Long term benefit of multiple sclerosis treatment: an investigation using a novel data collection technique.
BACKGROUND
The Knowledge Program (KP) is an initiative to collect self-reported patient data and objective clinician assessments electronically at each outpatient clinical encounter. Available outcomes include the EuroQoL-5D (EQ5D), Patient Health Questionnaire-9 (PHQ9), Multiple Sclerosis Performance Scales (MSPS), and the timed 25-foot walk (T25FW).


OBJECTIVE
This study was designed to use the KP to investigate the long-term benefits of early treatment (ET) in multiple sclerosis (MS).


METHODS
The KP was queried for patients with relapsing-remitting MS or secondary progressive MS who were ≥ 5 years from symptom onset. ET was defined as treatment with an approved agent for ≥ 3 of the first five years after symptom onset. Propensity scores for ET were calculated based on early clinical characteristics. Patients were divided into propensity score quintiles and linear regression models were constructed to determine the treatment effect sizes and confidence intervals.


RESULTS
From the 1082 patients that met entry criteria, 453 patients (41.9%) received ET. Those patients receiving ET showed significantly better scores on the EQ5D index, PHQ9, and MSPS, but only in the upper three propensity quintiles. For the T25FW, ET did not result in significantly better times in any quintile.


CONCLUSIONS
These results suggest that ET of MS is beneficial but the effect appears modest.
Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic Foundation, Cleveland, OH 44195, USA. conwayd2@ccf.org
Devon S
DS
Conway
Deborah M
DM
Miller
Ralph G
RG
O'Brien
Jeffrey A
JA
Cohen
D000328:Adult; D000553:Ambulatory Care; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D003625:Data Collection / Q000379:methods; D004185:Disability Evaluation; D005080:Exercise Test; D005260:Female; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D020528:Multiple Sclerosis, Chronic Progressive / Q000175:diagnosis / Q000188:drug therapy*; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000175:diagnosis / Q000188:drug therapy*; D057216:Propensity Score; D057566:Self Report; D013997:Time Factors; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents