Whilst we sort out what is going on I have agreed to try keep the news coming, as our contributors keep getting run over. However, I am pleased to say I zoomed with Dr Ide Smets today who is well and moving about.
As she now has metal plates following surgery I welcomed her to the MSblog “airline club” as I am sure she and ProfG will now get the feeling I have endured for years of repeately being stopped getting onto planes. With ProfGs pelvic scews no wonder he wants to cut down on air travel:-). During lock down I have done a deed poll to change my name….I wonder if it will work? Did you see the details it in the London Gazette? Anyway I digress
Where’s ProfG when you need him?
Today, I post on a concept of him and his mates (Colleagues).
A few years ago ProfG and others asked what are the drivers for disability progression? They came up with these concepts that an increase in disability could be due to a relapse causing damage. The called this Relapse associated worsening or RAW. However there was disability that accumulated later and this is called progression independent of progression of PIRA. See the diagrams below to explain this. I am sure ProfG would have done a better job explaining this.
They looked at the trial data of ocrelizumab and concluded that most disability accumulation was not associated with overt relapses (Kappos et al. JAMA Neurol 2020 77:1132).
So in this study they look at Natalizumab
Graf J, Leussink VI, Soncin G, Lepka K, Meinl I, Kümpfel T, Meuth SG, Hartung HP, Havla J, Aktas O, Albrecht P. Relapse-independent multiple sclerosis progression under natalizumab. Brain Commun. 2021 Oct 9;3(4):fcab229
The objective of this study was to investigate confirmed progression independent of relapse activity in relapsing-remitting multiple sclerosis patients under long-term natalizumab treatment. We performed a retrospective, cross-sectional study of clinical data captured between 1994 and 2019 at two German multiple sclerosis tertiary referral centres. Data files of all relapsing-remitting multiple sclerosis patients treated with natalizumab for ≥24 months were analysed. Confirmed progression independent of relapse activity was defined as ≥12 week confirmed disability progression on a roving Expanded Disability Status Scale reference score by 1 point in patients with an Expanded Disability Status Scale score ≤3 or 0.5 in patients with an Expanded Disability Status Scale score ≥3.5 in the absence of a relapse.
Among the 184 patients identified, 44 (24% = substantiat number according to the authors) developed confirmed progression independent of relapse activity under natalizumab irrespective of the Expanded Disability Status Scale score at natalizumab onset.
.Analysis revealed disease duration as the main factor for confirmed progression independent of relapse activity development (P = 0.005).
On the plus side the “uber-substantial” majority (67%) did not show PIRA. The authors say “Our data suggest that almost 80% of patients do not develop cPIRA and remain stable despite a mean disease duration of 15.6 ± 7.5 years” and “When comparing our results with existing natural disease course data, the rate for conversion to a secondary progressive disease course may be reduced by 50% under natalizumab”
General Disclaimer: Please note that the opinions expressed here are those of the author and do not necessarily reflect the positions of the Barts and The London School of Medicine and Dentistry, nor Barts Health NHS Trust and are not meant to be interpreted as personal clinical advice. Please note that Professor Gavin Giovannoni has no responsibility for this blog.