Fw: [MSViews_Multiple_Sclerosis] Mayo clinic study on the need for medication

[Guest guest]

----- Original Message -----

From: " maxthecat2 " <maxthecat2@...>

<MSViews_Multiple_Sclerosis >

Sent: Tuesday, September 28, 2004 12:43 PM

Subject: [MSViews_Multiple_Sclerosis] Mayo clinic study on the need for

medication

> Here is the entire mayo clinic article. For those of you who like all

> the facts.

>

> Monday, August 30, 2004

> Mayo Clinic Study Indicates Patients with Multiple Sclerosis May Want

> to Take Wait-and-See Approach to Medications

>

> Those with no or low disability over time likely to stay that way, may

> be able to forgo medications.

>

> ROCHESTER, Minn. -- Rather than taking medication to ward off a future

> potential attack, patients diagnosed with multiple sclerosis (MS) may

> want to take a conservative approach and wait watchfully with their

> doctors for the first few years to see how the disease progresses over

> time, according to a new Mayo Clinic study published in the August

> ls of Neurology

> (http://www3.interscience.wiley.com/cgi-bin/jhome/76507645).

>

> " Our study demonstrates that the longer the duration of MS and the

> lower the disability, the more likely a patient is to remain stable

> and not progress to a greater level of disability, " says Pittock,

> M.D., lead author of the paper. " This isn't a small issue; it's a big

> issue. "

>

> Moses , M.D., Mayo Clinic neurologist and senior author of

> the paper, adds, " The documentation of benign MS does exist, and this

> condition can be identified during an analysis of the patient at even

> five years with MS. "

>

> The investigators propose a definition of benign MS as patients who

> have MS for 10 years or more who have an Expanded Disability Status

> Scale (EDSS) score of 2 or less, because they have less than 10

> percent likelihood of developing significant disability in the future.

> The EDSS quantifies the amount of disability in MS patients from zero

> (normal neurological exam) to 10 (death due to MS). On this scale, a

> score of 2 indicates minimal disability, 4 indicates moderate

> disability but able to walk unassisted, 6 indicates requirement of an

> aid or cane to walk, and 8 indicates need for a wheelchair.

>

> Patients who have benign MS can have ongoing attacks, but they do not

> accrue any disability from the attacks, says Dr. . " You have

> symptoms, but they go away, and if they come back, they go away again,

> typically after a week or so. You might have a bad week or an attack

> -- like the loss of vision in one eye -- but you completely recover.

> Most of the time, however, there would be no outward sign of the

> disease, and the patients themselves would say that they are normal. "

>

> Drs. Pittock, and colleagues found that only 7 percent of

> patients who had minimal or no disability (EDSS score equal to or less

> than 2) after 10 years with MS progressed to a greater level of

> disability (EDSS score greater than 4), and none needed a wheelchair

> after 20 years with MS. However, for those MS patients studied who had

> an EDSS score of 2.5 to 4 after 10 years of the disease, 12 of 21

> patients' disabilities increased to a score greater than 4 after 20

> years with the disease.

>

> Another Mayo Clinic neurologist and author, Weinshenker, M.D.,

> says of the study: " This confirms some other studies, but it flies in

> the face of the commonly held belief that MS is never benign and that

> every person should be started on lifelong interferon therapy before

> we get a feel of how the natural course of their illness will behave. "

>

> The investigators indicate that this news is particularly important

> for patients who have had benign MS for 10 years or longer, for whom

> physicians can make a reasonable prediction that they will not develop

> progressive disability. However, forecasting the course of a patient's

> MS prior to the five-year mark remains difficult, the investigators

> indicate.

>

> These findings have potential impact for the 17 percent of all U.S.

> multiple sclerosis patients who have benign disease. Dr.

> indicates that this percentage represents as many as approximately

> 70,000 benign MS patients, assuming the total of MS patients in the

> United States to be 400,000.

>

> The current approach prevalent in the MS treatment community to

> prescribing drugs for MS patients is " the earlier the better, "

> according to Drs. and Pittock. " There is an overwhelming

> drive to start all patients with a diagnosis of MS on immunomodulatory

> medications, " says Dr. Pittock.

>

> However, the Mayo Clinic study calls this drive into question. " This

> study raises questions about the current dogma out there that all

> patients should be started on medications as soon as possible, " says

> Dr. . " If we treat everyone early, we would treat some people

> who never needed treatment. And, if they don't need treatment, we can

> save society hundreds of millions of dollars, and the patients with

> benign MS can avoid major side effects. "

>

> Dr. elaborates on the costs, monetary and physical, of

> prescribing medications to MS patients who may turn out to have benign

> disease. " Medications are expensive, about $10,000 per year, " he says.

> " The injections [of immunomodulatory medications] are painful, and

> they cause side effects like nausea, vomiting, fatigue, and achiness.

> You may have to lie down in bed for the day. It can be like having the

> flu every day of your life. In addition, the drugs are only partly

> effective, and their effectiveness over the long course of the disease

> has not been demonstrated. "

>

> Mayo Clinic Department of Neurology's philosophy in working with MS

> patients is to share the therapeutic decision-making process between

> physician and patient, weighing the pros and cons of starting

> medication with the predictive data on hand, as well as the patient's

> personality and personal wishes, to arrive at a customized

> determination of appropriate treatment for each patient. The

> investigators on this study believe that their findings will be

> helpful in this process.

>

> Though the concept of benign MS is not new, the study represented in

> August ls of Neurology manuscript is the most extensive population

> study of MS to date, says Dr. . The Olmsted County population

> of MS patients has been studied since 1905. The study included all

> people in the population, not just those who sought a doctor for MS.

> This is notable in that patients who have benign MS may not seek

> medical attention.

>

> For MS patients who have concerns or questions regarding whether they

> have benign MS or whether they should be on immunomodulatory

> medications, Dr. stresses that it is important for them to

> contact their personal physicians to discuss their diseases and make

> decisions customized to their personal situations.

>

>

>

>

> Link for chat:

> MSViews_Multiple_Sclerosis/chat

> Photos:

> http://photos./group/MSViews_Multiple_Sclerosis/lst

> Group Home: MSViews_Multiple_Sclerosis

> MyMSViews Home: http://www.mymsviews.org Home:

MSViews_Multiple_Sclerosis

> MyMSViews Home: http://www.mymsviews.org

>