Predictors of long-term disability accrual in relapse-onset multiple sclerosis.Jokubaitis VG, Spelman T, Kalincik T, Lorscheider J, Havrdova E, Horakova D, Duquette P, Girard M, Prat A, Izquierdo G, Grammond P, Van Pesch V, Pucci E, Grand'Maison F, Hupperts R, Granella F, Sola P, Bergamaschi R, Iuliano G, Spitaleri D, Boz C, Hodgkinson S, Olascoaga J, Verheul F, McCombe P, Petersen T, Rozsa C, Lechner-Scott J, Laura Saladino M, Farina D, Iaffaldano P, Paolicelli D, Butzkueven H, Lugaresi A, Trojano M; MSBase Study Group. Ann Neurol. 2016 . doi: 10.1002/ana.24682. [Epub ahead of print]
OBJECTIVE:To identify predictors of ten year expanded disability status scale (EDSS) change after treatment initiation in patients with relapse-onset MS.
METHODS:Using data obtained from MSBase, we defined baseline as the date of first injectable therapy initiation. Patients need only have remained on injectable therapy for one day and were monitored on any approved disease modifying therapy, or no therapy thereafter. Median EDSS score changes over a 10-year period were determined. Predictors of EDSS change were then assessed using median quantile regression analysis. Sensitivity analyses were further performed.
RESULTS: We identified 2,466 patients followed up for at least 10 years reporting post-baseline disability scores. Patients were treated an average 83% of their follow-up time. EDSS scores increased by a median 1 point (interquartile range 0-2) at 10 years post-baseline. Annualised relapse rate was highly predictive of increases in median EDSS over 10 years (coeff 1.14, p=1.9x10-22 ). On therapy relapses carried greater burden than off therapy relapses. Cumulative treatment exposure was independently associated with lower EDSS at 10 years (coeff -0.86, p=1.3x10-9 ). Furthermore, pregnancies were also independently associated with lower EDSS scores over the 10 year observation period (coeff -0.36, p=0.009).
INTERPRETATION: We provide evidence of long-term treatment benefit in a large registry cohort, and provide evidence of long-term protective effects of pregnancy against disability accrual. We demonstrate that high-annualised relapse rate, particularly on-treatment relapse, is an indicator of poor prognosis.
Today it seems like Slim Shady's mate is back after a lay-off, but the break does seem to have improved the music and the same old tones are being sung.
As usual, it looks like DrDre is full of rap spelt with a captial C and that anti-DMT/pharma mantra does not seem to be supported by the real world.
So what better to get that lower lip on the floor more than abit of evidence and a happy post to welcome Dre back.
So if you have relapses it is a predictor of your disability in the future. Don't have relapses and then maybe disability will not develop but if you are relapsing on therapy then it is worse news if you are not on therapy so maybe we need to change therapy if they are not working propertly.
What's the non pharma (Dre?) solution.....keep em pregant dude?
Only joking "we missed you babes:-)"