Monday, 24 September 2012

Do relapses count if you are on a DMT?

Bosca et al. Effect of relapses over early progression of disability in multiple sclerosis patients treated with beta-interferon. Mult Scler. 2008 Jun;14(5):636-9.

DESIGN: Observational study designed to explore the effect of demographical variables and number of relapses over the disability progression in the two first years of beta-interferon treatment for multiple sclerosis. 

RESULTS: 162 MSers treated with beta-interferon for at least two years were included, 70.9% females, mean age 33.4 years, mean disease duration 75.1 months, mean EDSS 2.4, previous year relapse rate 1.3. Main end-point was defined as a sustained EDSS increase (1.5 if previous EDSS 0-2.0; 1.0 if previous EDSS 2.5-4.0; 0.5 if previous EDSS 4.5 or higher). 62.3% of MSers presented one or more relapses and 32.7% of MSers reached sustained disability increase. The univariate and multivariate Cox regression analysis only showed statistical significance for the relapses in the two first years after the treatment (HR 1 relapse: 3.4, p = 0.05; HR > or = 2 relapses: 4.3, p < 0.001). The Kaplan-Meier survival analysis showed a higher probability of EDSS progression for MSers with one relapse (log rank 10.9, p = 0.02) and with > or = 2 relapses (log rank 17.7, p < 0.001), with no differences between them (p = 0.38). 

CONCLUSION: MSers with one or more relapses in the first two years of interferon treatment developed an earlier sustained progression of the disability.


"This study supports other data sets that relapses on DMTs are not good for you. MSers rendered relapse free do much better than those who continue to have attacks. Therefore if you are on a DMT and continue to have relapses you should ask your neurologist whether or not you should be switched to another therapy."

"More importantly, these data question the hypothesis that relapses don't count. They clearly do if you go onto interferon-beta and continue to have them."

2 comments:

  1. I get the impression now that DMTs and post-inmflammatory stages of MS do not match up. These drugs are working on the immune syastem (in the body), whereas post inflammatory MS is all about what happens in the brain (brain cells).

    I almost fel like to be a RRMSers is like holding one's breach and clenching the eyes shut hoping these modern DMTs stave off SPMS.

    We don't know for sure if any of this will work out. What we need are drugs that have an impact on established progression. That way we will have a real result.

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  2. I am convinced of the need for a complete remission of the disease. I want to believe in the drug free remission

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