Trend for decreasing Multiple Sclerosis Severity Scores (MSSS) with increasing calendar year of enrollment into the New York State Multiple Sclerosis Consortium

[doublevision1]

Trend for decreasing Multiple Sclerosis Severity Scores (MSSS) with increasing calendar year of enrollment into the New York State Multiple Sclerosis Consortium

Multiple Sclerosis Care Center, Department of Neurology, NYU School of Medicine, USA
on behalf of the New York State Multiple Sclerosis Consortium

Abstract
Background: Although the natural history of multiple sclerosis has been charted extensively, it is still not known whether the trajectory of disability accumulation has changed in the era of disease-modifying therapies (DMTs).

Objective: The objective of this study was to examine trends in Multiple Sclerosis Severity Score (MSSS) with regard to calendar year of enrollment into the New York State MS Consortium (NYSMSC).

Methods: Distributions of MSSS were calculated for each year of enrollment, from 1996 to 2007. Quantile regression was used in a multivariable analysis to model for conditional distribution of MSSS quantiles as functions of potential confounders.

Results: The cohort consisted of 6238 patients. Mean age at enrollment was 38 years (SD = 10) and mean disease duration was 10.1 years (SD = 7.3); 57% were on DMTs. The quantile regression model of trends in MSSS between 1996 and 2007 controlled for age, sex, ethnicity, diagnostic delay, and disease duration and demonstrated a robust trend toward lower MSSS with increasing year of enrollment. The model-predicted median MSSS at enrollment in 1996 was 5.04 (95% CI, 4.86–5.21), and in 2007 was 3.78 (95%CI, 3.36–4.20; p < 0.001). The downward trend in MSSS during the enrollment period was confirmed by analysis of Expanded Disability Status Scale (EDSS) distributions, adjusted for disease duration, in successive years of enrollment.

Conclusions: The recent enrollees into the NYSMSC had lower MSSSs compared to the earlier enrollees. The apparent slowing in disability accumulation is likely due to a complex combination of factors: advent of DMTs and improvements in MS care, as well as selection, migration, and recall biases.




Multiple Sclerosis Care Center, Department of Neurology, NYU School of Medicine, USA
Eric Chamot
Department of Epidemiology, University of Alabama at Birmingham School of Public Health, USA
Joshua H Bacon
MS Care Center, Dept of Neurology, NYU School of Medicine/Dept of Psychology, Stern College for Women, Yeshiva Uni., New York, USA
Gary Cutter
Department of Epidemiology, University of Alabama at Birmingham School of Public Health, USA
Joseph Herbert



© 2011 SAGE Publications. Los Angeles, London, New Delhi, Singapore and Washington DC.

[Guitar_grrrl]

There are Lies, Damn Lies, and Statistics.
Mark Twain

Just some more stuff to throw out there.  I'd sure love to see more money thrown at finding a cause to MS, rather than thrown at more meds to put a band-aid on MS, and silly studies like this.

Hmmph!

[doublevision1]

True what Lu says - I remember this point being hammered into me by my social work research prof.  Our research group had to come up with something to recommend to the next researcher who came along in order to continue to build the body of knowledge.  Funny that I remember that clearly, but have no recollection at all about the actual subject of our research.



For an interesting take on this topic as it relates to medical research, you might enjoy the opinions of the author of the essay:

"When Further Research Is NOT Warranted: The “Wisdom of Crowds” Fallacy"

http://www. sciencebasedmedicine .org/?p=260


ps The Wisdom of Crowds theory immediately brings CCSVI to my mind.

[Lulu54]

PD - the one thing they teach in all of the college level research classes is when you do a research paper, the final conclusion MUST include some type of statement that says further study is warranted.  

It's always a given ..........  take a look at any peer reviewed study and you will always find that caveat in the conclusion.  

[PastorDan]

It's been my observation that any large, carefully-controlled scientific study such as this one will invariably come to one conclusion: that more study (and therefore, more funding) is needed.

[jumpinjiminy]

With earlier diagnosis and treatment . . .

[Lulu54]

Don't you just hate it when they throw in all those other things at the end that could also  cause this change in numbers?  But it sure does make another strong case for supporting the use of DMT's by everyone to slow progression of disability,   Thanks for sharing this one!