Momentus Progress Within the MS Space Led by AHN

Thomas Scott, MD

This content was courtesy of Allegheny Health Network.

A significant AHN study shows that evolving medicine delays MS

Allegheny General Hospital (AGH) physicians’ landmark study proves that advanced therapies and disease education have slowed down multiple sclerosis (MS). The AGH report is one of the longest running and most detailed studies about MS. Titled "Outcomes in a Modern Cohort of Treated MS Patients Followed from Diagnosis up to 15 Years,” it was published in the December issue of the International Journal of MS Care.¹

"In the field of MS research, the most widely cited natural history studies involve the pretreatment era of a patient’s journey. The publication of our work is an exciting advancement in the world of MS care as it provides insight into better outcomes over the past few decades,” said Thomas Scott, MD, AHN neurologist and chief researcher of the 15-year study.

"The improvement is in part due to our ability to incorporate new therapies that improve
a person’s quality of life and slow progression rates.” – Dr. Scott

MS is a chronic condition where the body’s immune system mistakenly attacks the sheath (myelin) covering nerve fibers in the brain and spinal cord. The damaged sheath slows or blocks electrical signals from reaching the eyes, muscles, and other parts of the body.

Disease symptoms can include vision problems, tremors, unsteady gait, and numbness or weakness in one or more limbs. Most people have periods of intermittent disease remission or improvement. In the long-term, some may become disabled from weakness and loss of motor functions.

The 184 patients in the study were treated at the AGH MS Treatment Center from 1989 through 2006. Doctors examined most of the patients yearly from initial diagnosis through an average of 13 years. Outcomes were based on the expanded disability status scale (EDSS) ranging from 0.0 of “no disability” through 6.0, which indicates "the use of a cane or crutch to walk roughly 100 meters.” It took about 10 years for 25% of the patients to reach 3.0 of “moderate disability,” and about 17 years for 25% of patients to reach an EDSS of 6.0.

"For patients who were observed throughout the duration of the study, we looked at them until they reached about 50 years old," Dr. Scott said. "At that time, just under 20% had become cane dependent needing support to walk more than one or two blocks. From a bird’s eye view, it looks like general progression of the disease has slowed, and far fewer patients are ever disabled, thanks to advances in clinical therapies, education, and resources.”

New knowledge of immune systems helps change MS treatments

The breakthrough findings come on the heels of a related study published earlier this year by Dr. Scott’s group. Titled, “Multiple sclerosis relapses contribute to long-term disability,”² it highlights how immunotherapy reduced MS relapses.

The study also claims that prior studies may have overemphasized the role of slow progressive degenerative changes compared to autoimmune flares. Incomplete recovery from these relapses was the predominant type of worsening seen in the earliest years. And although it eventually declined, it remained an important cause of disability throughout the first 15 years from initial diagnosis.

"Together, our studies share an important voice in the ongoing conversation classifying MS as a predominantly autoimmune condition instead of a degenerative one. Through these findings, we begin to open a larger window of opportunities for clinicians to better understand and treat patients," Dr. Scott said. "For patients and their loved ones, I think we’re also shedding more light on the disease, which can lend to a healthier peace of mind and hope for a promising future."

In addition to Dr. Scott, other AGH researchers and MS specialists who contributed to the study include Troy Desai, MD; Chris Hackett, MS; Edward J. Gettings, MD; Teresa Hentosz, BS; Wisam Elmalik, MD; and Carol J. Schramke, PhD.

"We are committed to advancing the frontier of disease management for complex heath conditions through innovative research and early adoption of technologies and therapies that are life-changing for patients," said Donald Whiting, MD, AHN chief medical officer and chair of the AHN Neuroscience Institute. "We applaud the work of this exceptional team led by Dr. Scott. Together, they are enhancing our understanding of MS and setting the stage for ever improving treatments that offer new hope for those who develop it."