The Influence of Immunomodulatory Treatment on the Clinical Course of Multiple Sclerosis

  • Andrius Kavaliunas
  • Leszek Stawiarz
  • Jonas Hedbom
  • Anna Glaser
  • Jan Hillert
Conference paper
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 822)

Abstract

Background. Multiple sclerosis (MS) is a chronic disease of the central nervous system. One of the major questions concerning the clinical progression of MS, still insufficiently elaborated or confirmed, is if it can be slowed down or augmented by external factors. Immunomodulatory treatment is a disease modifiable factor shown to influence disease progression of various medical conditions.

Objective. To investigate if treatment affects the long-term clinical progression of MS, measured as time from diagnosis to score of 4 or higher of Expanded Disability Status Scale (EDSS).

Methods. Longitudinal, prospective data concerning treatment status and EDSS were collected by health professionals in the Swedish MS Registry. Study cohort comprised new diagnosed MS patients at Karolinska Hospital between 2001 and 2005. Survival analysis adjusted for suspected confounders was used with the outcome variable time from diagnosis to EDSS ≥4.

Results. Early treatment was correlated with longer time from diagnosis to EDSS ≥4 (HR: 1.77; 95 % CI: 1.15–2.73; p = 0.01). Additionally, the influence of the covariates—age at onset and the baseline EDSS, which were statistically significant with hazard ratios of 1.03 and 2.1, respectively, was found.

Conclusion. Early treatment was associated with a better clinical outcome.

Keywords

Multiple sclerosis Disease modifying drugs Disease progression Survival analysis 

References

  1. 1.
    Confavreux C, Vukusic S (2006) Age at disability milestones in multiple sclerosis. Brain 129(Pt 3):595–605CrossRefPubMedGoogle Scholar
  2. 2.
    Compston A, Coles A (2008) Multiple sclerosis. Lancet 372(9648):1502–1517CrossRefPubMedGoogle Scholar
  3. 3.
    Kurtzke JF (1983) Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 33(11):1444–1452CrossRefPubMedGoogle Scholar
  4. 4.
    Elovaara I (2011) Early treatment in multiple sclerosis. J Neurol Sci 311:S24–S28CrossRefPubMedGoogle Scholar
  5. 5.
    Gilmore CP, Cottrell DA, Scolding NJ, Wingerchuk DM, Weinshenker BG, Boggild M (2010) A window of opportunity for no treatment in early multiple sclerosis? Mult Scler 16(6):756–759CrossRefPubMedGoogle Scholar
  6. 6.
    Andersen O (2012) From the Gothenburg cohort to the Swedish multiple sclerosis registry. Acta Neurol Scand Suppl 195:13–19CrossRefPubMedGoogle Scholar
  7. 7.
    Langer-Gould A, Popat RA, Huang SM, Cobb K, Fontoura P, Gould MK, Nelson LM (2006) Clinical and demographic predictors of long-term disability in patients with relapsing-remitting multiple sclerosis: a systematic review. Arch Neurol 63(12):1686–1691CrossRefPubMedGoogle Scholar
  8. 8.
    Shirani A, Zhao Y, Karim ME, Evans C, Kingwell E, van der Kop ML, Oger J, Gustafson P, Petkau J, Tremlett H (2012) Association between use of interferon beta and progression of disability in patients with relapsing-remitting multiple sclerosis. JAMA 308(3):247–256CrossRefPubMedGoogle Scholar
  9. 9.
    Tedeholm H, Lycke J, Skoog B, Lisovskaja V, Hillert J, Dahle C, Fagius J, Fredrikson S, Landtblom AM, Malmeström C, Martin C, Piehl F, Runmarker B, Stawiarz L, Vrethem M, Nerman O, Andersen O (2013) Time to secondary progression in patients with multiple sclerosis who were treated with first generation immunomodulating drugs. Mult Scler 19(6):765–774PubMedCentralCrossRefPubMedGoogle Scholar
  10. 10.
    Kappos L, Freedman MS, Polman CH, Edan G, Hartung HP, Miller DH, Montalbán X, Barkhof F, Radü EW, Bauer L, Dahms S, Lanius V, Pohl C, Sandbrink R, BENEFIT Study Group (2007) Effect of early versus delayed interferon beta-1b treatment on disability after a first clinical event suggestive of multiple sclerosis: a 3-year follow-up analysis of the BENEFIT study. Lancet 370(9585):389–397CrossRefPubMedGoogle Scholar
  11. 11.
    Kappos L, Freedman MS, Polman CH, Edan G, Hartung HP, Miller DH, Montalbán X, Barkhof F, Radü EW, Metzig C, Bauer L, Lanius V, Sandbrink R, Pohl C, BENEFIT Study Group (2009) Long-term effect of early treatment with interferon beta-1b after a first clinical event suggestive of multiple sclerosis: 5-year active treatment extension of the phase 3 BENEFIT trial. Lancet Neurol 8(11):987–997CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • Andrius Kavaliunas
    • 1
  • Leszek Stawiarz
    • 1
  • Jonas Hedbom
    • 1
  • Anna Glaser
    • 1
  • Jan Hillert
    • 1
  1. 1.Department of Clinical NeuroscienceKarolinska InstituteStockholmSweden

Personalised recommendations