Here, you can read about the latest research into new drugs for MS and it's symptoms.
UK multiple sclerosis risk-sharing scheme: a new natural history dataset and an improved Markov model(20/01/14)
Objectives: In 2002, the UK's National Institute for Health and Care Excellence concluded that the multiple sclerosis (MS) disease modifying therapies; interferon-β and glatiramer acetate, were not cost effective over the short term but recognised that reducing disability over the longer term might dramatically improve the cost effectiveness. The UK Risk-sharing Scheme (RSS) was established to ensure cost-effective provision by prospectively collecting disability-related data from UK-treated patients with MS and comparing findings to a natural history (untreated) cohort. However, deficiencies were found in the originally selected untreated cohort and the resulting analytical approach. This study aims to identify a more suitable natural history cohort and to develop a robust analytical approach using the new cohort.
Design: The Scientific Advisory Group, recommended the British Columbia Multiple Sclerosis (BCMS) database, Canada, as providing a more suitable natural history comparator cohort. Transition probabilities were derived and different Markov models (discrete and continuous) with and without baseline covariates were applied.
Setting: MS clinics in Canada and the UK.
Participants: From the BCMS database, 898 ‘untreated’ patients with MS considered eligible for drug treatment based on the UK's Association of British Neurologists criteria.
Outcome measure: The predicted Expanded Disability Status Scale (EDSS) score was collected and assessed for goodness of fit when compared with actual outcome.
Results: The BCMS untreated cohort contributed 7335 EDSS scores over a median 6.4?years (6357 EDSS ‘transitions’ recorded at consecutive visits) during the period 1980–1995. A continuous Markov model with ‘onset age’ as a binary covariate was deemed the most suitable model for future RSS analysis.
Conclusions: A new untreated MS cohort from British Columbia has been selected and will be modelled using a continuous Markov model with onset age as a baseline covariate. This approach will now be applied to the treated UK RSS MS cohort for future price adjustment calculations.
Jacqueline Palace, Thomas Bregenzer, Helen Tremlett, Joel Oger, Fheng Zhu, Mike Boggild, Martin Duddy, Charles Dobson
Source: BMJ Open Copyright © 2014 by the BMJ Publishing Group Ltd (20/01/14)
Patients who received early and consistent disease modifying treatment at the first signs of multiple sclerosis – often called clinically isolated syndrome (CIS) – appeared to have a slower progression to disability than patients who were treated mainly for additional MS exacerbations, researchers reported here.
Over a 12-month period, patients treated 50% to 80% of the time following the first CIS event reduced their risk of progression -- as measured by the Expanded Disability Status Scale score -- by 45% compared with patients who received disease-modifying treatments less than 50% of the time or not at all (95% CI 0.39-0.79, P=0.001), and patients treated for more than 80% of the time following diagnosis reduced their risk of disability progression by 68% (95% CI 0.22-0.49, P<0.001), said Vilija Jokubaitis. PhD, post-doctoral fellow in neuroimmunology at the University of Melbourne.
"What was very interesting about this finding was that the patients who appeared to be worse after their CIS and MRI evaluation and who were treated early, did better than patients whose treatment was delayed," she said in her oral Young Investigators report at the annual meeting of the European Association for the Treatment and Research In Multiple Sclerosis.
About three-fourths of these patients were classified on the basis of T2 lesion enhancement as having relapsing-remitting multiple sclerosis at first treatment. Jokubaitis suggested that because their initial examinations looked worse, the patients were treated more aggressively, and that appeared to have long-term benefits in preventing progression.
"Study after study has shown that early treatment with disease-modifying drugs benefits patients with CIS," said Margaret Burnett, MD, assistant clinical professor of neurology and pathology at the University of Southern California in Los Angeles.
"It kills me that some places still are not treating CIS," she told MedPage Today. "These findings presented here are corroborating evidence that we should be treating CIS and we should make every effort to provide continuous treatment."
In the study, Jokubaitis and colleagues reviewed data involving 1,989 patients for whom complete records were available. The patients had a combined 6,724 years of follow-up with a median follow-up of 3 years per patient – ranging from 9 months to 9.9 years.
Of those patients, 1,339 were treated with disease-modifying agents, either interferon-based products or glatiramer acetate (Copaxone). The researchers included 307 patients who had sustained disability progression over 12 months.
The goal of the study was to determine predictors of progression, and the investigators found that advancing age was a weak prognosticator of disability progression – a 17% increased risk per decade (P=0.006). They also found that pyramidal system dysfunction was a strong predictor of disability progression – with higher imaging pathology translating to a 46% increased risk of disease progression (P=0.008).
Jokubaitis acknowledged that teasing out how treatment affected outcomes was confounded by the fact that sicker patients at diagnosis were more likely to be treated early and consistently, which helped them avoid disease progression.
She and her colleagues did scrutinize the different disease-modifying agents used in the study, but found all of them were successful in delaying progression and none appeared significantly better than the other, although treatment with glatiramer acetate approached significance compared with interferon-beta 1a intramuscular injection (P=0.052) in an ad-hoc analysis.
"Cumulative disease-modifying treatment duration significantly delays progression of multiple sclerosis," Jokubaitis said.
Co-Author Marie Trojano, MD, professor of neurology at the University of Bari in Italy, and president of ECTRIMS, told MedPage Today that concerns that clinically isolated syndromes might not be true multiple sclerosis should be discarded. "There really should not be a disease called CIS. Imaging scans can tell us these events are early multiple sclerosis."
Jokubaitis disclosed commercial interests with Novartis. Co-authors disclosed commercial interests with Biogen Idec, Bayer-Schering, sanofi, Merck-Serono, Teva, Genzyme, Roche, EMD-Serono, GSK and Biologix.
Trojano disclosed commercial interests with Biogen-Idec, Bayer-Schering, sanofi, Merck-Serono, Teva and Novartis.
Burnett had no disclosures.
Primary source: European Committee for Treatment and Research in Multiple Sclerosis Source reference: Jokubaitis V et al, "Predictors of 12-month confirmed disability progression after onset of clinically isolated syndrome (CIS) suggestive of multiple sclerosis" ECTRIMS 2013; Abstract 59.
Source: Medpage Today © 2013 MedPage Today, LLC (03/10/13)