Wednesday, 20 July 2016

The Trajectory of MS..Is an MS nurse the best MS DMT?

Hum S, Lapierre Y, Scott SC, Duquette P, Mayo NE.Trajectory of MS disease course for men and women over three eras.Mult Scler. 2016 Jun 30. pii: 1352458516655478. [Epub ahead of print]

Background: Heterogeneity in disease course exists within multiple sclerosis (MS) subtypes.
Objective: The objective was to estimate disease course heterogeneity over three distinct onset periods (pre-1995, 1995–2004, and 2005–present) for men and women.
Methods: Group-based trajectory model (GBTM) was used to estimate clusters of patients following stable or unstable disease progression trajectories based on the Expanded Disability Status Scale (EDSS). Inception cohorts were generated from the Montreal Neurological Institute MS Clinic registry. Stable trajectories were defined as an EDSS ⩽3.0 and change ⩽1 point over the study period. Annualized relapse rate (ARR) based on the first 5 years of disease was an explanatory variable.
Results: Proportion of women classified as stable was 0% for pre-1995, 69.0% for 1995–2004, and 83.9% post-2005; for men, these proportions were 18.4%, 41.4%, and 53.8%, respectively. Men had lower percentage of stable disease than women in both post-1995 cohorts (chi-square p < 0.0001). ARR was associated with higher disability trajectories in both post-1995 cohort (odds ratios >1.0) but not in the pre-1995 cohort.
Conclusion: Large proportions of patients remain stable at their initial disability level for at least 15 years. Higher ARR increases the odds of patients being in a higher disability trajectory in the latter cohorts.

The results speak for themselves over the past decade it is clear that people are fairing better and more people have stable disease compared to the pre-DMT era. Yet more info for the do nothing brigade who stay clear of potential treatment. The message is do nothing and you may pay the price. Pre 1996 before interferons and 0% stable to post 2005 89% stable. Whilst DMT will be part of the equation remember a the era of highly effective DMT. 

Pharma I think have played their part in terms of education of neuros, pwMS and somethink very important is the development of MS nurses. We often Joke that we bet a good MS nurse has as much impact as a CRAB drug. This data is not inconsistent with that. I sure you would agree they do a great job 

4 comments:

  1. This blog is better than any MS nurse I have been in contact with regards to the correct information about MS. I'm sure there are many MS nurses that do a great job.

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  2. Yes, an MS nurse is invaluable and being able to reach out at any time to, for many, the only person that you can talk to about your MS who can do anything for you, must save at the very least isolated suffering and at worst many suicide's. Many varied, new and worrying things can happen to someone with MS in a year, so seeing a Neurologist only once every 12 months is quite useless unless you have an amazing MS nurse as your interface with the team treating you. I'm sure not every nurse is responsive but mine (no name's mentioned - Norse goddess of love) should probably teach best practice in such things. This blog is also invaluable, thank you x

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    1. Norse goodness of love....loves to kick my arse when I'm out of line:-).

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  3. This seems to indicate MS is not that progressive for females diagnosed in the last 10 years?
    What was the sample size and study length as these stats seem to be at odds with MS being a tough progressive condition.

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