WESTPORT, CT (Reuters Health) Nov 17 - Once irreversible disability occurs in multiple sclerosis patients (MS), the time course of progressive disability is about same for patients with relapsing-remitting or progressive MS, according to a report by French researchers published in the November 16th issue of the New England Journal of Medicine.
Using the Lyons MS database, Dr. Christian Confavreux, from Hopital Neurologique, Lyons, and colleagues, collected data on 1844 patients who had had MS for a mean of 11 years and determined whether the initial course of the disease was relapsing-remitting or progressive.
Dr. Confavreux's team also collected data on the subsequent course of the condition, classifying it as relapsing-remitting, secondary progressive or primary progressive. In addition, they noted the times of relapses, the time to the onset of irreversible disability, and the time course of progressive, irreversible disability.
They found that among the 1562 patients with relapsing-remitting MS, the median time from onset to a score of 7 on the Kurtzke Disability Status Score was 33.1 years, compared with 13.4 years for the 282 with progressive MS from the onset.
"In contrast," they write, "the times from the assignment of a score of 4 to a score of 6 were similar in the two groups (5.7 and 5.4 years)." Using Kaplan-Meier analyses, Dr. Confavreux's group found that "the time course of progressive, irreversible disease among patients with the primary progressive type of MS was not affected by the presence or absence of superimposed relapses."
Elsewhere in the journal, Dr. W. Ian McDonald, from the Royal College of Physicians, London, writes that "these results should be interpreted with caution," because 49% of the patients received some form of treatment for up to a year during the study period.
Dr. McDonald also points out that "acute relapse is essentially an inflammatory event and progression is influenced by axonal degeneration." Therefore, "until the relation between inflammation and degeneration is clarified, it will remain difficult to arrive at a coherent picture of the relation between the pathological and the clinical evolution of MS."
N Engl J Med 2000;343:1430-1438,1486-1487.
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