title: Time to secondary progression in patients with multiple sclerosis who were treated with first generation immunomodulating drugs.
abstract: BACKGROUND
  It is currently unknown whether early immunomodulatory treatment in relapsing-remitting MS (RRMS) can delay the transition to secondary progression (SP).
  
  
  OBJECTIVE
  To compare the time interval from onset to SP in patients with RRMS between a contemporary cohort, treated with first generation disease modifying drugs (DMDs), and a historical control cohort.
  
  
  METHODS
  We included a cohort of contemporary RRMS patients treated with DMDs, obtained from the Swedish National MS Registry (disease onset between 1995-2004, n = 730) and a historical population-based incidence cohort (onset 1950-64, n = 186). We retrospectively analyzed the difference in time to SP, termed the "period effect" within a 12-year survival analysis, using Kaplan-Meier and Cox regression analysis.
  
  
  RESULTS
  We found that the "period" affected the entire severity spectrum. After adjusting for onset features, which were weaker in the contemporary material, as well as the therapy initiation time, the DMD-treated patients still exhibited a longer time to SP than the controls (hazard ratios: men, 0.32; women, 0.53).
  
  
  CONCLUSIONS
  Our results showed there was a longer time to SP in the contemporary subjects given DMD. Our analyses suggested that this effect was not solely driven by the inclusion of benign cases, and it was at least partly due to the long-term immunomodulating therapy given.
authors.affiliation: Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: H
authors.initials: H
authors.lastname: Tedeholm
authors.forename: J
authors.initials: J
authors.lastname: Lycke
authors.forename: B
authors.initials: B
authors.lastname: Skoog
authors.forename: V
authors.initials: V
authors.lastname: Lisovskaja
authors.forename: J
authors.initials: J
authors.lastname: Hillert
authors.forename: C
authors.initials: C
authors.lastname: Dahle
authors.forename: J
authors.initials: J
authors.lastname: Fagius
authors.forename: S
authors.initials: S
authors.lastname: Fredrikson
authors.forename: A-M
authors.initials: AM
authors.lastname: Landtblom
authors.forename: C
authors.initials: C
authors.lastname: Malmeström
authors.forename: C
authors.initials: C
authors.lastname: Martin
authors.forename: F
authors.initials: F
authors.lastname: Piehl
authors.forename: B
authors.initials: B
authors.lastname: Runmarker
authors.forename: L
authors.initials: L
authors.lastname: Stawiarz
authors.forename: M
authors.initials: M
authors.lastname: Vrethem
authors.forename: O
authors.initials: O
authors.lastname: Nerman
authors.forename: O
authors.initials: O
authors.lastname: Andersen
mesh_terms: D000328:Adult; D018450:Disease Progression; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D008297:Male; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007155:Immunologic Factors
keywords: Disease-modifying drugs; Sweden; disease progression; disease severity; epidemiology; multiple sclerosis; relapsing–remitting multiple sclerosis; secondary progressive multiple sclerosis; time to progression