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STUDY: Most consistent protective factor against SPMS—exposure to disease-modifying therapy

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  • STUDY: Most consistent protective factor against SPMS—exposure to disease-modifying therapy

    Transition to secondary progression in relapsing-onset multiple sclerosis: Definitions and risk factors

    Show all authors
    Pietro Iaffaldano, Giuseppe Lucisano, Francesco Patti, ...
    https://doi.org/10.1177/1352458520974366

    Abstract


    Background:

    No uniform criteria for a sensitive identification of the transition from relapsing–remitting multiple sclerosis (MS) to secondary-progressive multiple sclerosis (SPMS) are available.

    Objective:

    To compare risk factors of SPMS using two definitions: one based on the neurologist judgment (ND) and an objective data-driven algorithm (DDA).

    Methods:

    Relapsing-onset MS patients (n = 19,318) were extracted from the Italian MS Registry. Risk factors for SPMS and for reaching irreversible Expanded Disability Status Scale (EDSS) 6.0, after SP transition, were estimated using multivariable Cox regression models.

    Results:

    SPMS identified by the DDA (n = 2343, 12.1%) were older, more disabled and with a faster progression to severe disability (p < 0.0001), than those identified by the ND (n = 3868, 20.0%). In both groups, the most consistent risk factors (p < 0.05) for SPMS were a multifocal onset, an age at onset >40 years, higher baseline EDSS score and a higher number of relapses; the most consistent protective factor was the disease-modifying therapy (DMT) exposure. DMT exposure during SP did not impact the risk of reaching irreversible EDSS 6.0.

    Conclusion:

    A DDA definition of SPMS identifies more aggressive progressive patients. DMT exposure reduces the risk of SPMS conversion, but it does not prevent the disability accumulation after the SP transition.
    Dave Bexfield
    ActiveMSers

  • #2
    NOTE: Ocrevus has not technically been studied in secondary progressive MS, only primary progressive. But researchers expect it to perform similarly, as both diseases are now considered the same by many. Ocrevus has been shown to delay upper body disability in studies.
    Dave Bexfield
    ActiveMSers

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    • #3
      It took me a while, but I am now convinced that it is worth it to pay for a DMT. At first I didn't want to get in bed with Big Pharma but now I'm madly in love with Gilenya. I want to be a presenter for Novartis because I can still run a half marathon, thanks in large part to taking Gilenya.

      Comment


      • #4
        Originally posted by ThailandVal View Post
        It took me a while, but I am now convinced that it is worth it to pay for a DMT. At first I didn't want to get in bed with Big Pharma but now I'm madly in love with Gilenya. I want to be a presenter for Novartis because I can still run a half marathon, thanks in large part to taking Gilenya.
        Thanks for this post. I am also VERY hesitant to get in bed with Big Pharma. I am not allo-pathic at all. Needless to say, having MS causes me to feel like I'll be selling my soul taking DMTs. I'm still waiting on my first official neuro appointment (positive MRI for multiple lesions) so I'm researching a lot.

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        • #5
          Originally posted by Pistachio View Post
          I am also VERY hesitant to get in bed with Big Pharma. .. I'm still waiting on my first official neuro appointment (positive MRI for multiple lesions) so I'm researching a lot.
          I don't have time to search it, but somewhere in this forum you will find Dave's excellent arguments for taking DMTs.

          From my own experience, when I was first diagnosed in 2007 I researched the drugs available at that time and they all sounded really bad in terms of possible side effects and probably not really helping that much. So I decided to go on the Swank diet. For a few years I had only very minor symptoms and felt so good I decided it was OK to go back to eating more "regular" foods like the rest of my family. Then one day my legs temporarily stopped working and I was like "Woah, I really do have MS!" so I decided to go on the stricter McDougall diet. I was not 100% compliant most days but I tried. And over the next year or so I had more frequent and more severe relapses. Then my neurologist talked me into trying one of the new generations of DMTs. I tried it and I haven't regretted it. I luckily had no side effects at all and I haven't had a relapse in 2 years.

          Comment


          • #6
            ThailandVal, here you go, my article on the flawed arguments of going drug free: https://activemsers.blogspot.com/201...arguments.html

            They really help. The main doc on Barts' MS Blog wrote this about MS diets....

            I have seen many tragic examples of patients under my care who are now very disabled as a result of using lifestyle and wellness programmes as an alternative option to DMTs to manage their MS. [MS diets] should only ever be used as a complementary MS management tool.
            Dave Bexfield
            ActiveMSers

            Comment


            • #7
              I was fortunate to get on a DMT the week of my original diagnosis in 2000. I was on Avonex interferon beta-1a for 18 years, and fully credit it for my lack of severe exacerbation over the last 21 years!
              Retired engineer, now hobby farmer with goats, chickens, an old dog,and a lazy barn cat!
              Watch my goats at GoatsLive.com
              Active in amateur radio
              Linux geek, blogging at lnxgoat.com
              M.S. since 2000

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