Influence of treatment in multiple sclerosis disability: an open, retrospective, non-randomized long-term analysis.
The efficacies of immunosuppressive (IMS) and immunomodulatory (IMM) drugs for multiple sclerosis (MS) have been reported in several studies. These agents can reduce relapse rates and lesions observed by magnetic resonance imaging studies. However, the effect of these medications in disability progression over 4 years is rarely examined.


OBJECTIVE
To study the disabilities associated with MS patients after a long time period and to analyze the therapeutic influence of different types of treatments in patient disease progression.


METHODS
This is an open, uncontrolled, non-randomized, retrospective study of the disease progression using the Expanded Disability Status Scale (EDSS) and the Multiple Sclerosis Severity Score (MSSS) in 155 cases of MS, which were 76% female with a mean age of onset of 30.21+/-9.70. The follow-up period was 115.39+/-88.08 months (median 92, 3 to 447 months). These cases were submitted to the following 277 different therapeutic procedures: 62 without IMS or IMM therapy (SYT) (just corticosteroids), 53 with azathioprine (AZA), 53 interferon-beta (IFNbeta)-1b 250 microg (BET), 55 IFNbeta-1a 22 microg (R22), 19 IFNbeta-1a 30 microg (AVO), 15 IFNbeta-1a 44 microg (R44), 15 glatiramer acetate (COP) 20 mg, and 5 cases with mitoxantrone (MIT).


RESULTS
The median EDSS group was 2.00 (0 to 5.5, mean 1.89+/-1.52) at the onset of each treatment and 2.50 (0 to 9, mean 3.06+/-2.18) at the end. The median initial MSSS was 3.34 (0.25 to 9.50, mean 3.94+/-2.91) and the final medial was 3.90 (0.05 to 9.88, mean 4.02+/-2.78). The EDSS between initial and final score for the whole group had statistically significant progression, as well as for the sub-groups SYT, AZA, BET and R22. No statistically significance difference was found in the MSSS between initial and final scores in the whole group or treatment sub-groups. The variation between the initial and final EDSS and MSSS among the types of treatments found no statistical significance for any group.


CONCLUSIONS
In this study series, no statistical difference was found in the long-term progression of disability among the IMS and IMM treated cases, nor in the cases treated only with corticosteroids.
Werneck
Lineu Cesar
LC
Neurology Division Unit of Demyelinating Diseases, Internal Medicine Department, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil. werneck@ufpr.br
Lorenzoni
Paulo José
PJ
Radünz
Vitor A
VA
Utiumi
Marco A T
MA
Kay
Cláudia Suemi Kamoi
CS
Scola
Rosana Herminia
RH
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D018450:Disease Progression; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D009103:Multiple Sclerosis / Q000188:drug therapy*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D007155:Immunologic Factors; D007166:Immunosuppressive Agents