Title : The management of relapses in relapsing-remitting multiple sclerosis from 2014 to 2024: A systematic review
Abstract:
Background: Multiple Sclerosis (MS) is an inflammatory condition associated with the demyelination of axons. The inflammatory phase of MS is named “relapse”, and the following recovery phase is named “remission”. The MS which cycles between relapses and remissions is referred to as Relapsing-Remitting MS (RRMS). Each relapsing incident will produce axonal irreversible damage known as degeneration, and the amount of axonal irreversible axonal damage is determined by the relapse severity, duration, and the speed of intervention. If a relapse does not receive prompt and correct intervention, it can cause an irreversible damage changing RRMS to Secondary Progressive MS. This progression causes accumulation of physical, cognitive, and psychological disability, quantified by the Extended Disability Severity Scale (EDSS). Optimal management for MS relapse (MSR) hopes to prevent the accumulation of disabilities, keep the EDSS of a patient low, and delay or even prevent the progression of MS.
Aim: The aim of this study was to systematically review the management of relapses in Relapsing-Remitting MS from 2014 to 2024.
Methods: Three databases, Medline, EMBASE, and Cochrane Library, were systematically searched for peer-reviewed studies from 2014 to 2024, adhering to a pre-determined search strategy. These studies were accessed through the University of Warwick Library Catalogue. 10 papers remained following criteria-driven screening. Risk of bias was assessed using JBI Critical Appraisal Tools’ checklists. Data was extracted and analysed using Synthesis Without Meta-Analysis (SWiM), due to heterogeneity between the studies.
Results: IV Methylprednisolone (IVMP), Therapeutic Plasma Exchange (TPE), Immunoadsorption (IA), Repository Corticotropin Injection (RCI), and rHIgM22 were all found to improve their measured outcomes. IVMP was found to be effective in improving EDSS of relapse patients, though blood glucose may affect its efficacy. TPE, IA and RCI were all found to be effective in treating MSR and steroid-refractory MS relapse (SRMSR). rHIgM22 decreased EDSS in all treatment groups, however this was not significantly different to the placebo group, whose EDSS also decreased.
Conclusion: This study records the advances in the management of MSR from 2014 to 2024. TPE, IA, and RCI were found to be valid management options for MSR, though deeper understanding is required to compete with IVMP. rHIgM22 is not currently a viable management option. Further research into rHIgM22 is needed.
