Survival in MS

Abstract

Objective: To examine the effects of interferon beta (IFN␤)-1b on all-cause mortality over 21 years in the cohort of 372 patients who participated in the pivotal randomized clinical trial (RCT), retaining (in the analysis) the original randomized treatment-assignments. Methods:For this randomized long-term cohort study, the primary outcome, defined before data collection, was the comparison of all-cause mortality between the IFN␤-1b 250 g and placebo groups from the time of randomization through the entire 21-year follow-up interval (intention-totreat, log-rank test for Kaplan-Meier survival curves). All other survival outcomes were secondary.Results: After a median of 21.1 years from RCT enrollment, 98.4% (366 of 372) of patients were identified, and, of these, 81 deaths were recorded (22.1% [81 of 366]). Patients originally randomly assigned to IFN␤-1b 250 g showed a significant reduction in all-cause mortality over the 21-year period compared with placebo (p ϭ 0.0173), with a hazard ratio of 0.532 (95% confidence interval 0.314-0.902). The hazard rate of death at long-term follow-up by Kaplan-Meier estimates was reduced by 46.8% among IFN␤-1b 250 g-treated patients (46.0% among IFN␤-1b 50 g-treated patients) compared with placebo. Baseline variables did not influence the observed treatment effect. Conclusions:There was a significant survival advantage in this cohort of patients receiving early IFN␤-1b treatment at either dose compared with placebo. Near-complete ascertainment, together with confirmatory findings from both active treatment groups, strengthens the evidence for an IFN␤-1b benefit on all-cause mortality. Classification of Evidence:This study provides Class III evidence that early treatment with IFN␤-1b is associated with prolonged survival in initially treatment-naive patients with relapsingremitting multiple sclerosis. Neurology Multiple sclerosis (MS) is a chronic, inflammatory disease of the CNS with a lifelong course, necessitating outcome assessments over both the short term and long term.1 However, randomized clinical trials (RCTs) have typically focused only on short-term outcomes such as clinical measures of relapse and physical disability, as well as MRI measures of disease activity and severity.2-8 Although survival is the ultimate long-term outcome, to date mortality in patients with MS treated with disease-modifying therapy (DMT) has not been well-studied, largely because of the length and completeness of observation needed. 9 *These authors contributed equally to this work.

Prevalence of Multiple Sclerosis in Saudi Arabia

“…However, the diagnosing of more benign cases had probably a limited impact on prevalence, leaving increased survival as the most likely explanation to our findings. Improved survival in MS, possible due to more frequent use of advanced disease-modifying therapies, 31 was probably the most important factor related to the observed increase in prevalence. The importance of improved survival on the observed increase in prevalence was also supported by the shift towards an older age distribution of the present 2013 prevalence cohort compared with the prevalence reported in the 2003 study.…”

“…The sample comprised of 202(31.9%) male, and 431(68.1%) females. (20)(21)(22)(23)(24), While (34.1%) of the respondents Aged between (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35), While (18.8%) of the respondents Aged more than 35. Table (3) that (34.4%) of the respondents belong to the eastern region, while (33.5%) of them belong to the western region, (20.4%) of them belong to the Central Region, and (7.3%) of them belong to the southern district.…”

The Increasing Prevalence of Multiple Sclerosis in New Zealand

“…Thirdly, general improvement in health care services and awareness of the condition may be increasing case ascertainment. Finally, increasing long-term survival may be due to improved general medical care and the possible beneficial effect of disease-modifying treatments [30]. That the latitudinal gradient in the prevalence of MS has remained constant over time suggests that factors other those accounting for the gradient per se may be responsible for the overall increase in prevalence.…”

Long‐term epidemiology of multiple sclerosis in the N orthern S eville D istrict

“…A recent study has shown that early treatment with disease‐modifying therapy (in this case with IFN β ‐1b) was associated with a significant survival advantage over placebo in patients with MS followed up for 21 years 32. This decreasing mortality trend and the lack of a curative therapy means that patients and their caregivers are living with the consequences of MS for longer, and the associated morbidity can be significant.…”