Yesterday someone was asking about life expectancy, giving a list of personalities that did badly due to their MS. Clearly there are some people with very aggressive MS, but I made the point that all of the personalities mentioned didn’t live in a time when there were treatments and not in a time when the treatments work well for most people. I exclude the first generation CRAB drugs from my mind set. As I’m not a neuro I do this as I don’t have the weigh-up the pros and cons of each agent for each individidual.
However the point is that it is apt that this paper was just published as it supports the view that in the age of treatments you do better than doing nothing. If you take a DMT there is a survival advantage and the quicker you start the better. In addition if you take a more highly efficacious DMT, it is even better, supporting my mind set. After all it is simple biologcal sense
Ng HS, Zhu F, Kingwell E, Yao S, Ekuma O, Evans C, Fisk JD, Marrie RA, Zhao Y, Tremlett H. Disease-Modifying Drugs for Multiple Sclerosis and Association With Survival. Neurol Neuroimmunol Neuroinflamm. 2022 Jun 14;9(5):e200005. doi: 10.1212/NXI.0000000000200005.
Background and objectives: We examined the association between the disease-modifying drugs (DMDs) for multiple sclerosis (MS) and survival in a multiregion population-based study (4 Canadian provinces).
Results: We identified 35,894 persons with MS; 72% were female. The mean age at index date was 44.5 years (SD = 13.6)…… Compared with no exposure, exposure to any DMD or to any first-generation DMD was associated with a 26% lower hazard of mortality (both aHRs 0.74; 95% CI 0.56-0.98), while any second-generation DMD exposure was associated with a 33% lower hazard (aHR 0.67; 95% CI 0.46-0.98). Earlier DMD initiation (beta-interferon or glatiramer acetate vs no exposure) was associated with a significant mortality effect (p < 0.05), while later initiation was not (95% CIs included 1). However, the survival advantage with earlier initiation diminished over time, no longer reaching statistical significance at 15 years postindex date.
Discussion: Our study demonstrates an association between the DMDs for MS and improved survival in the real-world setting.
COI: Multiple
Disclaimer. These are the vews of the author and dobody else
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This interests me but I’m a bit confused- “exposure to any DMD or to any first-generation DMD was associated with a 26% lower hazard of mortality”. I am “Mr. 1st Generation DMT” and don’t see at my later age (64 yrs), heading to anything more radical. (“I’ve survived”). The article continues- “However, the survival advantage with earlier initiation [with 1st generation treatment] diminished over time”. Does this not translate to “less likely to die immediately or closely thereafter” versus those who waited to start? I browsed through the study and didn’t see how they defined “initiation of therapy”. And the “over time” bit, does that refer to the length of time with MS before initiating treatment, or the length of time a late starter has been on the drug? (Yes, I don’t do this for a living and it gets difficult to follow.)
Also, while not wanting to be “Mr. Contrary”, overall, might the tendency to be treated hint at a population that is more “on top” of their health and therefore account for fewer deaths over all, since MS per se was not ID’d as a specific cause of death? In other words, people who look out for their health (regardless of MS) tend not to die as much as people who don’t? And then by extension- perhaps: People who go on stronger DMTs tend to look out for their health just a wee bit more?
Also, the difference between 26% and 33% is not much, unless that is, you are one of those 7% making up the difference.
Thanks for the post MD. It’s kind of nice to read that perhaps my 23 years of every other day interferon injections were not a waste of time.
This is exactly why I read this blog on an almost daily basis. Someone raised the question in the comments only a day or two ago, and the detail article is presented out in response.
The fact that some of the writers and contributions are PhDs or Non Neuros is only an advantage as it gives different perspective.
Keep it up everyone!