Slower MS disability progression than previously reported
ECTRIMS Online Library. Tremlett H. 09/11/19; 279360; 2
Helen Tremlett
Helen Tremlett
Contributions
Abstract

Abstract: 2

Type: Hot Topic

Abstract Category: Hot Topic 1: Is MS becoming a milder disease, and, if so, why?

H. Tremlett

University of British Columbia | Faculty of Medicine (Neurology), University of British Columbia, Vancouver, BC, Canada

The concept that 'Disability progression in MS is slower than previously reported' (Neurology 2006;66:172-177) was first described prior to the widespread use of the disease-modifying drugs (DMDs) for MS. Subsequent studies of the natural history of MS, and analyses of individuals enrolled in the placebo arms of clinical trials, have generally concurred with these observations. So has the disease fundamentally changed? Or are a broader, and more representative population of MS patients now referred to MS centres? Thus are individuals with 'milder' MS now included in studies of disease progression and enrolled in clinical trials? It is interesting to delve into the not-so-distant past when the concept of actively withholding a diagnosis of MS, or to tell the patient was subject to debate by physicians (e.g., Lancet, 1985). Further, disparities between men and women with respect to access to, and treatment by the health system (including diagnosis of diseases) could also influence the types of MS patients traditionally included in research. All these aspects may have an important, often overlooked role in our ability to measure and assess MS in past decades, and likely continues in some regions of the world today. How to tease apart these potential temporal changes in the recognition of MS relative to other possible changes in exposures - from lifestyle (e.g., smoking, obesity) to better management of chronic diseases in general, as well as use of DMDs in the contemporary era remains an ongoing challenge. Looking to the future, our understanding of the MS disease course may shift substantially with the recent recognition of a measurable, symptomatic prodromal phase in MS. A greater understanding of the MS prodrome could profoundly alter our ability to recognize and manage MS earlier, but would also (naturally) result in a further apparent slowing in the accrual of disability.
Disclosure: Dr Tremlett is the Canada Research Chair for Neuroepidemiology and Multiple Sclerosis and has received research support in the last 3 years from the: National Multiple Sclerosis Society, Canadian Institutes of Health Research, Canada Foundation for Innovation, Multiple Sclerosis Society of Canada, and the Multiple Sclerosis Scientific Research Foundation.

Abstract: 2

Type: Hot Topic

Abstract Category: Hot Topic 1: Is MS becoming a milder disease, and, if so, why?

H. Tremlett

University of British Columbia | Faculty of Medicine (Neurology), University of British Columbia, Vancouver, BC, Canada

The concept that 'Disability progression in MS is slower than previously reported' (Neurology 2006;66:172-177) was first described prior to the widespread use of the disease-modifying drugs (DMDs) for MS. Subsequent studies of the natural history of MS, and analyses of individuals enrolled in the placebo arms of clinical trials, have generally concurred with these observations. So has the disease fundamentally changed? Or are a broader, and more representative population of MS patients now referred to MS centres? Thus are individuals with 'milder' MS now included in studies of disease progression and enrolled in clinical trials? It is interesting to delve into the not-so-distant past when the concept of actively withholding a diagnosis of MS, or to tell the patient was subject to debate by physicians (e.g., Lancet, 1985). Further, disparities between men and women with respect to access to, and treatment by the health system (including diagnosis of diseases) could also influence the types of MS patients traditionally included in research. All these aspects may have an important, often overlooked role in our ability to measure and assess MS in past decades, and likely continues in some regions of the world today. How to tease apart these potential temporal changes in the recognition of MS relative to other possible changes in exposures - from lifestyle (e.g., smoking, obesity) to better management of chronic diseases in general, as well as use of DMDs in the contemporary era remains an ongoing challenge. Looking to the future, our understanding of the MS disease course may shift substantially with the recent recognition of a measurable, symptomatic prodromal phase in MS. A greater understanding of the MS prodrome could profoundly alter our ability to recognize and manage MS earlier, but would also (naturally) result in a further apparent slowing in the accrual of disability.
Disclosure: Dr Tremlett is the Canada Research Chair for Neuroepidemiology and Multiple Sclerosis and has received research support in the last 3 years from the: National Multiple Sclerosis Society, Canadian Institutes of Health Research, Canada Foundation for Innovation, Multiple Sclerosis Society of Canada, and the Multiple Sclerosis Scientific Research Foundation.

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