Tuesday, 10 May 2016

Relapses are not good for you

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:-)"

7 comments:

  1. I am too old to stay or get pregnant. Perhaps Microsoft, Google, Apple and Boeing International can come up with "Robo Fetus" that just kinda sits there. It could fool my biologics (or lack thereof) into thinking I am pregnant and give me a kick or two when its close to need of a recharge of the lithium battery.

    Then maybe I could sit on a recharge pad like that for the phones.

    Perhaps it could also come with expansion packs, male, female, alien as well as a prescription for Lithium :)

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    Replies
    1. Lady in India in the news today, aged 72 had her first child by IVF. Her husband is 79. I'm in my early 40's, perhaps it's not too late for me to get pregnant after all.

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    2. Psychologists often say one's first thought is the one to choose.

      My first thought on your post is from Jet.com commercials where peoples cranium explodes and purple dust comes out :)

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  2. I did not know MSBase even existed... Learn something new all the time here!

    Thanks so much for sharing this article, not sure how I missed publication but apparently I did.

    "I'm singing in the rain... just singing in the rain... What a glorious feeling I'm soaked to the gills again..."

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  3. lol i don't disagree with you or the research findings. I'm all for DMTs and my partner has chosen the high efficacy route straight after diagnosis.

    But as you know, MSbase is a database bought off the pharma and funded by the pharma.... :D

    I'm not a believer in conspiracy theories. But the subtle effect that money, power, acceptance and belonging has on human psyche means that doctors aren't evil bad people who set out to hurt their patients by being friends with pharma - instead, they're generally good people who don't or won't believe that pharma is impacting their thought processes.

    When Barts prescribes Tysabri or Gilenya to patients, does Barts discuss the possibility of rebound effect or how to transition off those drugs with their patients? Australian neuros I've consulted haven't... ie. they don't raise the issue. Then they go to the internet or forums and learn about all sorts of things their neuro didn't tell them about. Then they get disgruntled with their neuro and bit by bit lose more and more trust in the neuro...

    Bojana

    ReplyDelete
    Replies
    1. You have to get one of the neuros to answer this.


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  4. I remembered the clinical trial that evaluated the use of Copaxone associated with Estradiol, and that in theory failed, showed no change in annual relapse within two years...

    So is it really what enables constant immunosuppressant status during pregnancy is, that we known well, to the Human Chorionic Gonadotropin (HCG)?

    Some studies have evaluated the use of HCG in women with MS, as therapy for the disease?!

    Well, of course as a hormone and the constant use of HCG will have adverse side effects ... actually like everything in this life ...

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