Tags

Type your tag names separated by a space and hit enter

Relating relapse and T2 lesion changes to disability progression in multiple sclerosis: a systematic literature review and regression analysis.
BMC Neurol 2013; 13:180BN

Abstract

BACKGROUND

In the treatment of multiple sclerosis (MS), the most important therapeutic aim of disease-modifying treatments (DMTs) is to prevent or postpone long-term disability. Given the typically slow progression observed in the majority of relapsing-remitting MS (RRMS) patients, the primary endpoint for most randomized clinical trials (RCTs) is a reduction in relapse rate. It is widely assumed that reducing relapse rate will slow disability progression. Similarly, MRI studies suggest that reducing T2 lesions will be associated with slowing long-term disability in MS. The objective of this study was to evaluate the relationship between treatment effects on relapse rates and active T2 lesions to differences in disease progression (as measured by the Expanded Disability Status Scale [EDSS]) in trials evaluating patients with clinically isolated syndrome (CIS), RRMS, and secondary progressive MS (SPMS).

METHODS

A systematic literature review was conducted in Medline, Embase, CENTRAL, and PsycINFO to identify randomized trials published in English from January 1, 1993-June 3, 2013 evaluating DMTs in adult MS patients using keywords for CIS, RRMS, and SPMS combined with keywords for relapse and recurrence. Eligible studies were required to report outcomes of relapse and T2 lesion changes or disease progression in CIS, RRMS, or SPMS patients receiving DMTs and have a follow-up duration of at least 22 months. Ultimately, 40 studies satisfied these criteria for inclusion. Regression analyses were conducted on RCTs to relate differences between the effect of treatments on relapse rates and on active T2 lesions to differences between the effects of treatments on disease progression (as measured by EDSS).

RESULTS

Regression analysis determined there is a substantive clinically and statistically significant association between concurrent treatment effects in relapse rate and EDSS; p < 0.01. Lower treatment effects were associated with higher relative rates of disease progression. Significant associations between T2 lesion measures and EDSS measures also were found (p < 0.05), with some suggestion that the strength of the association may differ for older versus newer DMTs.

CONCLUSIONS

Treatment differences in relapse reduction and T2 lesions are positively related to differences in disease progression over the first two years of treatment.

Authors+Show Affiliations

Evidera, 430 Bedford Street, Suite 300, Lexington, MA 02420, USA. Kyle.Fahrbach@evidera.com.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review
Systematic Review

Language

eng

PubMed ID

24245966

Citation

Fahrbach, Kyle, et al. "Relating Relapse and T2 Lesion Changes to Disability Progression in Multiple Sclerosis: a Systematic Literature Review and Regression Analysis." BMC Neurology, vol. 13, 2013, p. 180.
Fahrbach K, Huelin R, Martin AL, et al. Relating relapse and T2 lesion changes to disability progression in multiple sclerosis: a systematic literature review and regression analysis. BMC Neurol. 2013;13:180.
Fahrbach, K., Huelin, R., Martin, A. L., Kim, E., Dastani, H. B., Rao, S., & Malhotra, M. (2013). Relating relapse and T2 lesion changes to disability progression in multiple sclerosis: a systematic literature review and regression analysis. BMC Neurology, 13, p. 180. doi:10.1186/1471-2377-13-180.
Fahrbach K, et al. Relating Relapse and T2 Lesion Changes to Disability Progression in Multiple Sclerosis: a Systematic Literature Review and Regression Analysis. BMC Neurol. 2013 Nov 19;13:180. PubMed PMID: 24245966.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Relating relapse and T2 lesion changes to disability progression in multiple sclerosis: a systematic literature review and regression analysis. AU - Fahrbach,Kyle, AU - Huelin,Rachel, AU - Martin,Amber L, AU - Kim,Edward, AU - Dastani,Homa B, AU - Rao,Stephen, AU - Malhotra,Manoj, Y1 - 2013/11/19/ PY - 2013/01/03/received PY - 2013/11/04/accepted PY - 2013/11/20/entrez PY - 2013/11/20/pubmed PY - 2014/4/5/medline SP - 180 EP - 180 JF - BMC neurology JO - BMC Neurol VL - 13 N2 - BACKGROUND: In the treatment of multiple sclerosis (MS), the most important therapeutic aim of disease-modifying treatments (DMTs) is to prevent or postpone long-term disability. Given the typically slow progression observed in the majority of relapsing-remitting MS (RRMS) patients, the primary endpoint for most randomized clinical trials (RCTs) is a reduction in relapse rate. It is widely assumed that reducing relapse rate will slow disability progression. Similarly, MRI studies suggest that reducing T2 lesions will be associated with slowing long-term disability in MS. The objective of this study was to evaluate the relationship between treatment effects on relapse rates and active T2 lesions to differences in disease progression (as measured by the Expanded Disability Status Scale [EDSS]) in trials evaluating patients with clinically isolated syndrome (CIS), RRMS, and secondary progressive MS (SPMS). METHODS: A systematic literature review was conducted in Medline, Embase, CENTRAL, and PsycINFO to identify randomized trials published in English from January 1, 1993-June 3, 2013 evaluating DMTs in adult MS patients using keywords for CIS, RRMS, and SPMS combined with keywords for relapse and recurrence. Eligible studies were required to report outcomes of relapse and T2 lesion changes or disease progression in CIS, RRMS, or SPMS patients receiving DMTs and have a follow-up duration of at least 22 months. Ultimately, 40 studies satisfied these criteria for inclusion. Regression analyses were conducted on RCTs to relate differences between the effect of treatments on relapse rates and on active T2 lesions to differences between the effects of treatments on disease progression (as measured by EDSS). RESULTS: Regression analysis determined there is a substantive clinically and statistically significant association between concurrent treatment effects in relapse rate and EDSS; p < 0.01. Lower treatment effects were associated with higher relative rates of disease progression. Significant associations between T2 lesion measures and EDSS measures also were found (p < 0.05), with some suggestion that the strength of the association may differ for older versus newer DMTs. CONCLUSIONS: Treatment differences in relapse reduction and T2 lesions are positively related to differences in disease progression over the first two years of treatment. SN - 1471-2377 UR - https://www.unboundmedicine.com/medline/citation/24245966/Relating_relapse_and_T2_lesion_changes_to_disability_progression_in_multiple_sclerosis:_a_systematic_literature_review_and_regression_analysis_ L2 - https://bmcneurol.biomedcentral.com/articles/10.1186/1471-2377-13-180 DB - PRIME DP - Unbound Medicine ER -