Disease Modifying Drugs (DMDs) Seem To Work In The "Real World"
Submitted by art on Wed, 2007-09-26 07:15.
One of the problems with drug studies is that they include only a specific subset of the affected population. Then after they get approved, they are prescribed to the entire affected population. The differences in the controlled population in the trial and the general population in the "real world" can be substantial and impact the effectiveness of the drug for many people taking it.
This study looked at data from all Nova Scotians treated with DMDs and concluded that DMDs, as a class, are effective in delaying Expanded Disability Status Scale progression in patients with relapsing-onset definite multiple sclerosis (MS) (90%), although effectiveness is much better for relapsing-remitting MS than for secondary progressive MS groups.
I don't get it...
I am very skeptical of this article. The conclusions seem very imprecise, they say nothing about which drugs their patient population used, and the dates that they used in their study don't match the dates that the drugs were even available to MS patients...
To quote one line "Models were populated with 1980 through 2004 clinical data, including 1988 through 2004 data for all Nova Scotians treated with DMDs." Whoa - no DMDs existed for MS until the early 1990s (and that's in the US, which got the drugs approved before Canada), so how could this date range be valid?
The clinical trial data of the various drugs shows distinct differences in statistical significance among the various DMDs, but they don't indicate which DMDs were actually being used by their patient population. From the date range its clear that they didn't study tysabri, or possibly even rebif (intro'd in US in 2002, who knows about Canada?). That means (I guess) that they studied ABC only? But are all those drugs really equally utilized in Canada's cost conscious health care system? I've read in patient forums that its a bit like the UK where most of the MS patients are steered towards beta interferon for cost containment reasons.
Another incredible claim is that "relative effect size estimates were 112%, 21%, and 105%", which seems to mean that their study found that the average result with RRMS and R-onset MS (whatever subtype that is) actually IMPROVED in terms of EDSS score while they were on a DMD. Alas, this far exceeds the wildest claims of the pharma industry with respect to these drugs (as well as real world patient experience), which seem to show only a 1/3 reduction in disease activity - and even then only for some subset of patients who are responders.
I guess I gotta download the full article to "get" this more...I sure ain't grok-ing it from the free abstract.