Time is brain. Do you agree or not? #MSBlog #MSResearch
"I was invited to give a clinical talk on MS at a regional neuroscience centre in the South-East of England this week; Hurstwood Park. I spoke on the paradigm shift in treatment goals and discussed three aims of treatment: (1) early treatment, (2) highly-effective treatment and (3) the advantages that a true induction therapy offers over a maintenance therapy. I went through the scientific rationale of treat-2-target of NEDA (no evident disease activity) and why we need to adopt a zero tolerance strategy. I think most people at the meeting thought I was an outlier. I may be an outlier in the UK, but would sit firmly in the middle of the pack if I worked in the USA. Being an outlier is one thing, but neurologists need to ask themselves question what would they want if they had MS or a loved one of theirs had the disease. Would they be happy to live with a sub-optimal treatment response and have smouldering MS? Smouldering MS shreds your brain and sets you up for getting progressive disease. I think the most compelling data to support a more aggressive approach to MS treatment is recent brain atrophy data. Brain atrophy is the best integrator of end organ damage and if you can normalise brain atrophy rates in MSers you are giving that individual the best chance of remaining healthy and of ageing normally. We forget that MSers are as susceptible age-related cognitive decline as the general population. What protects us from the latter is brain health. Why shouldn't MSers have brain health? It is interesting that the only drugs that normalise brain atrophy rates in year two are the most effective ones; i.e. natalizumab and alemtuzumab, with fingolimod close behind. I exclude year 1 atrophy rates as they are all over the place and susceptible to the phenomenon of pseudoatrophy. This is why we have to rebaseline MSers on DMTs with MRI to reset the clock for comparison."
"As usual I discussed how bad MS can be at a personal level (unemployment, divorce, suicide, depression, quality of life, mortality, cognitive impairment, dementia, etc.) and at a socio-economic level for society (costs. loss of productivity, etc). This negative aspects of MS has to be stressed whenever there is a discussion about personal choice and risks vs. benefits of treatment."
"The study below is an interesting one; it shows that despite interferon-beta only being a moderately effective DMT it does improve the quality of life of MSers. I suspect this is because practice has changed since the interferons were first launched and that we now migrate treatment failures off interferons onto other agents. Therefore clinical practice now enriches for responders to interferon-beta. It is a pity we can't predict who is going to turn out to be a responder. We would not have to take a chance of waiting to see who does well on treatment or not. The waiting game can take anything up to 2 years and possibly more. Two years with a shredder in your head is not trivial. We now know that time lost waiting for an effective therapy is time lost; in short time is brain. Not everyone agrees with me when I say this."
Patti et al. Interferon-beta-1a treatment has a positive effect on quality of life of relapsing-remitting multiple sclerosis: Results from a longitudinal study. J Neurol Sci. 2013 Dec 26. pii: S0022-510X(13)03077-3.
PURPOSE: The impact of interferon beta (IFNβ) therapy on a patient's quality of life (QoL) has not been completely clarified. This multicenter, independent, observational and longitudinal study was aimed to evaluate the impact of different pharmaceutical formulations of IFNβ-1a on QoL in MSers affected by relapsing-remitting multiple sclerosis (RRMS).
METHODS: The multiple sclerosis quality of life-54 questionnaire was used to assess patients' QoL.
RESULTS: 394 (66%) MSers completed the two-year study; 152 were treated with IFNβ-1a i.m. weekly injected (group a), 152 with IFNβ-1a 44μg s.c. injected three times a week (group b) and 90 were untreated (group c). After two years, a significant increase was found in the physical health composite score (Δ=+3.1 in group a, Δ=+3 in group b, p<0.05 in both), mental health composite score (Δ=+4.7 in group a, Δ=+5.5 in group b, p<0.001 in both), in eight MSQoL sub-items of group a and in seven sub-items in group b. Conversely, the untreated group showed a slight decrease in seven domains. The variable "therapy with DMDs" was associated with improved QoL.
CONCLUSION: QoL of RRMS could be improved by IFNβ-1a treatment, despite natural history data which seem to demonstrate that QoL could get worse over the time.
Labels: Beta Interferon, NEDA, treat-2-target, zeto