STUDY: Time to SPMS in those treated with first generation immunomodulating drugs

[ActiveMSers]

Time to secondary progression in patients with multiple sclerosis who were treated with first generation immunomodulating drugs

H Tedeholm1
J Lycke1
B Skoog1
V Lisovskaja2
J Hillert3
C Dahle4
J Fagius5
S Fredrikson3
A-M Landtblom4
C Malmeström1
C Martin6
F Piehl3
B Runmarker1
L Stawiarz3
M Vrethem4
O Nerman2
O Andersen1

1Sahlgrenska University Hospital, Gothenburg, Sweden
2Department of Mathematical Sciences, Chalmers University of Technology and Department of Mathematical Sciences, University of Gothenburg, Sweden
3Karolinska University Hospital, Huddinge, Sweden
4Department of Clinical and Experimental Medicine/Neurology, University of Linköping, Sweden
5Department of Neurology, University Hospital, Uppsala, Sweden
6Institute of Clinical Science, Danderyds Hospital, Sweden
Oluf Andersen, University of Gothenburg, Institution of Neuroscience and Physiology, Gröna Stråket 11, Department of Neurology, Sahlgenska University Hospital, Göteborg, SE-413 45, Sweden.

Abstract

Background: It is currently unknown whether early immunomodulatory treatment in relapsing–remitting MS (RRMS) can delay the transition to secondary progression (SP).
Objective: To compare the time interval from onset to SP in patients with RRMS between a contemporary cohort, treated with first generation disease modifying drugs (DMDs), and a historical control cohort.

Methods: We included a cohort of contemporary RRMS patients treated with DMDs, obtained from the Swedish National MS Registry (disease onset between 1995–2004, n = 730) and a historical population-based incidence cohort (onset 1950–64, n = 186). We retrospectively analyzed the difference in time to SP, termed the “period effect” within a 12-year survival analysis, using Kaplan-Meier and Cox regression analysis.

Results: We found that the “period” affected the entire severity spectrum. After adjusting for onset features, which were weaker in the contemporary material, as well as the therapy initiation time, the DMD-treated patients still exhibited a longer time to SP than the controls (hazard ratios: men, 0.32; women, 0.53).

Conclusion: Our results showed there was a longer time to SP in the contemporary subjects given DMD. Our analyses suggested that this effect was not solely driven by the inclusion of benign cases, and it was at least partly due to the long-term immunomodulating therapy given.

[Marinadca]

I wish they would give us a number of years. What I wouldn't give to know what my disease course will be!

[LivWell]

I think worrying about how MS will progress and how it will impact my life is a pretty normal thing to do. And even though I can expend a ridiculous amount of energy doing it, worry in general doesn't seem to produce anything I can call helpful.

What did I do before I knew? Answer: whatever I was capable of doing. If it hadn't been for an MRI for a completely different problem 7 years ago I still might not know (well, except for the vertigo, and the walking and the crushing fatigue, etc., etc.).

No symptoms then, so I just went on my merry way. Chances are I had MS for some time prior to that but, who knows? And since there isn't an answer to the how-long-since or how-long-until questions, I figure I may as well plan something fun. (I saw a great movie last night. )

Next year I am taking a sabbatical leave from work and going .... somewhere. I'd like to see Paris.

[ActiveMSers]

The full journal article is now available. There are LOTS of numbers. The historical cohort took no DMDs, the contemporary cohort took DMDs. The difference is noticeable, but it is challenging to make heads or tails out of all the data.

Thus, for a man with a severity score of 0, the 20% quantile was 4 years in the historical cohort and 12 years in the contemporary cohort. For a woman with a severity score of 0, the 20% quantile was 7 years in the historical cohort and 10 years in the contemporary cohort. When the severity score was 3, we found that the 20% quantiles were, respectively, 1 and 4 years for men and 4 and 7 years for women.

http://msj.sagepub.com/content/19/6/765.full

[garyp]

Whenever you see terms like "Kaplan-Meier and Cox regression analysis" in the opening sentence of the methods section of a such a papet, what it really means is that unless you have a PhD with a substantial statistics component then please don't bother reading anything but the conclusion

So, I only read the conclusion section and here is the take away a lay person with MS should, well, take away "longer time to SP.....was at least partly due to the long-term immunomodulating therapy given".

When I was diagnosed, I was in graduate school at the University of Chicago...they do a lot of statistics there, though it was something I avoided doing until the last semester. In a desperate effort to find some sort of magic formula to predict what might happen to me - I took myself to medical school library. Ended up locating multiple studies on the "natural history" or MS which, among other things, attempted to identify the course of MS based on things such as environmental factors (place of birth etc..) and initial symptoms. Below is the formula I was able to extract from this effort:

Outcome of MS = no real way to predict

Yes, there were factors which did seem to be present in "better" outcomes - but lots of what are called "residuals" remain which in laymans terms means there are other things going on which no one can really identify.

Over my 18 years with this disease I have developed a rule of thumb to rationalize what I have learned about managing MS. Living a peaceful life with those closest to you helps. Being on a DMD helps. Eating a healthy diet helps. Exercising helps. Finding humor in MS (which Dave is just extremely good at and why, amongst other reasons, I keep returning to this site) helps. Being mindful of where you mind is helps. Setting goals, even if the goal is only to stand for more than 5 seconds without falling, and achieving them helps.

None of these factors either individually or all together assure a good "outcome" - whatever the term "good outcome" means. I can though confidently say that doing these things will put you in a better place than you would have been if you had done none of these things. And I don't need to do "Kaplan-Meier and Cox regression analysis" to back this up....which is good because I would have no clue where to even begin to do such a thing.