The Apparent Slowing of Disability Progression in Multiple Sclerosis

STOCKHOLM — Further understanding of the recently recognized symptomatic, measurable prodrome phase in multiple sclerosis (MS) will increase clinicians’ ability to diagnose and manage the disease earlier. This understanding could potentially slow disability progression, according to research presented at the 35th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), held September 11-13, 2019 in Stockholm, Sweden.

Study author Helen Tremlett, PhD, Professor and Research Chair in Neuroepidemiology and Multiple Sclerosis at The University of British Columbia Department of Medicine, highlights in her presentation that first description of disability progression in MS being “slower than previously reported” was published before the use of disease-modifying drugs became widespread.² She goes on to note that this observation has since been backed up with subsequent analyses of placebo participants in MS clinical trials and studies of the natural history of the disease.

In the current report, the Dr Tremlett asks whether the disease has changed in some fundamental way, or if perhaps a more representative MS population is now being referred for treatment, with “milder” MS now included in current research. She also goes on to note that the patient population studied today may be broader as a result of improved disparities in healthcare and treatment access between men and women. She adds that not long ago, physicians debated the concept of actively withholding a diagnosis of MS from patients.

Dr Tremlett points out that numerous factors likely played an important, frequently overlooked role in how MS was diagnosed, measured, and assessed in prior decades, some of which may continue to influence MS diagnosis certain parts of the world today.

She concluded her presentation with a discussion pertaining to the ongoing challenge to tease apart the changes in recognizing MS vs changes in environmental exposures (eg, lifestyle choices; use of disease-modifying drugs). She notes that “looking to the future, our understanding of the MS disease course may shift substantially with the recent recognition of a measurable, symptomatic prodromal phase in MS.” In a final note Dr Tremlett notes that “a greater understanding of the MS prodrome [would not only] alter our ability to recognize and manage MS earlier, but would also naturally result in a further apparent slowing in the accrual of disability.”

Reference

1. Tremlett H. Slower MS disability progression than previously reported. Presented at: The 35th Congress of the European Committee for Treatment and Research in Multiple Sclerosis and the 24th Annual Conference of Rehabilitation in MS; September 11-13; Stockholm, SE. Abstract 2.

2. Tremlett H, Paty D, Devonshire V. Disability progression in multiple sclerosis is slower than previously reported. [published January 24, 2006]. Neurology. doi:10.1212/01.wnl.0000194259.90286.fe