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Immunomodulatory therapies delay disease progression in multiple sclerosis
Roberto Bergamaschi1
Silvana Quaglini2
Eleonora Tavazzi1
Maria Pia Amato3
Damiano Paolicelli4
Valentina Zipoli3
Alfredo Romani1
Carla Tortorella4
Emilio Portaccio3
Mariangela D’Onghia4
Francesca Garberi2
Valeria Bargiggia1
Maria Trojano4
1Centre of Research in Multiple Sclerosis (CRISM), Neurological Institute C. Mondino, Italy
2Department of Computer Engineering and Systems Science, University of Pavia, Italy
3Department of Neurological and Psychiatric Sciences, University of Florence, Italy
4Department of Neurological and Psychiatric Sciences, University of Bari, Italy
Roberto Bergamaschi, MD, Multiple Sclerosis Centre, Department of Clinical Neurology, Neurological Institute C. Mondino, Via Mondino 2, 27100 Pavia, Italy.
Abstract
Background: Few studies have analysed long-term effects of immunomodulatory disease modifying drugs (DMDs).
Objective: Assessment of the efficacy of DMDs on long-term evolution of multiple sclerosis, using a Bayesian approach to overcome methodological problems related to open-label studies.
Methods: MS patients from three different Italian multiple sclerosis centres were divided into subgroups according to the presence of treatment in their disease history before the endpoint, which was represented by secondary progression. Patients were stratified on the basis of the risk score BREMS (Bayesian risk estimate for multiple sclerosis), which is able to predict the unfavourable long-term evolution of MS at an early stage.
Results: We analysed data from 1178 patients with a relapsing form of multiple sclerosis at onset and at least 10 years of disease duration, treated (59%) or untreated with DMDs. The risk of secondary progression was significantly lower in patients treated with DMDs, regardless of the initial prognosis predicted by BREMS.
Conclusions: DMDs significantly reduce the risk of multiple sclerosis progression both in patients with initial high-risk and patients with initial low-risk. These findings reinforce the role of DMDs in modifying the natural course of the disease, suggesting that they have a positive effect not only on the inflammatory but also on the neurodegenerative process. The study also confirms the capability of the BREMS score to predict MS evolution.
Roberto Bergamaschi1
Silvana Quaglini2
Eleonora Tavazzi1
Maria Pia Amato3
Damiano Paolicelli4
Valentina Zipoli3
Alfredo Romani1
Carla Tortorella4
Emilio Portaccio3
Mariangela D’Onghia4
Francesca Garberi2
Valeria Bargiggia1
Maria Trojano4
1Centre of Research in Multiple Sclerosis (CRISM), Neurological Institute C. Mondino, Italy
2Department of Computer Engineering and Systems Science, University of Pavia, Italy
3Department of Neurological and Psychiatric Sciences, University of Florence, Italy
4Department of Neurological and Psychiatric Sciences, University of Bari, Italy
Roberto Bergamaschi, MD, Multiple Sclerosis Centre, Department of Clinical Neurology, Neurological Institute C. Mondino, Via Mondino 2, 27100 Pavia, Italy.
Abstract
Background: Few studies have analysed long-term effects of immunomodulatory disease modifying drugs (DMDs).
Objective: Assessment of the efficacy of DMDs on long-term evolution of multiple sclerosis, using a Bayesian approach to overcome methodological problems related to open-label studies.
Methods: MS patients from three different Italian multiple sclerosis centres were divided into subgroups according to the presence of treatment in their disease history before the endpoint, which was represented by secondary progression. Patients were stratified on the basis of the risk score BREMS (Bayesian risk estimate for multiple sclerosis), which is able to predict the unfavourable long-term evolution of MS at an early stage.
Results: We analysed data from 1178 patients with a relapsing form of multiple sclerosis at onset and at least 10 years of disease duration, treated (59%) or untreated with DMDs. The risk of secondary progression was significantly lower in patients treated with DMDs, regardless of the initial prognosis predicted by BREMS.
Conclusions: DMDs significantly reduce the risk of multiple sclerosis progression both in patients with initial high-risk and patients with initial low-risk. These findings reinforce the role of DMDs in modifying the natural course of the disease, suggesting that they have a positive effect not only on the inflammatory but also on the neurodegenerative process. The study also confirms the capability of the BREMS score to predict MS evolution.