Progressive Brain Atrophy and Multiple Sclerosis
- Thursday, August 13, 2009, 10:21
- Multiple Sclerosis
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- Dick:
- And then progressive disabilities, which of course 48% of patients said was the most important to them?
- Dr. Skeen:
- Absolutely. In my opinion, there’s a little differentiation between the medications, at least in terms of the data that we have available to us. In the original Avonex trial it was very clear that Avonex reduced the progressive disability in those patients as compared with folks who were taking a placebo. The other two drugs, the short version is that they’ve had a little bit more difficulty demonstrating that. Some of that can be due to the way the studies were designed. The fact that they’ve had difficulty doesn’t mean they don’t do it.
- Dick:
- And then how about progressive brain atrophy?
- Dr. Skeen:
- The data on progressive brain atrophy is similar to the cognitive decline data, and that is that it’s been done in different ways. And atrophy has been measured in different ways. I would say the best data is with Avonex. This trial – looking back at the original folks who were in the Avonex trial – looked at a particular measure that looked at the total volume of the brain, if you will, and the trial was statistically not significant in terms of reducing brain atrophy. But when you looked at the trial carefully, you saw that what happened is in the first year atrophy seemed to progress at the same rate in the placebo patients as in the patients with Avonex. In the second year, however, there was a significant decrease in atrophy in the patients who were on Avonex. To me that’s, again, a very hopeful indicator that perhaps these drugs do affect brain atrophy and that it’s not too surprising that with a longstanding course of illness, which the atrophy is, and if it’s due to neurons or brain cells dying, it may really take some time to have a significant impact. So, the finding that it wasn’t significant until the second year, I would say, is not all that surprising and that indeed maybe it does suggest to us that we can really impact brain atrophy over the course of time.
- Dick:
- Can we expect similar trials for Betaseron and Copaxone as well?
- Dr. Skeen:
- I think so. I think everybody now appreciates that the story is not just relapses and MRI changes. There was a study published in New England Journal in 2000 by Dr. Confavreux who looked at the long-term course of multiple sclerosis. And what they noticed very clearly, in my mind, is that when you compare the number of exacerbations that people have with the progressive disability that it really doesn’t correlate, that people progress despite not having exacerbations and that the exacerbations really don’t seem to influence the course of the disability. So, I think that’s why I said in the beginning I think our focus has evolved to the point that we realize exacerbation rate is what’s easy to see and measure, but it’s not necessarily what impacts the lives of folks with multiple sclerosis. That’s why I think we’ll be looking at cognitive decline, atrophy, and disability much more in the future.
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