Monday, 11 March 2013

Research: quality of life and the risk of progression

#MSBlog: Poor health-related quality of life predicts a poorer prognosis in MS. Let's change this!

Tepavcevic et al. Predictive value of health-related quality of life in progression of disability and depression in persons with multiple sclerosis: a 3-year study. Acta Neurol Belg. 2013 Mar 5. 


Background: This study examined whether health-related quality of life (HRQoL) could predict changes in disability, depression, and fatigue in MSers over a 3-year follow-up period. 

Methods: A group of 109 consecutive MSers (McDonald's criteria) referred to the Institute of Neurology, Belgrade were enrolled in the study. At two time points during the study (baseline, and after a 3-year period) an HRQoL (measured by MSQoL-54), EDSS, Hamilton Rating Scale for Depression (HDRS) and Fatigue Severity Scale (FSS) were assessed. 

Results: At the end of a 3-year follow-up, 12 out of 109 MSers (11 %) had dropped out. Multiple linear regression analysis showed that Physical Health scale of MSQoL-54 is significant independent predictor of change in EDSS after 3 years (p = 0.035). Mental health composite score of MSQoL-54 was predictor of change in HDRS score (p = 0.049). In separate regression analysis, only social function was independent predictor of the development of depression (p = 0.041). None of the HRQoL domains had predictive effect on the change of FSS. 

Conclusions: This study indicates that baseline HRQoL scores, measured by MSQoL-54, could be applied as a prognostic marker for progression of both, disability, and severity of depressive symptoms in MS.

"Are you surprised by this result? I am not. Baseline quality of life (QoL) measures predict future progression of disability. MSers with poor baseline QoL are more likely to have active or progressive MS and hence this result is not unexpected. It will be interesting to see that as we move into the era of personalised medicine with more effective disease-modifying therapies (DMTs) that will increasingly allow us to treat-2-target of NEDA (no evidence of disease activity) if we will be able to change this observation? I am becoming increasingly confident we can! MSers with highly active RRMS treated early and aggressively and rendered free of disease activity (NEDA) are doing very well. Yes, very well; much better than you would expect from natural history data."


"Is it time for a zero-tolerance strategy in relation to inflammation? A lot of my colleagues are already adopting this approach; particularly in the USA were there is no limitations on prescribing apart from being insured or able to afford the DMTs! American neurologists don't have a prescribing doughnut to fill."


Other posts of interest in relation NEDA

12 Feb 2013
At present NEDA is defined using a composite of a) no relapses, or b) no EDSS progression, or c) no MRI activity (new or enlarging T2 lesions or no Gd-enhancing lesions) (Havrdova, Galetta et al. 2009; Giovannoni, Cook et ...
08 Jan 2013
Treat-2-Target: NEDA (no evidence of disease activity). "I would appreciate your comments on the following beta version of a treatment or monitoring algorithm for relapsing MSers. The idea is to adopt the strategy of ...

8 comments:

  1. Zero-tolerance? I am not sure my neurologist would buy into this strategy.

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  2. Prof G,

    "I am becoming increasingly confident we can! MSers with highly active RRMS treated early and aggressively and rendered free of disease activity (NEDA) are doing very well. Yes, very well; much better than you would expect from natural history data."


    I love this shift - which is commonsense. Why would anyone want any inflammation in their brain / spinal cord? I was someone with highly active RRMS and am so grateful that I got Alemtuzumab. 6 years after my 2nd infusion - completely stable (on MRI, disability and no relapses). Similar to two others I met when I got my treatment. My biggest regret - not getting sooner. I still have deficits from the bad relapses (prior to treatment). Are these with me forever? I've become greedier - initially stopping relapses was all I wanted. I see that they can make teeth from stems cells. Not sure if any repair treatments coming the future might be beneficial for someone like me - describe myself as RRMS in long-term remission. Keep up the good work.

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  3. This post is such garbage. The MS barons are taking credit for an individual's good fortune. If things are working out then they say it's the DMTs that are controlling MS, but if the MSer develops progression despite being on expensive DMTs then the MS barons argue the individual went on the medicines too late. Either way they get paid.

    Relapses and progression are different processes at play. This blog is simply peddling out propaganda to brainwash people into embracing drugs. They even posted a report today on how spasticity can only be effectively treated with drugs instead of physiotherapy, which is nonsense when you consider how mind/ personality-altering such drugs are. Anti-spasticity drugs are turning MSers into zombies whilst DMTs are effectively killing them in many cases.

    It is all about making cash money. We're in a ticking time bomb situation where we'll realise new DMTs are simply working on relapses and never stopped progression from activating.

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    Replies
    1. Anonymous Monday, March 11, 2013 4:30:00 pm.

      What if you are wrong? They drug peddlers may be right. I like the concept of zero-tolerance; I don't want inflammation in my brain. Who would?

      Delete
    2. "This post is such garbage".- Thanks for the constructive criticism!

      "Relapses and progression are different processes at play."- Nobody here has suggested anything different BUT if we stop relapses early enough can we at least significantly slow progression? I think we can but we also need to consider neuroprotective therapies as a belt and braces approach.

      "Anti-spasticity drugs are turning MSers into zombies" Agreed. Many MSers hate the current anti-spastic medications such as Baclofen, which is why we are working hard on developing a treatment that will not have these negative side-effects.




      Delete
    3. ... and how is your Zamboni procedure treating you? Are you now cured?

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  4. " I think we can but we also need to consider neuroprotective therapies as a belt and braces approach"

    Give us the facts md2 ;)

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  5. "American neurologists don't have a prescribing doughnut to fill."

    Just wait till Obamacare kicks in. They will have all the "good" things of most of the european systems. Collectives, Commissions, Boards who will tell you what is best for you.

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