa, Maria Jose

AU - Mihaela, Simu

AU - Al-Harbi, Talal

AU - Gouider, Riadh

AU - Mrabet, Saloua

AU - Karabudak, Rana

AU - Marriott, Mark

AU - Kilpatrick, Trevor

AU - King, John

AU - Nguyen, Ai Lan

AU - Dwyer, Chris

AU - Monif, Mastura

AU - Taylor, Lisa

AU - Baker, Josephine

AU - Larochelle, Catherine

AU - Chisari, Clara

AU - D'amico, Emanuele

AU - Salvatore, Lo Fermo

AU - Diamanti, Matteo

AU - Sartori, Charlotte

AU - Farr, Pamela

AU - Moore, Rein

AU - Stupar, Dusko

AU - Tang, Cynthia

AU - Smirnova, Sonya

PY - 2025/12

Y1 - 2025/12

N2 - 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.

AB - 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.

KW - CLINICAL NEUROLOGY

KW - DEMYELINATING DISEASES

KW - EVIDENCE-BASED NEUROLOGY

KW - MULTIPLE SCLEROSIS

UR - https://www.scopus.com/pages/publications/105012431984

U2 - 10.1136/jnnp-2025-336343

DO - 10.1136/jnnp-2025-336343

M3 - Article

C2 - 40721309

AN - SCOPUS:105012431984

SN - 0022-3050

VL - 96

SP - 1185

EP - 1193

JO - Journal of Neurology, Neurosurgery and Psychiatry

JF - Journal of Neurology, Neurosurgery and Psychiatry

IS - 12

ER -

Corticosteroid treatment of multiple sclerosis relapses is associated with lower disability worsening over 5 years

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Keywords

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