Large-scale analysis from Nova Scotia
suggests that disease-modifying drugs for MS are effective
in reducing disability progression in people whose MS
started with relapses
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Medical Update Memo
January 9, 2008
Summary
Murray Brown, PhD (Dalhousie University,
Halifax, Nova Scotia) and colleagues developed
estimates
of drug effectiveness based on data from
590 people with MS treated with the drugs.
Compared to estimated rates of progression
before treatment, therapy was estimated to
reduce progression in the EDSS by 90-105%
over the course of the period studied in
people with relapsing MS. The reduction in
progression of the EDSS was 100-112% for
patients with relapsing-remitting MS but
only 8-22% for those with secondary-progressive
MS. Although this study was based on clinical
observations and not on a well-controlled
clinical trial, it provides much-needed evidence
of the longer-term benefit of therapy.
Details
Disease-modifying drugs (DMDs) have been
shown to reduce future disease activity for
many
individuals with relapsing forms of MS by reducing
the frequency and severity of clinical attacks,
the accumulation of tissue damage seen on MRI,
and in some cases the progression of disability
over the relatively short duration of the studies
(usually approximately 2 years). However, research
proving that these drugs can delay the progression
of disability over the long term is lacking.
In this novel study (Neurology 2007
Oct 9;69[15]: 1498-507), funded by Health Canada,
the MS Society of
Canada, Nova Scotia Health Research Foundation
and others, Murray Brown, PhD and colleagues
used the Dalhousie MS Research Unit’s
database to track the course of 590 people
with relapsing forms of MS. The database includes
25 years of clinical data on people with MS,
including up to six years of data on people
whose three classes of DMDs were paid for by
Nova Scotia’s Department of Health from
1998 to 2004.
The study population included 390 people with
RR MS and 200 people with SP MS at an average
of 8.9 years since disease onset. This study
was "observational" meaning that the
investigators were looking at this group of
patients in a real-world setting and not in
a controlled clinical trial. Annual disability
(EDSS) progression was estimated for years before,
during and after DMD treatment using statistical
models.
The results suggest that the DMDs significantly
delayed estimated EDSS progression in both
groups combined by 90-105%. The effect was
greater in those who began treatment and remained
classified as RR MS in 2004 (100-112%) than
in those who began treatment as RR MS or SP
MS and ended up being classified as SP MS in
2004 (8-22%). Switching treatments was followed
by significant estimated EDSS progression in
those with SP MS, and stopping treatment also
resulted in significant estimated EDSS progression
in the group as a whole, although not significantly
in RR MS and SP MS separately.
Aaron Miller, MD, Chief Medical Officer of
the National MS Society, adds, “This
study adds important information to our knowledge
about DMDs, and hopefully will inspire future
observational and controlled studies to further
report on their ability to delay disease progression.
These drugs remain the best defence available
to reduce future disease course of MS.”
ASK Information System Code: 1.4.1.60.g
Disponible en français.
Disclaimer
The Multiple Sclerosis Society of Canada is an independent, voluntary health
agency and does not approve, endorse or recommend any specific product or
therapy, but provides information to assist individuals in making their own
decisions.
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