Vilija Jokubaitis is a Postdoctoral Research Fellow at University of Melbourne and Helmut Butzkueven is a neurologist and Associate Professor The University of Melbourne. Helmut is the director of MSBase.
In our recent study, we tried to determine which factors, in early MS could predict or prevent the accumulation of disability. We observed people from their very first neurological symptoms suggestive of MS (Clinically Isolated Syndrome, CIS), for up to 10 years. Average follow-up was 3 years. We took many demographic and clinical factors into consideration including: gender, age at diagnosis, MS-specific disability measures, and also the effect of treatment.
First of all, we looked at the relationship between amount of time people spent on disease modifying therapies (DMT), and how quickly they accumulated disability. Secondly, we looked at the identity of individual drugs that were used, specifically: Avonex, Betaferon, Rebif and Copaxone.
On average, people in our study commenced DMT treatment 8 months after first symptoms (CIS). In our adjusted model, where we considered all of the factors together, we found that patients who had motor symptoms at first presentation were more likely to experience persistent disease worsening at a faster rate than those who did not. In addition, people who were older at diagnosis were more likely to accumulate disability faster. However, we also found that people who persisted on their DMT for greater than 50% of the observation period had a significantly slower rate of disability accumulation than those patients who did not receive treatment. Moreover, there was a step-wise reduction in the rate of disability accumulation the longer people remained on their DMT (up to 75% slower in people who stayed on drug for >80% of the time).
We did not however, find a difference in the rate of disease worsening in patients who spent 50% or less of the time on treatment. When we looked at individual DMTs, we found that all of the first-line therapies significantly reduced the rate of disability accumulation. There were no significant differences between individual drugs, meaning that they were all as effective as each other.
|This graph shows you the effect of show the effect of cumulative DMT exposure
versus. no DMT on disease progression. MSers with no exposure do worse over 8 years.
The consistent and persistent use of DMT from early on in MS therefore slows disability accumulation and prolongs quality of life.
Conflicts: Vilija Jokubaitis has received conference travel support from Novartis. Helmut Butzkueven has served on scientific advisory boards for Biogen Idec, Novartis and Sanofi-Aventis and has received conference travel support from Novartis, Biogen Idec and Sanofi Aventis. He serves on steering committees for trials conducted by Biogen Idec and Novartis, and has received research support from Merck Serono, Novartis and Biogen Idec.