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Multiple Sclerosis Disability Progression Taking Place at Slower Rates Thanks to Advances in Medicine, According to Landmark Allegheny General Hospital Study

Wednesday, December 18, 2019

PITTSBURGH – The average progression to heightened disability levels in patients diagnosed with multiple sclerosis (MS) takes place at a much slower rate than previously thought, according to a landmark study just published in the International Journal of MS Care by researchers from the Allegheny Health Network (AHN) Neuroscience Institute at Allegheny General Hospital (AGH) in Pittsburgh. The study points to advancing clinical therapies and education as a primary reason for improved prognosis and outcomes compared to natural history studies and previously reported data.

Titled ‘Outcomes in a Modern Cohort of Treated MS Patients Followed from Diagnosis up to 15 Years,’ the AGH report is one of the longest running and most detailed longitudinal studies of its type ever published, following patients diagnosed with MS up to 15 years from the onset of early symptoms.

“In the field of MS research, the most widely cited natural history studies involve the pretreatment era of a patient’s journey. The publication of our work is an exciting advancement in the world of MS care as it provides insight into better outcomes over the past few decades. The improvement is in part due to our ability to incorporate new therapies that improve a person’s quality of life and slow progression rates,” said Thomas Scott, MD, AHN neurologist and chief researcher in the study.

MS is a degenerative condition in which an abnormal response of the body’s immune system is directed against the central nervous system i.e. the brain, spinal cord and optic nerves. The immune system causes inflammation that damages protective insulation of the nerves as well as the nerves themselves.

Symptoms of the disease can include visual problems, tremors, unsteady gait and numbness or weakness in one or more limbs. For the majority of those diagnosed, the journey of MS will worsen at times, with periods of intermittent disease remission or improvement. In the long-term, some may become disabled due to weakness and lose various motor functions involving coordinated movements.

One hundred and eighty four newly diagnosed patients followed at AGH MS Treatment Center met criteria for the study, among all MS patients seen there from 1989 through 2006.  Most of the patients were examined at least yearly from the point of initial diagnosis and were followed on average for 13 years.

In the study, measurement of outcomes was based on the expanded disability status scale (EDSS) ranging from 0.0 of ‘no disability’ through 6.0 which indicates ‘the use of a walking aid such as a cane or crutch to walk roughly 100 meters.’ It took about ten years for 25 percent of the patient population to reach 3.0 of ‘moderate disability’, and it took roughly 17 years for 25 percent of patients to reach an EDSS of 6.0.

“For patients who were observed throughout the duration of the study, we looked at them until they reached about 50 years old. At that time, just under 20 percent had become cane dependent needing support to walk more than one or two blocks. From a bird’s eye view, it looks like general progression of the disease has slowed, and far fewer patients are ever disabled, thanks to advances in clinical therapies, education and resources,” Dr. Scott said. 

The landmark findings come on the heels of a related study published earlier this year by Dr. Scott’s group. Titled, ‘Multiple sclerosis relapses contribute to long-term disability,’ the work outlines the connection between a reduction of MS relapses through immunotherapy, and a resulting positive impact on the disease’s progression.

Further, it claims that prior studies may have overemphasized the role of slow progressive degenerative changes compared to autoimmune flares. Incomplete recovery from these flares or ‘relapses’ was the predominant type of worsening seen in the earliest years, and although it eventually declined, it remained an important cause of disability throughout the first 15 years from initial diagnosis.

“Together, our studies share an important voice in the ongoing conversation classifying MS as a predominantly autoimmune condition instead of a degenerative one. Through these findings, we begin to open a larger window of opportunities for clinicians to better understand and treat patients. For patients and their loved ones, I think we’re also shedding more light on the disease which in turn can lend to a healthier peace of mind and hope for a promising future.”

In addition to Dr. Scott, other AGH researchers and MS specialists who contributed to the study include Troy Desai, MD, Chris Hackett, MS, Edward J. Gettings, MD, Teresa Hentosz, BS, Wisam Elmalik, MD and Carol J. Schramke, PhD.

“Allegheny Health Network’s Neuroscience Institute is committed to advancing the frontier of disease management for complex heath conditions through innovative research and early adoption of technologies and therapies that are life-changing for patients,” said Don Whiting, MD, AHN Chief Medical Officer and Chair of the AHN Neuroscience Institute. “We applaud the work of this exceptional team led by Dr. Scott.  Together, they are enhancing our understanding of MS and setting the stage for ever improving treatments that offer new hope for those who develop it.” 

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