Death and MS

E&E; early and effective. Why wait and why mess around with low efficacy DMTs? #MSBlog #MSResearch

Scalfari A, Knappertz V, Cutter G, Goodin DS, Ashton R, Ebers GC. Mortality in patients with multiple sclerosis. Neurology. 2013; 81:184-192.


Mortality in MSers is significantly increased compared with the general population. Many questions concerning survival in MS are still unanswered due to the difficulty of comparing information collected at different times and in different geographic areas. 

The increasing incidence of MS, the improvement in care of the chronically disabled, and different methodologies may explain the lack of coherence among studies' results. Reported times to death from birth and from disease onset/diagnosis are highly variable. 

MSers older at onset or with primary progressive course have shorter survival; however, data on sex and mortality are contradictory. Changes in sex ratio in MS over time represent one possible explanation. 

MS is the main cause of death in ≥50% of MSers and the incidence of deaths not due to MS varies among countries. Particularly, suicide is substantially increased in MSers, and, despite its varying incidence, mainly due to "cultural bias," it should be considered an MS-related cause of death. 

Recent results of the long-term follow-up study of interferon-β-1b demonstrated a significant reduction of mortality among treated MSers. 

Notwithstanding its long latency, mortality is therefore an unambiguously valid long-term outcome in randomized controlled trials. 

It usefully combines the net impact of treatment efficacy on longevity and adverse events, which may reduce it.



"I didn't think I would live to see the day when Professor George Ebers would admit that DMTs in MS are effective and reduce mortality. What he is referring to is the very clear data that starting interferon-beta three years early reduces the chances of dying at 21 years by 47%."

"Death is equivalent to EDSS 10 if interferon-beta reduces your chances of reaching EDSS 10 it also reduces your chances of getting to EDSS 6 (stick), EDSS 7 (wheelchair) and EDSS 8 & 9 (bed)."

"If interferon-beta, which is only a moderately effective DMT can do this imagine what a highly effective DMT could achieve?"

"Another message that is loud and clear from this data is to start treatment early without a delay; if 3 years can make such a difference why wait?"

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