Saturday, 29 September 2012

Research: predicting efficacy of interferon-beta

Epub: Sormani et al. Scoring treatment response in patients with relapsing multiple sclerosis. Mult Scler. 2012 Sep 25.

BACKGROUND: Clinical and MRI) measures in combination, to assess patient responses to interferon in multiple sclerosis.

OBJECTIVE: To optimize and validate a scoring system able to discriminate responses to interferon treatment in RRMSers.


METHODS: The analysis included two large, independent datasets of RRMSers who were treated with interferons that included 4-year follow-up data. The first dataset ("training set") comprised of 373 RRMSers from a randomized clinical trial of subcutaneous interferon beta-1a. The second ("validation set") included an observational cohort of 222 RRMSers treated with different interferons. The new scoring system, a modified version of that previously proposed by Rio et al., was first tested on the training set, then validated using the validation set. The association between disability progression and risk group, as defined by the score, was evaluated by Kaplan Meier survival curves and Cox regression, and quantified by hazard ratios (HRs).

RESULTS: The score (0-3) was based on the number of new T2 lesions (>5) and clinical relapses (0,1 or 2) during the first year of therapy. The risk of disability progression increased with higher scores. In the validation set, MSers with score of 0 showed a 3-year progression probability of 24%, while those with a score of 1 increased to 33% (HR = 1.56; p = 0.13), and those with score greater than or equal to 2 increased to 65% (HR = 4.60; p < 0.001).

CONCLUSIONS: The investigators report development of a simple, quantitative and complementary tool for predicting responses in interferon-treated MSers that could help clinicians make treatment decisions.




"Is this something you want? It is related to the recent discussions on disease-activity free status in trying to predict who responds to treatment or not! This is a discussion that should be happening. You  should ask your neurologists to set a target and aim for that; i.e. treat-to-target or TOT. This is a concept the rheumatologists use that we should adopt. TOT was discussed at the Cleveland meeting and there was a general consensus that we should adopt the concept in MS."

2 comments:

  1. First time i heard of Treat to Target and I doubt if it's workable
    Suppose you set a target and don't reach the aim. The ideal next treatment may not exist. If it exists it may not be covered by your insurance/approved by NICE/available in your country/etc

    ReplyDelete
  2. The next term is NED - no evidence of disease! This is what oncologists use. In MS we would say NEDA or "no evidence of disease activity".

    ReplyDelete

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