{"id":1204,"date":"2012-07-20T12:21:03","date_gmt":"2012-07-20T10:21:03","guid":{"rendered":"http:\/\/viscontitoscoalda.com\/?p=1204"},"modified":"2012-07-20T12:21:03","modified_gmt":"2012-07-20T10:21:03","slug":"1204","status":"publish","type":"post","link":"https:\/\/viscontitoscoalda.com\/index.php\/2012\/07\/20\/1204\/","title":{"rendered":"Sclerosi Multipla: controversie terapeutiche…mi chiedo a chi credere…"},"content":{"rendered":"

http:\/\/www.amsicora.net\/2012\/07\/19\/sclerosi-multipla-studio-canadese-smentisce-efficacia-interferone-beta-per-fermare-la-disabilita\/<\/a><\/h3>\n

Sclerosi Multipla: studio canadese smentisce efficacia interferone beta per fermare la disabilit\u00e0<\/h3>\n

\"\"<\/a>E\u2019 stato pubblicato sulla prestigiosa rivista medica\u00a0Journal of the American Medical Association (JAMA)<\/em> un interessante studio intitolato \u201cAssociazione tra l\u2019uso dell\u2019interferone beta e la progressione della disabilit\u00e0 nei pazienti con sclerosi multipla recidivante-remittente<\/em>.\u201d
\n<\/ins><\/ins><\/p>\n

Secondo un gruppo di ricercatori canadesi, coordinati dalla dr.ssa\u00a0Helen Tremlett dell\u2019Universit\u00e0 del British Columbia di Vancouver, l\u2019interferone beta viene ampiamente prescritto per il trattamento della sclerosi multipla (SM), ma deve essere ancora stabilito il suo rapporto con la progressione della disabilit\u00e0.<\/p>\n

Obiettivo della ricerca era studiare l\u2019associazione tra l\u2019esposizione all\u2019interferone beta e la progressione della disabilit\u00e0 nei pazienti con sclerosi multipla recidivante-remittente (SM-RR).<\/p>\n

E\u2019 stato quindi effettuato uno studio di gruppo retrospettivo sulla base dei dati raccolti in maniera prospettica (1985-2008) nel British Columbia (Canada). I pazienti con sclerosi multipla recidivante-remittente trattati con interferone beta (n = 868) sono stati confrontati con gruppi di controllo non trattati, contemporanei (n = 829) e storici (n = 959).<\/p>\n

La principale misura di risultato era il tempo dall\u2019ammissibilit\u00e0 al trattamento con interferone beta (base di rilevamento) ad un punteggio confermato e sostenuto di 6 (che richiede un bastone per camminare 100 m; confermato da pi\u00f9 di 150 giorni senza miglioramento misurabile) nella scala di disabilit\u00e0 per pazienti affetti da sclerosi multipla (EDSS) (range, 0-10, con i punteggi pi\u00f9 alti che indicano una maggiore disabilit\u00e0). E\u2019 stato usato un modello di regressione multivariata di Cox, con il trattamento con interferone beta incluso come covariata tempo-dipendente, per valutare il rischio di progressione della malattia associata al trattamento con l\u2019interferone beta. L\u2019analisi comprendeva anche l\u2019aggiustamento del punteggio di propensione ad affrontare il confondimento dall\u2019indicazione.<\/p>\n

I tempi medi attivi di follow-up (dalla prima all\u2019ultima misurazione dell\u2019EDSS) sono stati i seguenti: per il gruppo trattato con interferone beta, 5.1 anni (range interquartile [IQR], 3.0-7.0 anni) per il gruppo di controllo contemporaneo, 4,0 anni (IQR, 2.1-6.4 anni), e per il gruppo di controllo storico, 10,8 anni (IQR, 6.3-14.7 anni). I tassi osservati dei risultati per raggiungere un punteggio sostenuto di EDSS di 6 nei 3 gruppi erano rispettivamente del 10,8%, 5,3% e 23,1%. Dopo l\u2019aggiustamento dei potenziali fattori di base confondenti (sesso, et\u00e0, durata della malattia e punteggio di EDSS), l\u2019esposizione ad interferone beta non \u00e8 risultata associata con una differenza statisticamente significativa nel rischio di raggiungere un punteggio EDSS di 6 quando sono stati considerati il gruppo di controllo contemporaneo (rapporto di rischio: 1,30, 95% CI, 0,92-1,83, p = 0,14) o il gruppo di controllo storico (rapporto di rischio: 0,77, 95% CI, 0,58-1,02, p = 0,07). L\u2019ulteriore aggiustamento per le comorbidit\u00e0 e lo stato socio-economico, ove possibile, non ha cambiato le interpretazioni, e l\u2019aggiustamento del tasso di propensione non ha modificato sostanzialmente i risultati.<\/p>\n

Al termine dello studio, secondo gli autori, tra i pazienti con sclerosi multipla recidivante-remittente, la somministrazione di interferone beta non era associata ad una riduzione della progressione della disabilit\u00e0.<\/strong><\/p>\n

COMMENTO:<\/p>\n

Questo studio smentisce in maniera clamorosa l\u2019efficacia dell\u2019interferone beta nel fermare la disabilit\u00e0 nella sclerosi multipla recidivante-remittente (la forma pi\u00f9 comune).<\/p>\n

Addirittura i non trattati hanno un trend statistico verso una minore probabilit\u00e0\u00a0di progredire verso la sedia a rotelle. Questo esprime l\u2019inadeguatezza degli studi basati sul numero di attacchi e sul numero delle lesioni in RM nel predire l\u2019efficacia di un farmaco nei confronti della SM. Questo sistema falsamente predittivo \u00e8 purtroppo quello usato per rendere disponibile ogni nuovo farmaco.<\/p>\n

I costi elevati di questo farmaco uniti ai rilevanti effetti collaterali imporrebbero ai medici specialisti di guardare anche ad altre proposte come, ad esempio, la possibile correlazione della SM con l\u2019insufficienza venosa cronica cerebro spinale (CCSVI), scoperta
\nAndrebbero anche superati i potenziali conflitti d\u2019interesse, per il bene dei malati (63.000 in Italia) e delle loro famiglie verso una malattia dalle cause ancora sconosciute e dalle soluzioni terapeutiche ancora limitate, come si vede da questo studio.<\/p>\n

Fonte:\u00a0http:\/\/jama.jamanetwork.com\/article.aspx?articleid=1217239<\/a><\/p>\n

Multiple Sclerosis: A Canadian study disproves effectiveness interferon beta to stop the disability<\/p>\n

It ‘was published in the prestigious medical journal, the Journal of the American Medical Association (JAMA) an interesting study entitled “Association between the use of interferon beta and progression of disability in patients with relapsing-remitting MS.”<\/p>\n

A group of Canadian researchers, led by Dr. Helen Tremlett at the University of British Columbia in Vancouver, interferon beta is widely prescribed for the treatment of multiple sclerosis (MS), but has yet to be established his relationship with progression of disability.<\/p>\n

Objective of the research was to investigate the association between exposure to interferon beta and progression of disability in patients with relapsing-remitting MS (RR-MS).<\/p>\n

It ‘was then carried out a retrospective cohort study based on data collected prospectively (1985-2008) in British Columbia (Canada). Patients with relapsing-remitting MS treated with interferon beta (n = 868) were compared with control groups not treated, contemporary (n = 829) and historical (n = 959).<\/p>\n

The main outcome measure was the time from access to treatment with interferon beta (based detection) to score a confirmed and supported by 6 (requires a cane to walk 100 m; confirmed more than 150 days without measurable improvement) in disability scale for patients with multiple sclerosis (EDSS) (range, 0-10, with higher scores indicating greater disability). E ‘was used a multivariate Cox regression model, with treatment with interferon beta included as a time-dependent covariate, to assess the risk of disease progression associated with treatment with interferon beta. The analysis also included the propensity score adjustment to address the confounding indication.<\/p>\n

The average time active follow-up (from the first to the last measuring EDSS) were as follows: for the group treated with interferon beta, 5.1 years (interquartile range [IQR], 3.0-7.0 years) for the group of simultaneous control, 4.0 years (IQR, 2.1-6.4 years), and the historical control group, 10.8 years (IQR, 6.3-14.7 years). The observed rates of the results to achieve a sustained EDSS score of 6 in the 3 groups were respectively 10.8%, 5.3% and 23.1%. After adjustment for potential confounding factors base (gender, age, disease duration and EDSS score), exposure to interferon beta was not associated with a statistically significant difference in the risk of reaching an EDSS score of 6 when they are were considered the control group contemporary (hazard ratio 1.30, 95% CI, 0.92 to 1.83, p = 0.14) or the historical control group (hazard ratio 0.77, 95 % CI, 0.58 to 1.02, p = 0.07). Further adjustment for comorbidity and socioeconomic status, where possible, has not changed the interpretations, and the rate adjustment propensity has not substantially changed the results.<\/p>\n

At the end of the study, according to the authors, among patients with relapsing-remitting MS, administration of interferon beta was not associated with a reduction in the progression of disability.<\/p>\n

COMMENT:<\/p>\n

This study refutes a striking manner the efficacy of interferon beta in stopping disability in relapsing-remitting MS (the most common form).<\/p>\n

Even the untreated have a statistical trend toward a lower likelihood of progress towards the wheelchair. This expresses the inadequacy of studies based on the number of attacks and the number of lesions on MRI in predicting the efficacy of a drug against MS. This system falsely predictive unfortunately that is used to make available any new drug.<\/p>\n

The high cost of this drug combined with significant side effects to impose medical specialists to look to other proposals such as, for example, the possible correlation of MS with chronic venous insufficiency cerebro spinal (CCSVI), discovery
\nShould also overcome potential conflicts of interest, for the benefit of patients (63,000 in Italy) and their families to a disease with unknown causes and therapeutic options remain limited, as shown by this study.<\/p>\n

Source: http:\/\/jama.jamanetwork.com\/article.aspx?articleid=1217239<\/p>\n

Scl\u00e9rose en plaques: une \u00e9tude canadienne r\u00e9fute l’efficacit\u00e9 interf\u00e9ron b\u00eata pour arr\u00eater le handicap<\/p>\n

Il a \u00e9t\u00e9 publi\u00e9 dans la prestigieuse revue m\u00e9dicale, le Journal de l’American Medical Association (JAMA) une int\u00e9ressante \u00e9tude intitul\u00e9e \u00abAssociation entre l’utilisation de l’interf\u00e9ron b\u00eata et la progression du handicap chez les patients atteints de SEP r\u00e9currente-r\u00e9mittente.”<\/p>\n

Un groupe de chercheurs canadiens, dirig\u00e9e par le Dr Helen Tremlett \u00e0 l’Universit\u00e9 de la Colombie-Britannique, \u00e0 Vancouver, l’interf\u00e9ron b\u00eata est largement prescrit pour le traitement de la scl\u00e9rose en plaques (MS), mais n’a pas encore \u00e9tabli sa relation avec progression du handicap.<\/p>\n

Objectif de la recherche \u00e9tait d’\u00e9tudier l’association entre l’exposition \u00e0 l’interf\u00e9ron b\u00eata et la progression du handicap chez les patients atteints de SEP r\u00e9currente-r\u00e9mittente (RR-MS).<\/p>\n

Il a ensuite \u00e9t\u00e9 proc\u00e9d\u00e9 \u00e0 une \u00e9tude de cohorte r\u00e9trospective bas\u00e9e sur des donn\u00e9es recueillies de fa\u00e7on prospective (1985-2008) en Colombie-Britannique (Canada). Les patients atteints de SEP r\u00e9currente-r\u00e9mittente trait\u00e9s par interf\u00e9ron b\u00eata (n = 868) ont \u00e9t\u00e9 compar\u00e9s \u00e0 des groupes t\u00e9moins non trait\u00e9s, contemporaine (n = 829) et historique (n = 959).<\/p>\n

Le crit\u00e8re de jugement principal \u00e9tait le d\u00e9lai entre l’acc\u00e8s au traitement \u00e0 l’interf\u00e9ron b\u00eata (d\u00e9tection bas\u00e9e sur) pour marquer un confirm\u00e9e et \u00e9tay\u00e9e par 6 (n\u00e9cessite une canne pour marcher 100 m, a confirm\u00e9 plus de 150 jours sans am\u00e9lioration mesurable) dans \u00e9chelle d’incapacit\u00e9 pour les patients atteints de scl\u00e9rose en plaques (EDSS) (gamme, 0-10, avec des scores plus \u00e9lev\u00e9s indiquant une plus grande invalidit\u00e9). E ‘a \u00e9t\u00e9 utilis\u00e9 un mod\u00e8le de r\u00e9gression multivari\u00e9e de Cox, avec un traitement \u00e0 l’interf\u00e9ron b\u00eata incluse comme covariable d\u00e9pendante du temps, afin d’\u00e9valuer le risque de progression de la maladie associ\u00e9e au traitement par l’interf\u00e9ron b\u00eata. L’analyse comprenait \u00e9galement l’ajustement du score de propension \u00e0 r\u00e9pondre \u00e0 l’indication de confusion.<\/p>\n

La dur\u00e9e moyenne de suivi actif (de la premi\u00e8re \u00e0 la derni\u00e8re mesure EDSS) \u00e9taient les suivants: pour le groupe trait\u00e9 par l’interf\u00e9ron b\u00eata, 5,1 ans (intervalle interquartile [IQR], 3,0 \u00e0 7,0 ans) pour le groupe de contr\u00f4le simultan\u00e9, 4,0 ans (IQR, 2.1 \u00e0 6.4 ans), et le groupe t\u00e9moin historique de 10,8 ans (IQR, de 6,3 \u00e0 14,7 ans). Les taux observ\u00e9s de r\u00e9sultats \u00e0 atteindre un score EDSS de 6 soutenue dans les 3 groupes ont \u00e9t\u00e9 respectivement de 10,8%, 5,3% et 23,1%. Apr\u00e8s ajustement pour les facteurs de confusion potentiel de base (sexe, \u00e2ge, dur\u00e9e de la maladie et le score EDSS), l’exposition \u00e0 l’interf\u00e9ron b\u00eata n’a pas \u00e9t\u00e9 associ\u00e9 \u00e0 une diff\u00e9rence statistiquement significative du risque de parvenir \u00e0 un score EDSS de 6 quand ils sont ont \u00e9t\u00e9 consid\u00e9r\u00e9s comme le groupe t\u00e9moin contemporain (hazard ratio 1,30, IC 95%, 0,92 \u00e0 1,83, p = 0,14) ou le groupe de contr\u00f4le historique (hazard ratio 0,77, 95 % IC, 0,58 \u00e0 1,02, p = 0,07). Un nouvel ajustement de la comorbidit\u00e9 et le statut socio\u00e9conomique, le cas \u00e9ch\u00e9ant, n’a pas chang\u00e9 les interpr\u00e9tations, et la propension rajustement tarifaire n’a pas sensiblement modifi\u00e9 les r\u00e9sultats.<\/p>\n

A la fin de l’\u00e9tude, selon les auteurs, chez les patients atteints de SEP r\u00e9currente-r\u00e9mittente, l’administration d’interf\u00e9ron b\u00eata n’a pas \u00e9t\u00e9 associ\u00e9e \u00e0 une r\u00e9duction de la progression du handicap.<\/p>\n

COMMENTAIRE:<\/p>\n

Cette \u00e9tude r\u00e9fute d’une mani\u00e8re frappante l’efficacit\u00e9 de l’interf\u00e9ron b\u00eata dans l’arr\u00eat du handicap dans la SEP r\u00e9currente-r\u00e9mittente (la forme la plus commune).<\/p>\n

M\u00eame les non trait\u00e9e ont une tendance statistique vers une plus faible probabilit\u00e9 de progr\u00e8s vers le fauteuil roulant. Cela exprime l’insuffisance des \u00e9tudes fond\u00e9es sur le nombre d’attaques et le nombre de l\u00e9sions \u00e0 l’IRM pour pr\u00e9dire l’efficacit\u00e9 d’un m\u00e9dicament contre la SP. Ce syst\u00e8me de pr\u00e9diction fausse, malheureusement, qui est utilis\u00e9 pour mettre \u00e0 la disposition d’un nouveau m\u00e9dicament.<\/p>\n

Le co\u00fbt \u00e9lev\u00e9 de ce m\u00e9dicament associ\u00e9 \u00e0 des effets secondaires importants pour imposer des m\u00e9decins sp\u00e9cialistes \u00e0 se tourner vers d’autres propositions telles que, par exemple, la corr\u00e9lation possible avec la scl\u00e9rose en plaques insuffisance veineuse chronique c\u00e9phalo rachidien (CCSVI), d\u00e9couverte
\nDoivent \u00e9galement surmonter les conflits d’int\u00e9r\u00eats potentiels, pour le b\u00e9n\u00e9fice des patients (63,000 en Italie) et de leurs familles \u00e0 une maladie dont les causes sont inconnues et les options th\u00e9rapeutiques restent limit\u00e9es, comme le montre cette \u00e9tude.<\/p>\n

Source: http:\/\/jama.jamanetwork.com\/article.aspx?articleid=1217239<\/p>\n","protected":false},"excerpt":{"rendered":"

http:\/\/www.amsicora.net\/2012\/07\/19\/sclerosi-multipla-studio-canadese-smentisce-efficacia-interferone-beta-per-fermare-la-disabilita\/ Sclerosi Multipla: studio canadese smentisce efficacia interferone beta per fermare la disabilit\u00e0 E\u2019 stato pubblicato sulla prestigiosa rivista medica\u00a0Journal of the American Medical Association (JAMA) un interessante studio intitolato \u201cAssociazione tra l\u2019uso dell\u2019interferone beta e la progressione della disabilit\u00e0 nei pazienti con sclerosi multipla recidivante-remittente.\u201d Secondo un gruppo di ricercatori canadesi, coordinati dalla dr.ssa\u00a0Helen … Continua a leggere Sclerosi Multipla: controversie terapeutiche…mi chiedo a chi credere…<\/span><\/a><\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[33],"tags":[],"class_list":["post-1204","post","type-post","status-publish","format-standard","hentry","category-sclerosi-multipla-e-dintorni"],"_links":{"self":[{"href":"https:\/\/viscontitoscoalda.com\/index.php\/wp-json\/wp\/v2\/posts\/1204","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/viscontitoscoalda.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/viscontitoscoalda.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/viscontitoscoalda.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/viscontitoscoalda.com\/index.php\/wp-json\/wp\/v2\/comments?post=1204"}],"version-history":[{"count":0,"href":"https:\/\/viscontitoscoalda.com\/index.php\/wp-json\/wp\/v2\/posts\/1204\/revisions"}],"wp:attachment":[{"href":"https:\/\/viscontitoscoalda.com\/index.php\/wp-json\/wp\/v2\/media?parent=1204"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/viscontitoscoalda.com\/index.php\/wp-json\/wp\/v2\/categories?post=1204"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/viscontitoscoalda.com\/index.php\/wp-json\/wp\/v2\/tags?post=1204"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}