MS Speaks

Multiple Sclerosis => MS - RESEARCH AND NEWS => Topic started by: agate on March 25, 2018, 09:33:12 am

Title: DMTs not beneficial in SPMS (NEJM)
Post by: agate on March 25, 2018, 09:33:12 am
This article has become available in its entirety after the standard 6-month waiting period. In NEJM Journal Watch (September 21, 2017), Robert T. Naismith, MD, reviews and comments on an article in Neurology. Naismith's article is entitled "Disease modifying therapies not beneficial in secondary progressive multiple sclerosis," and the article he is reviewing is "Anti-inflammatory disease-modifying treatment and short-term disability progression in secondary progressive MS" by Lorscheider et al.


https://www.jwatch.org/na44978/2017/09/21/disease-modifying-therapies-not-beneficial-secondary?query=etoc_jwneuro&jwd=000100983645&jspc=


These remarks on the study's limitations are is from the comment section:


Quote
Several limitations are important to consider. Although propensity matching is a powerful tool, this was not a randomized study, and there may be unknown variables between patients who are treated versus those who discontinue treatment. Whereas some patients had follow-up for >4 years, median follow-up was 2 years perhaps not enough time to appreciate any long-term benefits. Because treatments were largely standard-efficacy agents, this study was underpowered to show whether high-efficacy therapies provide additional benefit on disability. Randomized discontinuation studies are underway to determine the safety of stopping treatment. For patients who wish to discontinue due to older age or progressive MS, a program of withdrawal under medical and imaging observation would be prudent to identify disease reactivation, should it occur.





Abstract of the study being reviewed above:


http://n.neurology.org/content/89/10/1050


The evidence presented in the study is classified as Class IV. Class I evidence is the best.