Research: DMTs slow the onset of progression in relapsing MS

EpubBergamaschi et al. Immunomodulatory therapies delay disease progression in multiple sclerosis. Mult Scler. 2012 May 31.

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.
Results: We analysed data from 1178 MSers with a relapsing form of MS at onset and at least 10 years of disease duration, treated (59%) or untreated with DMDs. The risk of secondary progression was significantly lower in patients treated with DMDs, regardless of the initial prognosis predicted by BREMS.

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."

"If you have active relapsing MS you should be on a DMT. I define active MS as having relapses or MRI evidence of disease activity. Unfortunately, NICE does not allow us to practice what we preach!"

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