Article of interest (11): relapses not linked to progression

Confavreux et al. Relapses and progression of disability in multiple sclerosis. N Engl J Med. 2000 Nov 16;343(20):1430-8.

BACKGROUND: The influence of the patterns of onset of MS and relapses of the disease on the time course of irreversible disability is controversial.

METHODS: In 1844 MSers who were followed for a mean (+/- SD) of 11 +/- 10 years, they determined the time of the clinical onset of the disease, the initial course (relapsing-remitting or progressive) and the subsequent course (relapsing-remitting, secondary progressive, or primary progressive), the times of relapses, the time to the onset of irreversible disability, and the time course of progressive, irreversible disability. They used three scores on the Kurtzke Disability Status Scale (range, 0 to 10, with higher scores indicating more severe disability) as measures of the severity and progression of disability: a score of 4 (limited walking ability but able to walk for more than 500 m without aid or rest), a score of 6 (ability to walk with unilateral support no more than 100 m without rest), and a score of 7 (ability to walk no more than 10 m without rest while leaning against a wall or holding onto furniture for support). They used Kaplan-Meier analyses to determine the influence of relapses on the time to the onset of irreversible disability.

RESULTS: The median times from the onset of MS to the assignment of a score of 4, a score of 6, and a score of 7 on the disability scale were longer among the 1562 MSers with a relapsing-remitting onset of disease (11.4, 23.1, and 33.1 years, respectively) than among the 282 MSers who had progressive disease from the onset (0.0, 7.1, and 13.4 years, respectively; P<0.001 for all comparisons). In contrast, the times from the assignment of a score of 4 to a score of 6 were similar in the two groups (5.7 and 5.4 years, P=0.74). The time course of progressive, irreversible disease among patients with the primary progressive type of multiple sclerosis was not affected by the presence or absence of superimposed relapses.

CONCLUSIONS: Among MSers, relapses do not significantly influence the progression of irreversible disability.

"The graphs show that the rate of progression in MSers with and without relapses occurs at the same rate. The graph on the left is from EDSS 4 and the right from EDSS 6. Importantly, the presence of absence of supreimposed relapses did not affect the course of progressive disease. Therefore will switching off relapses at these stages of MS affect the progressive course? Unlikely! What is needed once progression starts are drugs that are neuroprotective; i.e. the protect nerves and axons from dying."

Other articles of interest on this blogThis series of articles highlights landmark discoveries in the field of MS; in scientific jargon citation classics!

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