The holy grail of MS therpay is to prevent the onset of the debilitating MS phase. All of the current therpaies are aimed at preventing such developments, and more importantly early treatment with immunomodulatory therapies was shown to be more efficacious at preventing disability development. The issue of whether multiple relapses or “attacks” govern diability development has been one of active research, and certainly all therapeutic trial assess the anualised relapse rates.
In the January issue of JNNP, Scalfari and colleagues assess the the factors that govern development of secondary progressive MS. Importantly, a higher annualised relpase rate (increased relapse frequency), older age at disease onset and male sex all predict diasbility development in MS. Clealry, the only modifiable factor is the relapse rate and consequently, early therpy does seem to make sense. It would be interesting tokow whether “non-clinical” biomakers, say peratining to lesion load or neurophysiological parameters could further stratify risk for progresison in MS.
Let me know your thoughts? Read more at http://jnnp.bmj.com/content/85/1/67.abstract
Onset of secondary progressive phase and long-term evolution of multiple sclerosis