Is a treatment working?
Posted: Wed Jun 21, 2006 9:08 am
I really like the Canadian MS Society website's 'Ask the Expert' section.
Today's question and answer may be of interest:
Q :
How do we know if the disease-modifying drug is working? I had a major relapse while on, and am still on, mine and questions have arisen whether the drug is actually doing something or the relapse would have been worse if i had not been using the injectable.
A :
This is an excellent and very important question. Neurologists in Canada and really worldwide have been wrestling with the same question since in the studies we had a “placebo” group with which to compare to know that treated patients were actually doing better, but with no “placebo” group how do you really know how you’re doing? We devised a scheme that, it appears, is not all that different from other treatment evaluations and that can be applied to chronic disease states in which a treatment is beneficial but not curative. In essence, some ongoing disease activity is inevitable but how much is too much? We rated events such as relapses, progression or MRI changes in terms of how much these raised concern that a sub-optimal treatment response was being realized or in other words, whether or not a patient is truly benefiting from a treatment, and might there be an opportunity to do better. We actually went across the country with a series of talks together with the MS Society of Canada last spring to promote this concept and empower patients to be able to rate their own benefit and assist their neurologists in judging a treatment response.
Some changes in terms of attacks, progression or on MRI scans are more acceptable than others, whereas certain types of changes really should make the neurologist consider that the treatment response is sub-optimal and maybe with a different treatment, a patient could do better. It is important to realize that current treatments are only really effective in the early relapsing-remitting stage and therefore we need to closely address “optimal” treatment response during that phase of the illness.
Today's question and answer may be of interest:
Q :
How do we know if the disease-modifying drug is working? I had a major relapse while on, and am still on, mine and questions have arisen whether the drug is actually doing something or the relapse would have been worse if i had not been using the injectable.
A :
This is an excellent and very important question. Neurologists in Canada and really worldwide have been wrestling with the same question since in the studies we had a “placebo” group with which to compare to know that treated patients were actually doing better, but with no “placebo” group how do you really know how you’re doing? We devised a scheme that, it appears, is not all that different from other treatment evaluations and that can be applied to chronic disease states in which a treatment is beneficial but not curative. In essence, some ongoing disease activity is inevitable but how much is too much? We rated events such as relapses, progression or MRI changes in terms of how much these raised concern that a sub-optimal treatment response was being realized or in other words, whether or not a patient is truly benefiting from a treatment, and might there be an opportunity to do better. We actually went across the country with a series of talks together with the MS Society of Canada last spring to promote this concept and empower patients to be able to rate their own benefit and assist their neurologists in judging a treatment response.
Some changes in terms of attacks, progression or on MRI scans are more acceptable than others, whereas certain types of changes really should make the neurologist consider that the treatment response is sub-optimal and maybe with a different treatment, a patient could do better. It is important to realize that current treatments are only really effective in the early relapsing-remitting stage and therefore we need to closely address “optimal” treatment response during that phase of the illness.