Breaking News
January 24, 2018 - Study illustrates role of specific antibodies in protection against influenza
January 24, 2018 - Curcumin could provide meaningful cognitive benefits, study suggests
January 24, 2018 - Tenax Therapeutics Announces Plan to Develop Levosimendan for a Pulmonary Hypertension Indication with No FDA Approved Therapies
January 24, 2018 - EndoBreak: Obesity in 2018; Diabetes Risks in Pregnancy
January 24, 2018 - Recommendations to improve the quality of ultrasound imaging in obstetrics and gynecology
January 24, 2018 - Sensory feedback facilitates enhanced brainwave control of portable hand-exoskeleton
January 24, 2018 - Innovative system helps medical staff to accurately evaluate patients’ risk of falling
January 24, 2018 - Porvair Sciences to showcase microplate and chromatography products at Analytica 2018
January 24, 2018 - Children with cochlear implant learn words faster than kids with normal hearing
January 24, 2018 - Ionis’ Inotersen NDA Accepted for Priority Review by the FDA
January 24, 2018 - Abuse-Deterrent Opioid No Help in Australia
January 24, 2018 - Maternal mortality rates are on the rise, but more accurate estimates are needed
January 24, 2018 - New essential oil inhaler facilitates pain management
January 24, 2018 - USPSTF: Insufficient Evidence to Screen Kids for Scoliosis
January 24, 2018 - Team develops method to identify seizure-causing regions in the brain
January 24, 2018 - New report takes comprehensive look at health effects of e-cigarettes
January 24, 2018 - Researchers develop new indicator for assessing active aging
January 24, 2018 - Research highlights decreasing trend in traditional hysterectomy
January 24, 2018 - Computer-based speech analysis has potential to improve prediction of psychosis
January 24, 2018 - New family of FFPE reagent kits launched by Beckman Coulter Life Sciences
January 24, 2018 - Researchers use epigenetic signatures to advance diagnosis for neurodevelopmental disorders
January 24, 2018 - EPI report reveals air quality as major environmental threat to public health
January 23, 2018 - How to Fight the Flu This Season
January 23, 2018 - Mixed Data for Fatty Acid Intake and Glaucoma
January 23, 2018 - The brains of jazz and classical pianists work differently
January 23, 2018 - Scientists identify protein biomarkers to track patients with Hutchinson-Gilford progeria syndrome
January 23, 2018 - Exercise could extend the life expectancy of breast cancer survivors, study states
January 23, 2018 - Researchers show association between microbiome and cancer-related blood infections
January 23, 2018 - Site Sat Dormant for 10 Years. Now It’s Live Again.
January 23, 2018 - FDA’s program to speed up drug approval shaved nearly a year off the process
January 23, 2018 - Study reveals key challenges and frustrations associated with current RTSM/IRT solutions
January 23, 2018 - Researchers unravel function of protein ‘smallish’
January 23, 2018 - Infants born in withdrawal due to opioid exposure in utero show abnormalities
January 23, 2018 - Researchers block common siren call of glioblastoma and metastatic breast cancer
January 23, 2018 - FDA Accepts New Drug Applications for Merck’s Doravirine, the Company’s Investigational Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI), for Treatment of HIV-1 Infection
January 23, 2018 - Six Concerns About Practice Consolidation
January 23, 2018 - How Alzheimer’s Changes the Brain
January 23, 2018 - Pharmaceutical stirs outrage over price hike for brain tumor drug
January 23, 2018 - University under fire for off-the-grid herpes vaccine experiments
January 23, 2018 - Gastric environment permanently changes in the presence of Helicobacter pylori infection
January 23, 2018 - Scientists take tissue-engineering approach to improve healing related to skeletal system
January 23, 2018 - Consumption of dietary fiber can prevent obesity and metabolic syndrome, study shows
January 23, 2018 - FDA Alert: Multiple Drug Products by Flawless Beauty: Recall
January 23, 2018 - Rhymes with Amyloid: That’s Improbable!
January 23, 2018 - CLCN2-related leukoencephalopathy – Genetics Home Reference
January 23, 2018 - Can road salt and other pollutants disrupt our circadian rhythms?
January 23, 2018 - ‘Depression literacy’ program encourages many teens to seek adult help
January 23, 2018 - New initiative seeks to transform the way people live with dementia
January 23, 2018 - Isosec introduces first Virtual Smartcard for NHS Trusts and clinicians
January 23, 2018 - New report reveals rapid growth in Vietnam pharmaceutical market
January 23, 2018 - Obamacare Led to Rise in Breast Cancer Screening
January 23, 2018 - Bariatric Tx Bests Usual Care for Long-Term Health
January 23, 2018 - Keep Your Dogs and Cats Safe From Holiday Hazards
January 23, 2018 - New AI technology significantly improves human kidney analysis
January 23, 2018 - In Trump’s first year, anti-abortion forces make strides despite setbacks
January 23, 2018 - Small PFS Bump in Gastric/GEJ Cancer
January 23, 2018 - Defending against environmental stressors may shorten lifespan
January 23, 2018 - Researchers create cavitation bubbles to remove dental plaque
January 23, 2018 - Discovery offers fresh perspective on how the brain keeps its balance
January 23, 2018 - Opioid exposure linked to physical abnormalities in newborns
January 23, 2018 - Study identifies genes involved in latent asymptomatic state of breast cancer metastases
January 23, 2018 - Kala Pharmaceuticals Announces New Drug Application for Inveltys (KPI-121 1%) Has Been Accepted for Review by the U.S. Food and Drug Administration
January 23, 2018 - Closer Look at Household Contacts Finds More TB Cases
January 23, 2018 - Type 1 IFNs may mediate Zika pregnancy complications
January 23, 2018 - Anti-inflammatory pill could help make vaccines more effective for the elderly
January 23, 2018 - New discovery sheds light on iron-restricted anemia that causes fatigue in millions
January 23, 2018 - BMG LABTECH’s Australian office celebrates 20 years of innovation and growth in APAC region
January 23, 2018 - FDA Alert: Basic Drugs Brand of Senna Laxative by Magno-Humphries Laboratories: Recall
January 23, 2018 - Chronic Opioid Use High Among IBD Patients
January 23, 2018 - New long-acting, less-toxic HIV drug suppresses virus in humanized mice
January 23, 2018 - Findings provide better understanding of cognitive inflexibility in Fragile X Syndrome
January 23, 2018 - Powerful anti-oxidant can stop progression of fatty liver disease in young mice
January 23, 2018 - Marijuana use does not lower probability of conception, study shows
January 23, 2018 - Study shows value of occupational therapy in the lives of young adults with diabetes
January 23, 2018 - Chinese researchers develop multifunctional vehicle to transport gene therapeutics
January 23, 2018 - Researchers seek to understand effect of very low birth weight on the brain
January 23, 2018 - Be a Savvy Supermarket Shopper
January 23, 2018 - NIH Striving to Avoid False Hope in Chronic Fatigue
January 23, 2018 - Occupational Stress
January 23, 2018 - PrEP could make US easily hit its 2020 HIV prevention goal, study finds
Getting a Handle on Benign MS

Getting a Handle on Benign MS

image_pdfDownload PDFimage_print

PARIS — The debate over what exactly constitutes “benign” multiple sclerosis still rages, with several presentations here — each with different methodologies — coming to markedly different conclusions.

Using a popular definition of an Expanded Disability Status Scale (EDSS) score of 3.5 or lower at 15 years, a prospective British cohort found a prevalence of about 42%, and a Swedish registry study using a similar cutoff found a prevalence of 22% — both involving mostly untreated patients.

But a Welsh registry study that took into account more than just the EDSS — including fatigue, depression, and cognition — put the prevalence far lower, at around 1%. Meanwhile, a U.S. retrospective chart review that included patients treated with disease-modifying therapies counted 31% to still be “benign” at 20 years.

The variance reflects the current wide range reported in the literature, cited across all presentations to be from 6% to 64%.

One thing all the presenters at the joint ECTRIMS-ACTRIMS 2017 meeting agreed on, however, is that there does appear to be a certain subset of MS patients who will have much slower and less debilitating disease progression.

“We shouldn’t put a label on it,” Ali Manouchehrinia, PhD, of the Karolinska Institute, who reported the Swedish data, told MedPage Today. “The conclusion is that there are a group of patients who progress at a much lower rate. They still progress. They are getting worse. MS has an impact. But it’s not as much as it is for the rest.”

By the ‘Standard’ Definition

His study evaluated 11,222 relapsing MS patients in the Swedish National MS Registry, and using a cutoff of an EDSS of 3 or lower found a prevalence of 22% at 15 years that fell to 6% at 25 years.

In further analyses, they found that those without benign MS accumulated an extra 0.2 points on the EDSS per year compared with those with so-called benign MS. By the age of 40, for instance, mean EDSS score in those with benign disease at year 15 was two points lower than in those with non-benign MS.

Cognitive impairment worsened by an extra 0.4 points on the Symbol Digit Modalities Test (SDMT) per year in those without benign disease, so that 10 years into their disease their SDMT scores were 7 points lower than those with benign disease.

Finally, non-benign MS patients had more missed workdays per year than benign MS patients; they also had a 7-fold higher risk of all-cause mortality.

Manouchehrinia said the patients with benign disease were younger at disease onset (age 28 versus 32), slightly more likely to be female (75% versus 70%), had a lower relapse rate within 2 and 5 years of onset, their first relapse was often a sensory relapse, and they were more likely to show complete recovery from their first relapse.

Though benign disease is a “retrospective” diagnosis, he said, further study of these risk factors can help determine which patients will have a less aggressive disease course — an important consideration in the age of more expensive and more potent medications that come with side effects.

Karen Chung, MBBS, of University College London, who presented the prospective British cohort data, said her results support “the idea a very stable ‘benign’ MS does exist.”

Her team recruited 132 patients who had clinically isolated syndrome (CIS) in 1984-1987 and followed them for a mean of 30 years, for both clinical and MRI outcomes. They excluded CIS patients who never developed MS.

After also excluding those lost to follow-up, they ended up with about 80 patients with known MS; 35 had relapsing MS, 25 had secondary progressive MS, and 16 patients had died with an EDSS of 10, indicating their death had to do with their disease.

Chung and colleagues found that over the 30-year study, 32 people had an EDSS of 3.5 or lower, putting the prevalence at 42%. Only three of these patients used a disease-modifying drug, and they were all first-line injectables, Chung said.

Counting Other Factors

Emma Tallantyre, PhD, of Cardiff University in Wales, said the EDSS is a “blunt tool” for assessing the full impact of MS, and proposed a far more stringent definition of truly benign MS. In addition to an EDSS of 3 or less at 15 years, “benign” patients should have no clinically significant fatigue, depression, bladder symptoms, or cognitive impairment; no impact of MS on occupation; and no exposure to disease-modifying drugs.

By that definition, she found a prevalence of 1% in a Welsh cohort of 222 patients with unlimited walking ability, 56 of whom were assessed and included in the study.

Despite the low numbers, she said researchers and clinicians “shouldn’t use the term ‘benign MS’ readily because it could be dismissive and it isn’t representative of what’s really going on. EDSS is a blunt tool; cognition and fatigue aren’t being detected, but they could cause significant disability.”

Andrew Bouley, MD, of Beth Israel Deaconess Medical Center in Boston, and colleagues found that 31% of patients had benign disease defined as EDSS of 3 or less at 20 years — but about half of their patients were on disease-modifying therapy.

Those with more benign disease, he said, were less likely to be on the more aggressive therapies such as natalizumab, rituximab, and the other chemotherapeutic agents.

“The idea that not all MS is the same isn’t new,” Bouley said.

Tallantyre disclosed financial relationships with Biogen, Merck, and Novartis.

Manouchehrinia, Chung, and Bouley disclosed no financial relationships with industry.


Tagged with:

About author

Related Articles