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 MS, using a Bayesian approach to overcome methodological problems related to open-label studies.
“A Bayesian approach refers to a statistical method that allows you to analyse the data in a different way to so called classic statistics. It is in vogue and a useful way to analyse complex data sets.”
Methods: MSers from 3 different Italian MS centres were divided into subgroups according to the presence of treatment in their disease history before the endpoint, which was represented by secondary progression. MSers were stratified on the basis of the risk score BREMS (estimate for MS), which is able to predict the unfavourable long-term evolution of MS at an early stage.
Conclusions: DMDs significantly reduce the risk of MS progression both in MSers with initial high-risk and MSers 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.
“As we have been saying previously, you do better if you are recieving some form of disease modyfying treatment if you are an RRMSer. This effect should get larger with more effective therapies that have a greater impact on relapses.”
I thought you could now prescribe rebif for a CIS?
Just curious, then. If allowed by NICE, would you start your RRMSer's on the most potent therapies (natalizumab, alemtuzumab) for the best results long term? Or do you like the approach of starting light and escalating therapy as needed?
From what I can figure by reading this blog is that early and aggressive treatment is essential to stave off progresion. But this will come at a financial cost, so it's best to not bother even though the long-term implications are so much worse in every way.Essentially, any new MSer is being deprived, forced to slide into progression and disability.Gosh, the world of MS seems so hopeless.
"early and aggressive treatment is essential to stave off progresion. But this will come at a financial cost"They all come with a financial cost but the worry is the physical costs because these aggressive treatments come with side effects.
Re: "I thought you could now prescribe rebif for a CIS?"Although they have a CIS license in Europe the Department of Health's risk-sharing scheme stipulates that we prescribe under the Association of British Neurology 2001 guidelines; these state clearly that we should not be prescribing for CIS.
Re: "Just curious, then. If allowed by NICE, would you start your RRMSer's on the most potent therapies (natalizumab, alemtuzumab) for the best results long term? Or do you like the approach of starting light and escalating therapy as needed?"It is all about risk:benefit. In an ideal world you would like both options and then you could allow MSers to choose. At the end of the day risk is personal thing. I am all for MSer choice.
Re: "Gosh, the world of MS seems so hopeless."Not true; there are several very effective treatments in the pipeline that promise to make a big difference!