Sunday, 4 October 2015

Cognitive problems predict decline

Moccia M, Lanzillo R, Palladino R, Chang KC, Costabile T, Russo C, De Rosa A, Carotenuto A, SaccĂ  F, Maniscalco GT, Brescia Morra V.Cognitive impairment at diagnosis predicts 10-year multiple sclerosis progression. Mult Scler. 2015. pii: 1352458515599075. [Epub ahead of print}

BACKGROUND:Cognitive impairment occurs from the early phases of multiple sclerosis (MS), and more frequently affects secondary progressive (SP) subjects than relapsing-remitting (RR).
OBJECTIVE:To investigate relationships between cognitive dysfunctions in newly diagnosed RRMS, and long-term MS-related outcomes.
METHODS:The present 10-year retrospective longitudinal study included 155 RRMS subjects, tested with the Rao Brief Repeatable Battery at MS diagnosis. The reaching of Expanded Disability Status Scale (EDSS) 4.0, and the SP conversion were recorded.
RESULTS: 67 subjects (43.2%) reached EDSS 4.0, and 34 subjects (21.9%) converted to SP during a follow-up period of 10.0±1.8 years. Subjects with cognitive impairment at diagnosis had a rate of reaching EDSS 4.0 more than three times greater (p<0.001; HR=3.183), and a rate of SP conversion more than two times greater, as compared to cognitively preserved subjects (p=0.008; HR=2.535). In particular, better scores in the Selective Reminding Test-Delayed Recall and in the Symbol Digit Modalities Test at baseline were associated with lower SP conversion rates during the follow-up period (p=0.018; HR=0.835; and p=0.001; HR=0.941, respectively).
CONCLUSION: Cognitive impairment, with particular involvement of processing speed and memory, predicts disability progression and SP conversion in newly diagnosed RRMS, highlighting the importance of cognitive assessment from the beginning of MS.


I guess it is not rocket science but this study says if you have cognitive impairment early in disease, you have a poorer outlook for the future, likewise there are many studies saying if people have lots of relapses early in disease had a poorer outlook too.  

So during the time UK-based Neuros are "waiting and seeing" to keep NICE happy,  its your brain being shredded, especially early when disease is often more active chomping on the cognitive and movement reserve. By the time you notice there is a problem maybe up to 80% of that reserve is gone, whilst waiting for MS to show itself. In the mice the first attack wipes out 15% of the nerves it is hardly noticed second attack another 5% goes as you start to see it another attack and another 5% goes, 40% gone and relapses burn out loose 0.1% now and you know big time as the reserve is gone.

Sadly to me it is economics and not biology due system we have allowed to generate. If there was an effective low cost alternative, to the current block buster, which there could be if people had a spine to stand up to the broken system or the power to change this, which is driving cost-based rationing, then could practice change?

In a couple of years that may change as patents on chemical DMT expire, but Copaxone patents were kept alive for 40 years....hats off to Teva  Lawyers. 

Are we happy that the UK has almost the worse uptake of DMT in Europe?  Should we be more like Australia and now New Zealand and do early and effective and not sit on our bums and wait.

Whats in the brain health policy document, get it on tuesday

5 comments:

  1. Actually what I realize it is not a concern that "DMT's are effective or not" but "what it will cost in monetary terms these treatments offered" ... Pharma tries to "boot until the last strand of hair" in the prices of their drugs offered, of course under the justification that the capital invested heavily in developing their drugs. Except that unless it's MSers "millionaires" the vast majority of us do not have to bear too expensive treatments and in the case of the CRABS are expensive given the low efficacy that presentation. It is then that enters the state paying for part or all of the high cost of treatments for MS, but the State always finds a way to "control your spending" and then the vicious circle never ends. Pharma does not want to "drop the bone" but there will come a time when this vicious circle will be broken ...So I'm all in favor of more effective off-label therapy, in particular Cladribine, be administered as soon as possible in order to prevent irreversible damage to the moment ...

    ReplyDelete
    Replies
    1. The costs from pharma are now ot really based on their cost of R & D, it is what the market will pay or in the UK (NICE) will pay.

      Delete
    2. Agree with Cinara "I'm all in favor of more effective off-label therapy, in particular Cladribine"
      Since I'm not in Europe, off-label therapy is possible. But it will be a task finding a doctor who is willing to prescribe

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  2. The viscous circle must be broken. You guys (MD ProfG etc) are advocating early treatment but the cost is too much so NICE say 'lets play play wait and see'. It would be a win-win-win if Pharma dropped their prices and NICE advocated treat-treat-treat. Mayne I'm being too naive

    Incidentally Is off-label therapy efficient or a possibility?

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    Replies
    1. Off label is not a possibility in Europe if you are targeting RRMS. The position is, if there is a licenced therapy for the indication this is what should be used. if you do not do this (a) Pharma may sue the NHS trust e.g. Novartis and the Avastin/Lucentis case for AMD or the neuro may be exposed insurance wise, so if anything went wrong they could be liable. Therefore it is unlikely to happen.

      So the only way to develop a drug, is to do it just like pharma do it, as you shouldn't have a two ruled system.

      However, it could be a possibility to do this for a cheap effective drug if there was a really the will in the system to do this....sadly I am ashamed by to say there isn't enough will by the people in power and current system is stacked against something like this.

      Maybe Harry Potter could weave some magic

      The UK is an important place for MS, but it is really the USA and rest of Europe that calls the shots in terms of what are the costs

      Delete

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