Professor George Ebers, recent winner of the 2013 John Dystel Prize for MS research, has published another paper throwing light on key determinants of outcome from MS. Prof Ebers has previously noted the interaction of environmental and genetic factors in MS, stating that MS can be viewed largely as a preventable disease.
This is very much in line with the OMS approach of primary prevention for relatives of those with multiple sclerosis, and secondary and tertiary prevention with modification of lifestyle risk factors for those already diagnosed.
Ebers' latest paper examines the factors leading to development of secondary progressive disease; as he rightly points out, developing secondary progressive disease is the key determinant of long term outcome for people with MS.
He has been highly critical of the drug industry that measures relapse rate as the major outcome in its drug trials; very few of the drugs have been shown to have any effect at all on slowing the development of secondary progressive MS (SPMS), which is the major determinant of whether PwMS do well or badly in the long run.
In this paper, Ebers examines data from 806 people with relapsing-remitting MS from the London Ontario database.
He shows that over the 28 years of the study, two-thirds of PwMS starting with relapsing-remitting MS had gone into SPMS. By 6 years from diagnosis, a quarter of PwMS had SPMS; by 15 years, half the PwMS had SPMS.
For each additional year of having the disease, there was a 7% increase in risk of developing SPMS; the risk of developing SPMS doubled after 10 years and quadrupled after 20 years.
The best predictors of progression to secondary progressive MS were older age at diagnosis (if diagnosed after age 30, one has 35% greater risk of developing SPMS than someone diagnosed between age 20 and 30), male sex (men were 41% more likely to develop SPMS during the study than women), and increased frequency of relapses early after diagnosis.
While these data may be alarming to some people with MS, it is important to know exactly what the natural history of the disease is without any intervention.While we know drugs make some modest difference to relapse rate, mostly they make little difference to when people develop SPMS.
A preventive approach however, as recommended here at OMS, with attention to lifestyle modification, particularly risk factors around diet, sun exposure, vitamin D supplementation, exercise, stress reduction, etc, is likely to have a significant effect in delaying progression to SPMS, thereby having a major impact of people's lives long term.
Read paper below