Wednesday, 7 November 2012

Research: time to secondary progression after DMT

Epub: Tedeholm H et al. Time to secondary progression in patients with multiple sclerosis who were treated with first generation immunomodulating drugs Mult Scler [Epub doi:10.1177/1352458512463764]

Background: It is currently unknown whether early immunomodulatory treatment in relapsing–remitting MS (RRMS) can delay the transition to secondary progression (SP).

Objective: To compare the time interval from onset to SP in patients with RRMS between a contemporary cohort, treated with first generation disease modifying drugs (DMDs), and a historical control cohort.

Methods: We included a cohort of contemporary RRMS patients treated with DMDs, obtained from the Swedish National MS Registry (disease onset between 1995–2004,n = 730) and a historical population-based incidence cohort (onset 1950–64, n = 186). We retrospectively analyzed the difference in time to SP, termed the “period effect” within a 12-year survival analysis, using Kaplan-Meier and Cox regression analysis.

Results: We found that the “period” affected the entire severity spectrum. After adjusting for onset features, which were weaker in the contemporary material, as well as the therapy initiation time, the DMD-treated patients still exhibited a longer time to SP than the controls (hazard ratios: men, 0.32; women, 0.53).

Conclusion: Our results showed there was a longer time to SP in the contemporary subjects given DMD. Our analyses suggested that this effect was not solely driven by the inclusion of benign cases, and it was at least partly due to the long-term immunomodulating therapy given.

The results indicate that if you take the first line DMT such a beta interferon and glaterimenr acetate, there is a slowing of the rate at which secondary progressive MS starts. One would imagine that if we get results from the new generation of DMT then this effect will be even more striking. Therefore further reason to ensure that you are taking a DMT if this treatment option in appropriate for your MS.


  1. I'm waiting for Sam Trucker to throw rose petals at the feet of this report.

  2. Does it need rose petals? This is a positive endorsement for those who promote DMTS - it delays the time to SPMS which is one of the most important of all outcomes as it is SPMS that is responsible for most permanent disability in MSers. The report only looks at a 12 year period from onset but it tells us that in treated cases there is an c. 70% probability of remaining 'non-SPMS' after this time compared with c. 50% in older, untreated cases.


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