Onset of secondary progressive MS is not influenced

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Onset of secondary progressive MS is not influenced

Postby Petr75 » Tue Aug 28, 2018 12:28 pm

2018 Jun 26
Neuroimmunology Unit, Hospital Clínic de València, Spain
Onset of secondary progressive multiple sclerosis is not influenced by current relapsing multiple sclerosis therapies
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6077906/

Abstract
Background:
Disease-modifying therapies are thought to reduce the conversion rate to secondary progressive multiple sclerosis.
Objective:
To explore the rate, chronology, and contributing factors of conversion to the progressive phase in treated relapsing-remitting multiple sclerosis patients.
Methods:
Our study included 204 patients treated for relapsing-remitting multiple sclerosis between 1995 and 2002, prospectively followed to date. Kaplan-Meier analysis was applied to estimate the time until secondary progressive multiple sclerosis conversion, and multivariate survival analysis with a Cox regression model was used to analyse prognostic factors.
Results:
Relapsing-remitting multiple sclerosis patients were continuously treated for 13 years (SD 4.5); 36.3% converted to secondary progressive multiple sclerosis at a mean age of 42.6 years (SD 10.6), a mean time of 8.2 years (SD 5.2) and an estimated mean time of 17.2 years (range 17.1-18.1). A multifocal relapse, age older than 34 years at disease onset and treatment failure independently predicted conversion to secondary progressive multiple sclerosis but did not influence the time to reach an Expanded Disability Status Scale of 6.0.
Conclusions:
The favourable influence of disease-modifying therapies on long-term disability in relapsing-remitting multiple sclerosis is well established. However, the time to progression onset and the subsequent clinical course in treated patients seem similar to those previously reported in natural history studies. More studies are needed to clarify the effect of disease-modifying therapies once the progressive phase has been reached.
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Re: Onset of secondary progressive MS is not influenced

Postby ElliotB » Wed Aug 29, 2018 6:34 am

This is certainly an interesting study.

One oddity I found:

"The favourable influence of disease-modifying therapies on long-term disability in relapsing-remitting multiple sclerosis is well established."

I was told when I started my DMD that this was not the case. I was shown a chart by the doctor that showed fewer relapses but the end point did not change. Who really knows for sure? Ultimately we can only hope this is the case (better safe than sorry)
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Re: Onset of secondary progressive MS is not influenced

Postby NHE » Wed Aug 29, 2018 6:24 pm

ElliotB wrote:This is certainly an interesting study.

One oddity I found:

"The favourable influence of disease-modifying therapies on long-term disability in relapsing-remitting multiple sclerosis is well established."

I was told when I started my DMD that this was not the case. I was shown a chart by the doctor that showed fewer relapses but the end point did not change. Who really knows for sure? Ultimately we can only hope this is the case (better safe than sorry)

The link takes you to the full paper. At least read the intro and discussion. The paper clearly states that treatment with drugs for RRMS did not affect the conversion to SPMS.

...the times to reach an EDSS score of 6.0 from disease onset (19 years) and once progression started (9 years) resembled those reported in the natural history studies.2,23


When the switch to progression occurred, the estimated mean time to SPMS conversion was comparable to that reported in most of the natural history studies published to date.2,23 Zeydan and Kantarci have suggested that underlying mechanisms of progression not influenced by DMT exist from the beginning of the disease and become evident when patients are in their forties, explaining this phenomenon.26,27


According the criteria to treat MS patients with DMTs in our country, these therapies should be withdrawn when an EDSS higher than 6.5 is reached.


We did not find any clinical or demographic factor that could influence the rate of progression to an EDSS score of 6.0 once a secondary progressive course had been confirmed (9 years from SPMS), in line with natural history studies.30


In conclusion, we consider it likely that long-term treatment with DMTs might reduce the number of patients who will develop SPMS. However, in patients who do convert to SPMS, time to conversion, age of transition and subsequent cumulative disability are not influenced by current therapies.
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Re: Onset of secondary progressive MS is not influenced

Postby ElliotB » Thu Aug 30, 2018 6:26 am

"The paper clearly states that treatment with drugs for RRMS did not affect the conversion to SPMS."

My comment was with regard to the statement regarding DMDs and disability only, not to transition from RRMS to something else:
"The favourable influence of disease-modifying therapies on long-term disability in relapsing-remitting multiple sclerosis is well established."
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Re: Onset of secondary progressive MS is not influenced

Postby NHE » Thu Aug 30, 2018 9:58 pm

Dr. George Ebers states that none of DMTs prevent the progression to long term disability.

https://www.youtube.com/watch?v=OqY-_K1fYJY
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Re: Onset of secondary progressive MS is not influenced

Postby frodo » Fri Aug 31, 2018 12:04 am

I think both hypothesis are compatible.

Probably they mean that when you are on MS drugs, you get to SPMS at the same time, but you get there in better conditions.
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Re: Onset of secondary progressive MS is not influenced

Postby ElliotB » Fri Aug 31, 2018 5:32 am

"Probably they mean that when you are on MS drugs, you get to SPMS at the same time, but you get there in better conditions."

That was the point of my comment, I was shown that I would have less relapses on a DMD but the endpoint would be about the same when it came to disability. My hope and I guess everyone's hope who takes a DMD is that your condition with regard to disability would be better at the time of transition to the next stage. I guess the reality is there is no way of knowing for sure.

I had late onset of MS, have only had a couple of relapses, my doctor says I have transitioned to SPMS and I now find my condition worsening a bit at this point (with regard to disability) which is most apparent when I am tired. Proper sleep (difficult at best and has been this way for about 5 years although I am doing a bit better now) and of rest have now become more important than ever to me.
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