Research news
Open Door - November 2008 pages 2-3
- Effectiveness of rehabilitation
- Natalizumab (Tysabri): risks and benefits
- The economics of MS investigated
- Increasing prevalence of MS in north-east Ireland
- Functional electrical stimulation for MS
- Alemtuzumab (Campath) study results
- Fampridine for walking
- Low dose naltrexone (LDN)
Effectiveness of rehabilitation
Australian researchers have studied the effectiveness of personalised rehabilitation programmes. 98 people with MS received either a tailored, multidisciplinary rehab programme (treatment group) or no treatment (control group). A number of measures were taken at the beginning of the study and after 12 months to assess progress.
At the end of the study, researchers found reduced disability in the treatment group, with statistically significant differences in several of the measures for the two groups. In the treatment group, 70% improved, compared with 13% of the controls. Notably, more individuals in the control group deteriorated (59% vs 17%).
The researchers conclude that a personalised rehabilitation programme reduces disability compared to no intervention. Further study is needed on the impact of rehab on quality of life and the effectiveness of the various components of the multidisciplinary rehab programme.
Khan F, et al.
Effectiveness of rehabilitation intervention in persons with multiple sclerosis: a randomised controlled trial.
Journal Neurology Neurosurgery Psychiatry 2008;79(11):1230-1235
Natalizumab (Tysabri): risks and benefits
To date, four cases of PML (progressive multifocal leukoencephalopathy), a rare but serious disease of the central nervous system, have been reported in people with MS treated with natalizumab. To put these cases into perspective, a computer model that compared the long-term risks and benefits of the therapy in individuals with relapsing remitting MS indicated that a seven-fold increase in the actual risk of PML would be required to outweigh the benefits of treatment.
Thompson JP, et al.
Quantitative risk-benefit analysis of natalizumab.
Neurology 2008:71(5): 356-364.
The economics of MS investigated
1,942 people with MS completed a questionnaire covering their personal and social circumstances, use of health and social care services, health status and level of disability. The responses were analysed to investigate links between use of services, costs and disability. The average service cost over the preceding six months was £8,397 and most of this (71%) was due to informal care. Only a small amount of cost (8%) was due to the use of disease modifying drugs and drugs for spasticity. In addition, lost employment costs averaged £4,240. Predictably, higher costs were associated with higher levels of disability and lower levels of quality of life. The study revealed that the group surveyed had high levels of service use and that quality of life was low compared to other conditions.
McCrone P, et al.
Multiple sclerosis in the UK: service use, costs, quality of life and disability.
Pharmacoeconomics 2008;26:847-860.
Increasing prevalence of MS in north-east Ireland
Studies of the prevalence of MS in Northern Ireland conducted from 1951 to 1996 have consistently shown increasing levels. In 1996, prevalence was 168.2/100,000. In 2004, a survey in the north-east of Northern Ireland reported a further increase in prevalence to 200.5/100,000. The ratio of female to male in both 1996 and 2004 remained constant at 2:1, in contrast to other recent studies which have reported an increase in female to male ratio to 3:1. The authors conclude that Northern Ireland is an area of high and rising prevalence; while this may be partly explained by earlier diagnosis there is also a true increase in the incidence of MS.
Gray OM , et al.
Factors in the rising prevalence of multiple sclerosis in the north-east of Ireland.
Multiple Sclerosis 2008;14(7):880-886.
Functional electrical stimulation for MS
Functional electrical stimulation (FES) applies electrical stimulation to unresponsive or weak muscles and forces functional movement; this technique has proved particularly useful for treating dropped foot. The lack of trials of FES use specifically in MS has lead to uneven provision in the UK. A recent study has provided evidence to support the use of FES.
Walking speed and energy expended were compared in 12 people with MS, both with and without their FES. Wearing FES led to a significant improvement in speed and a reduction in the energy expended.
Paul L, et al.
The effect of functional electrical stimulation on the physiological cost of gait in people with multiple sclerosis.
Multiple Sclerosis 2008; 14(7):954-961.
Alemtuzumab (Campath) study results
The results of a study comparing alemtuzumab with one of the standard disease modifying treatments, Rebif, have just been published, attracting considerable media interest. 334 people with early, previously untreated relapsing remitting MS took part in this three year study comparing two doses of alemtuzumab with Rebif.
People receiving both doses of alemtuzumab fared significantly better compared to those receiving Rebif on all the measures. EDSS scores (a measure of disability) improved on alemtuzumab and worsened on Rebif, suggesting that alemtuzumab may be reversing the damage caused by MS.
Several serious side effects were found, including one fatality due to idiopathic thrombocytopenic purpura, a blood clotting disorder. Following the fatality, strategies were put in place to ensure that all future cases were recognised early. 22.6% of the trial participants developed thyroid-related side effects. Phase III clinical studies are currently underway to further assess the effectiveness of alemtuzumab.
Coles AJ et al.
Alemtuzumab vs interferon beta-1a in early multiple sclerosis.
New England Journal of Medicine 2008;359:1786-1801.
Fampridine for walking
Fampridine is thought to improve the transmission of messages along damaged nerves. It is currently under development as a treatment to improve walking. In this study, 206 people with MS received either fampridine (10, 15 or 20mg daily) or placebo for 15 weeks. There was a trend towards increased walking speed in the groups taking fampridine, but this was not statistically significant. Subsequent analysis of the data revealed subsets of participants in each of the treatment groups who did experience an actual and consistent improvement in walking speed.
Goodman AD, et al.
Dose comparison trial of sustained-release fampridine in multiple sclerosis.
Neurology 2008; 71(15):1134-1141.
Low dose naltrexone (LDN)
Naltrexone (Nalorex) is a drug used to treat people with addictions. There are anecdotal reports that low doses help the symptoms of people with a wide range of conditions, including cancer, AIDS and MS but until recently no independent research has been carried out.
A recent pilot study involved 40 people with primary progressive MS who took LDN for six months. The main aim of the study was to look at the safety and tolerability of LDN. Two serious adverse events occurred but were judged to be unrelated to LDN treatment. The remaining side effects, which included mild agitation and an increase in liver enzyme levels, were mild and returned to normal at the end of the study. Overall, the researchers considered the drug to be safe and well tolerated. A secondary goal of the study was to investigate the effect on spasticity, pain, fatigue, depression, and quality of life. A significant reduction in spasticity was reported. These initial results are promising, but further large-scale clinical trials are needed to assess the efficacy of LDN in MS.
Gironi M , et al.
A pilot trial of low-dose naltrexone in primary progressive multiple sclerosis.
Multiple Sclerosis 2008;14:1076-1083.
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