Multiple Sclerosis Patients May Want to Take Wait-and-see Approach

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Multiple Sclerosis Patients May Want to Take Wait-and-see Approach

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Rather than taking medication to ward off a future potential attack,

patients diagnosed with multiple sclerosis 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.

Newswise ‹ 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).

³Our 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,² says Pittock, M.D., lead author of

the paper. ³This isn¹t a small issue; it¹s a big issue.²

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

paper, adds, ³The documentation of benign MS does exist, and this condition

can be identified during an analysis of the patient at even five years with

MS.²

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. . ³You 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.²

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 patients¹ 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: ³This 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.²

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 patient¹s 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 ³the earlier the better,² according to Drs.

and Pittock. ³There is an overwhelming drive to start all patients

with a diagnosis of MS on immunomodulatory medications,² says Dr. Pittock.

However, the Mayo Clinic study calls this drive into question. ³This study

raises questions about the current dogma out there that all patients should

be started on medications as soon as possible,² says Dr. . ³If we

treat everyone early, we would treat some people who never needed treatment.

And, if they don¹t need treatment, we can save society hundreds of millions

of dollars, and the patients with benign MS can avoid major side effects.²

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

medications to MS patients who may turn out to have benign disease.

³Medications are expensive, about $10,000 per year,² he says. ³The

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.²

Mayo Clinic Department of Neurology¹s 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 patient¹s 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.