Friday, 14 August 2015

Relapses after withdrawal of CRAB drugs

Treatment withdrawal in relapsing-remitting multiple sclerosis: a retrospective cohort study. Eur J Neurol. 2015. doi: 10.1111/ene.12790. [Epub ahead of print] Lus GSignoriello EManiscalco GTBonavita SSignoriello SGallo C.

BACKGROUND:To investigate the effect of drug withdrawal on the course of relapsing-remitting multiple sclerosis (RR-MS).
METHODS:An observational cohort retrospective study was performed to compare the time to relapse of patients who discontinued disease-modifying therapy (1a or 1b beta-interferons or glatiramer acetate) with the patients who did not. One hundred and twenty-eight RR-MS patients were investigated using a time-dependent approach.
RESULTS:Over a median follow-up of 108 months, 60 patients discontinued treatment and 89 relapses were observed. The time to relapse was shorter in patients who discontinued treatment compared with those who did not (P < 0.001), median times being 31.1 months (95% confidence interval 10.4-50.8) and 85.8 months (95% confidence interval 58.6-106.3), respectively, whilst the baseline covariates (gender, Expanded Disability Status Scale at diagnosis) did not significantly affect the prognosis.
CONCLUSIONS:It was found that stopping treatment strongly reduces the time to relapse and this information may be useful in patient management.

Well the conclusion is a bit of an under statement and if it is not obvious that you should be on treatment than getting nothing, we only have to say wake-up and smell the roses people!! 

If you stop treatment you are at a greater chance of having further attacks. Is this just natural history against rebound with a vengence that can occur after natalizumab cessation? The incidence of relapse often decreases over time and so it took a while before relapses returned. 

I wonder what this says on the need to be injecting daily with some drugs could it be weekly or longer. However, these drugs induce NEDA in some people, but if they don't get yourself onto something that is going to stop your relapses

CoI None

2 comments:

  1. MD, is there a threshold effect to this based on the level of immunosuppression?

    ReplyDelete

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