Friday, 27 December 2013

Progression slower than expected

Pandey KS et al. Clinical course in multiple sclerosis patients presenting with a history of progressive disease Mult scler Rel Dis 2013 2:67-71


Objectives: Determine the likelihood of worsening clinical status in the near-term course of progressive MS and evaluate the predictive validity of our diagnostic impression of progressive forms of MS.
Methods:Retrospective review of charts from 175 patients seen between 2000 and 2007 who were diagnosed with either primary or secondary progressive multiple sclerosis. Data extracted included demographic factors, neurological examination findings to determine EDSS, timed 25 foot walk (T25FW) when available, duration of symptoms, clinical course as documented on initial visit, and history of disease-modifying agent (DMA) use. Significant change in EDSS was defined as a change of one point or more from initial to final clinical evaluation. Significant change in T25FW was defined as a ±20% difference from baseline.
Results:Of the 175 charts reviewed, 35 patients met criteria and had sufficient documentation to allow for EDSS abstraction. Twenty-four patients (68.6%) showed no significant change in EDSS from baseline while eleven patients (31.4%) worsened and none improved. For those patients that had T25FW data available, 6 out of 20 (30%) patients worsened while 11 (55%) showed no change. Three patients (15%) improved.
Conclusion:In this observational study at a tertiary care MS centre, patients classified as progressive MS did not progress as often, or as rapidly, as previous studies have suggested. Greater than two-thirds of patients in this cohort, did not increase 1 step on the EDSS.

About 70% of progressive MSers did not progress within the observation period in EDSS and for walking it was 55% . The cupid trial had problems because progressive Msers did better than predicted. I wonder if this relates to being in an age of DMT that slows damage accumulation and maybe healthier life styles. Who knows?

6 comments:

  1. "....and history of disease-modifying agent (DMA) use."

    It looks like they have the data available to evaluate if treatment has an effect over the long term in progrssive ms.

    More evaluations of this type are needed to investigate if DMD's have an effect on progressive disease since the two year trial is useless.

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  2. MD, Do you disagree that brain atrophy is strongly correlated to the long term disability? If not, I guess you should advocate the use of DMT's with significant effect on brain atrophy instead of focusing too much on ARR measures.

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    1. I think long term effect on brain volume is the most important factor which was why I chose Copaxone:

      http://www.ncbi.nlm.nih.gov/m/pubmed/21920559/

      I know no one on this blog thinks it is of any value since it has a moderate impact on ARR at two years, which is their measure of effectivness. But from the above study, your brain atrophy rate meets or approaches that of a healthy person after 5 years. Again, I don't work for Teva but I am so glad this drug is available to me. Everytime I read more about it, the daily shots become insignificant.

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    2. Wrong...ARR. This not my measure of effectiveness.
      Prof G may do something on atrophy.

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  3. I dont disgree
    should i besinging praises of sommething

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    1. MD, a bit curious why you in that case are so negative to Laquinimod?

      If you really agree that brain atrophy is the most important driver of long-term disability, how come you always refer to ARR scores and not what really matters?

      If risk-benefit is considered, I suppose nothing is near Laquinimod with regards to slow down of brain atrophy and disability progression.

      Appreciate your comments if I perhaps get you wrong.

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