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Old 08-23-2019, 11:11 AM
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Default The long-term effects of disease modifying therapies on disability in MS

Multiple Sclerosis and Related Disorders
Volume 36, November 2019, 101374
Multiple Sclerosis and Related Disorders

The long-term effects of disease modifying therapies on disability in people living with multiple sclerosis: A systematic review and meta-analysis

Suzi B. Claflin, et al
https://doi.org/10.1016/j.msard.2019.08.016

Highlights

•Systematic review returned 18 studies that met inclusion criteria.

•15 (83%) received a moderate risk of bias rating; 3 (17%) received a serious risk of bias rating using the ROBINS-I tool for non-randomized studies.

•Meta-analysis shows that long-term (≥4) year of DMT treatment significantly improves time to EDSS 6.0 and that long-term interferon beta treatment improved time to SPMS, but showed no effect on time to EDSS 4.0.

•More work is needed to confirm this effect, determine the impact of DMT other than interferon beta, and assess the relative effect of DMT in long-term treatment.

Abstract

Background
Disease modifying therapies (DMT) are a common medication class for treating people living with MS. However, although treatment with DMT can extend over more than a decade, little is known about their long-term effects. Here, we systematically review long-term (≥4 years) studies on the effect of DMT on disability progression and relapse in people living with MS.

Methods
We searched the EMBASE and Medline databases in January 2018, using search terms that included DMT and relevant outcome measures. Two authors screened all resulting studies and evaluated the risk of bias of included studies using the ROBINS-I tool for non-randomized studies. Where there was sufficient data, we performed meta-analyses using RevMan 5. Studies that could not be included in a meta-analysis were included in data synthesis.

Results
Our search returned 7,766 unique articles for review. After screening, 18 articles were included. Follow-up in these studies ranged from a mean of 3.9 years to a median of 17.8 years. Fifteen (83.3%) of the included studies had a moderate risk of bias and three (16.7%) had a serious risk of bias. Meta-analysis showed that DMT significantly reduced the risk of EDSS 6.0 and SPMS compared to no treatment.

Conclusion
There is some evidence that long-term treatment with interferon beta reduces the risk of EDSS 6.0 and SPMS compared to no treatment or placebo. More work is needed on the effect of second generation DMT and the relative effect of DMT on health outcomes.
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Old 08-23-2019, 11:13 AM
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The entire article is not available to show the breakdown of DMTs, however an earlier version of this study IS available for free. This provides more insight into her findings.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6335290/
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Old 08-29-2019, 03:29 PM
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8 months without my Avonex after being on it for 18 years. No major exacerbation but my energy level is noticeably lower...
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Old 08-29-2019, 03:46 PM
Suebee Suebee is offline
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Goat herder, I remember in another post that you explained the reason you went off Avonex but I can’t remember what it was. Why did you discontinue?
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Old 09-02-2019, 04:01 PM
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Quote:
Originally Posted by Suebee View Post
Goat herder, I remember in another post that you explained the reason you went off Avonex but I can’t remember what it was. Why did you discontinue?
My evil insurance company chose not to pay for it any longer.
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Old 09-02-2019, 08:51 PM
Suebee Suebee is offline
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Goatherder, That’s what I thought. Please forgive me if I step over the line, I know advocating for oneself is a full time job when one has MS, but I’m worried this is a harbinger for things to come. Insurance companies should not be allowed to make a “policy” decision that continuing a DMT does’t benefit people after 55 yrs of age. I think any person denied continuing a DMT because of age, like you, needs to document the negative impact it is having on your energy level and tirelessly (sorry) report it to your dr, insurance co, State Div of Insurance, and MS Society, etc. I feel they are gambling with our lives using a cost saving policy, which is not currently supported by hard science. Over time I fear, the insurance companies will then point to meta data to support this policy because increased fatigue, pain, or cognitive difficulties are subjective variables that won’t be reported as linked to DMT discontinuance.
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Old Yesterday, 09:26 PM
GoatHerder GoatHerder is online now
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Sorry for the late reply...

Yes, I am documenting increased side effects of not being on them as is my doctor. Mostly, it's just my energy level, but we'll see how it goes when the temps are no longer sky high!
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