As the UK celebrates Queen Elizabeth II's platinum jubilee it is worthwhile reflecting on what would have been if the Queen had been diagnosed with multiple sclerosis in 1952.
“illustrates to me why we need to celebrate the progress we have made in the field of MS over the last 70 years. Do you agree?” Are there drugs to stop the underlying neurodegeneration / progression? Are there drugs which stimulate repair of a brain / spinal cord damaged by MS? I’d be surprised if anyone diagnosed with PPMS today would share your view on the progress made. My 57 year old friend (diagnosed 2005) operates her electric wheelchair with one finger and relies on multiple carers (her husband walked out ten years ago). She’s got nothing to celebrate. My GP visits a local care home where there are two women with MS who are in their mid to late 30s. No careers, no family life, no future…. even my GP gets choked up when she mentions them. They won’t be the only cases in the country. Piggy backing on the Jubilee is an odd way of trying to show the progress made in the field of MS. Progress in the MS field has been slow and patchy, with the main work (stopping progression, encouraging repair) still to do - no reason to wave the flags or let off any fireworks. In 1952 no one knew the trigger cause / trigger of MS. In 2022 (70 years later) a paper pointed the finger at ebv. Although even you admit that you don’t know how ebv is involved (another recent paper came up with 10+ possible ways ebv may trigger / drive MS). More research required! Maybe in ten years time (BTK inhibitors, anti-virals targeting ebv, remyelination therapies) the world of neurology can reassess the progress made in treating MS. Compared to the progress made in other fields eg cancer, neurology is at the back of the queue. Don’t get me started on MND ((family friend) or Huntington’s (colleague’s wife).
>My 57 year old friend (diagnosed 2005) operates her electric wheelchair with one finger and relies on multiple carers (her husband walked out ten years ago). She’s got nothing to celebrate. My GP visits a local care home where there are two women with MS who are in their mid to late 30s. No careers, no family life, no future….
All of these stories are due to the negligence and/or incompetence of contemporary neurologists. If your friend had been put on Tysabri at diagnosis she would be in much better shape. If oncologists were in charge of managing MS, bone marrow transplantation would have become the standard of care for all patients in the 90s. Neurology as a whole is full of weird and arrogant characters who are very interested in diagnosis but aren't capable of empathizing with their patients or feeling a sense of urgency about helping them. Almost every possible thing that could be mismanaged about MS research or treatment over the last 50 years, has been mismanaged. Some doctors still refuse to believe facts as basic as that MS causes pain. Neurologists with a conscience should be begging the MS community for forgiveness instead of patting themselves on the back.
I feel very lucky to have been diagnosed now vs. 70 years ago. I am empowered to manage my symptom with diet, exercise and mindfulness and am on a high efficacy DMT. There is plenty to celebrate though there may be a ways to go until MS is considered preventable or easily treatable.
Perhaps I am one of the unlucky ones but my prognosis is not too different from if I’d been diagnosed in 1952. It is worth pointing out that even wonder treatments such as alemtuzamab have an efficacy of 70-80percent leaving 20-30 percent of us no better off. That’s what I think of the back patting.
I appreciate the attempt to highlight progress. I take issue with the part about Norway finding that MS patients lose "only 3 years" of life compared to healthy controls. When I think about how drugs are approved for cancer and the costs justified for "only 6 months" prolonged life of a cancer patient, 3 years seems like a very long time to live- or not. The adverb "only" is what caught my eye. In the past I have read that MS shortens a life span by 7-8 years. In comparison, 3 years is an improvement, but not a comfort to a MSer.
Perhaps a gentle warning of content on some of your posts would be appropriate, especially for those of us with untreated SPMS - you really didn't get my day off to a great start ........
My grandmother would have been the same age as the Queen. She was diagnosed with MS before I was born and as a small child I can remember her getting down on the floor to play with me (around the time of the silver jubilee). She died when I was 18 from sepsis related to bed sores. I've already been diagnosed 21 years (symptoms much longer) and I am still mobile with a stick. I don't nod off mid sentence, choke on food (on my own saliva though), need a SP catheter (all the things she needed for her last 5 years or so).
And talking about disease modifying therapy and MS, I don’t see things as you see them at all.
We could use cyclophosphamide pills in early SPMS and achieve better results, but we don’t do this. Why? Those pills are cheap. For early active SPMS, the cancer risk from that doesn’t even matter. Those people are only going downhill. And there are studies that testified that.
We could use i.v. cladribine in much higher dosis and more often for active SPMS, but we don’t. Why? I.v. Cladribine is cheap. And the list goes on, you know it very well. I respect you, you’re a great person and much more involved in the search of a MS cure than any other, but knowing all that pharma does in MS, I’m not happy. I’m mad.
I am not sure if you aware that cyclophosphamide has not been shown to be effective in progressive MS (see Cochrane review below). The data for cladribine in SPMS is better, but based on a small study and our open-label real-life data, which is why we commonly use the subcutaneous (generic) formulation in more advanced MS and underpins our CHARIOT-MS study. So I am not sure what point you are making?
La Mantia et al. Cyclophosphamide for multiple sclerosis. Cochrane Database Syst Rev . 2007 Jan 24;2007(1):CD002819.
Background: Multiple sclerosis is a presumed cell-mediated autoimmune disease of the central nervous system. Cyclophosphamide (CFX) is a cytotoxic and immunosuppressive agent, used in systemic autoimmune diseases. Controversial results have been reported on its efficacy in MS. We conducted a systematic review of all relevant trials, evaluating the efficacy of CFX in patients with progressive MS.
Objectives: The main objective was to determine whether CFX slows the progression of MS.
Search strategy: We searched the Cochrane MS Group Trials Register (searched June 2006), Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3 2006), MEDLINE (January 1966 to June 2006), EMBASE (January 1988 to June 2006) and reference lists of articles. We also contacted researchers in the field.
Selection criteria: Randomised controlled trials (RCTs) evaluating the clinical effect of CFX treatment in patients affected by clinically definite progressive MS.CFX had to be administered alone or in combination with adrenocorticotropic hormone (ACTH) or steroids. The comparison group had to be placebo or no treatment or the same co-intervention (ACTH or steroids)
Data collection and analysis: Two reviewers independently decided the eligibility of the study, assessed the trial quality and extracted data. We also contacted study authors for original data.
Main results: Of the 461 identified references, we initially selected 70: only four RCTs were included for the final analysis. Intensive immunosuppression with CFX (alone or associated with ACTH or prednisone) in patients with progressive MS compared to placebo or no treatment (152 participants) did not prevent the long-term (12, 18, 24 months) clinical disability progression as defined as evolution to a next step of Expanded Disability Status Scale (EDSS) score. However, the mean change in disability (final disability subtracted from the baseline) significantly favoured the treated group at 12 (effect size - 0.21, 95% confidence interval - 0.25 to -0.17) and 18 months (- 0.19, 95% confidence interval - 0.24 to - 0.14) but favoured the control group at 24 months (0.14, CI 0.07 to 0.21). We were unable to verify the efficacy of other schedules. Five patients died; sepsis and amenorrhea frequently occurred in treated patients (descriptive analysis).
Authors' conclusions: We were unable to achieve all of the objectives specified for the review. This review shows that the overall effect of CFX (administered as intensive schedule) in the treatment of progressive MS does not support its use in clinical practice.
The Cy therapy protocol used (15) consisted of monthly intravenous (i.v.) administration of Cy for the first year, and then at two month interval for a second year. The dose of Cy was tailored to the leukocyte and lymphocyte counts, starting at 600 mg/m2 and then increasing by 200 mg/m2 every month to obtain leukocyte and lymphocyte counts not lower than 2000/µl and 700/µl, respectively, at nadir (i.e., 10–12 days after therapy).
Subgroups of mitoxantrone- and cyclophosphamide-responding patients were identified (14/25 and 17/25, respectively) and were characterized by a significantly shorter duration of the secondary progressive phase of the disease. In these subgroups, the improvement in the EDSS score at the end of therapy was highly significant (p<0.0001 for Mito, p = 0.0004 for Cy).
Until MS sufferers stop being the “poor cousin “ of neurological chronic diseases, treatment will always be a grave disappointment. The demographic is still on the back foot. I’m talking about older female, post fertility, low economic importance factor which will always prevail until society radically changes. Everybody needs to get very pro feminist before changes might happen. We are just too jolly expensive and our worth comes in for judgment. For the record I think we are worth it.
For the NHS to adopt a treatment it has to be cost-effective. The algorithm for to show a new treatment is cost-effective is well known. Si if ATA188 is effective it will have to priced relative too its effectiveness, which is why I don't think it will be that expensive.
I was diagnosed in 1965 aged 16 by Dr Aldren Turner …( a silent man) I had x rays and a lumber puncture over a three week stay in hospital…hadn’t appreciated the LP was to eliminate neurosyphilis !.
He proscribed me acthar gel injections which I think were quite cutting edge.
From an episode of complete paralysis from waist down over a period of six months ..I made a total recovery …I have not had any other drugs .
However I now apparently have SPMS ..a new concept from the disseminated sclerosis I was initially diagnosed with . I am deteriorating now but have had a very full and free from symptom life until now. So had I been the Queen and diagnosed in 1952 by Aldren Turner when I think the situation was much the same as it was in the 1960s ..I might not have been dead by 1970s….!
Great article and the progress in MS has been good. Especially last 15 years
Do you think with more people (bar the US) starting on higher efficacy DMT as first line treatment the overall outlook on disability and expectancy is much better especially those of us in their 30s?
I know there isn't any long-term data to show that but surely the overall outlook for us starting it now will have better outcomes?
Thx for this post. In it you write that the latest data from Nordic countries indicate that life expectancy of someone with MS is now only 3 years less vs general population. Do you mind letting us know which study this is? All the studies I see still point to 5-10 years less.
Rachel, the study below is where the modelling data was presented from. It shows that for Norwegian people diagnosed with MS during the epoch 1997-2012 they have a standardised mortality ratio of 0.7, i.e. an equivalent or better survival rate than the general population. However, as these pwMS are still in early adulthood this SMR result should be interpreted carefully. But the overall message is that for someone diagnosed with MS now in 2022 their life expectancy will be very good.
Bøe Lunde et al. Survival and cause of death in multiple sclerosis: a 60-year longitudinal population study. J Neurol Neurosurg Psychiatry. 2017 Aug;88(8):621-625.
Objective: Survival and causes of death (COD) in multiple sclerosis (MS) provide ultimate endpoints. We aimed to investigate survival and COD in a 60-year population-based MS cohort compared with the general population.
Methods: All patients with incident multiple sclerosis (MS) (N=1388) with onset during 1953-2012 in Hordaland County, Western Norway, were included. Data were obtained from patient records at Haukeland University Hospital and linked to the Norwegian COD registry. Survival adjusted for sex, age and disease course were estimated by Kaplan-Meier analyses from birth and from disease onset. Mortality and COD in MS relative to the general population were examined by standardised mortality ratio (SMR).
Results: Of 1388 patients, 291 had deceased, mainly of MS (56.4%). Median life expectancy was 74.7 years for MS and 81.8 years for the general population (p<0.001); 77.2 years for women with MS and 72.2 years for men with MS (p<0.001). Life expectancy for patients with relapsing remitting MS (RRMS) was 77.8 years and -71.4 years for primary progressive MS (PPMS) (p<0.001). Overall SMR was 2.7 (p>0.0001); 2.9 in women and 2.5 in men (p=0.0009). SMR was 2.4 in RRMS and 3.9 in PPMS (p<0.0001). SMR from disease onset during 1953-1974 was 3.1; 2.6 during 1975-1996 and 0.7 during 1997-2012 (p<0.0083). No difference in cause-specific deaths were found (p=0.0871).
Conclusion: We found a 7-year shorter life expectancy and almost threefold higher mortality in MS compared with the general population. A rise in survival in MS was observed during the entire observation period.
Yes, you are right the published figures are between 5-10 years, but these are based on historical cohorts, i.e. on people who developed MS in the pre-DMT era. However, I was at a meeting where modelling data was presented that a person born today with MS, based on the slower acquisition of disability on DMTs, would on average only be expected to have a 3 year reduction in life expectancy.
However, other commentators are right they are likely to live this life with increasing disability. All that we have done is move the EDSS curve to the right, i.e. you reach all disability end-points later including EDSS 10.
“illustrates to me why we need to celebrate the progress we have made in the field of MS over the last 70 years. Do you agree?” Are there drugs to stop the underlying neurodegeneration / progression? Are there drugs which stimulate repair of a brain / spinal cord damaged by MS? I’d be surprised if anyone diagnosed with PPMS today would share your view on the progress made. My 57 year old friend (diagnosed 2005) operates her electric wheelchair with one finger and relies on multiple carers (her husband walked out ten years ago). She’s got nothing to celebrate. My GP visits a local care home where there are two women with MS who are in their mid to late 30s. No careers, no family life, no future…. even my GP gets choked up when she mentions them. They won’t be the only cases in the country. Piggy backing on the Jubilee is an odd way of trying to show the progress made in the field of MS. Progress in the MS field has been slow and patchy, with the main work (stopping progression, encouraging repair) still to do - no reason to wave the flags or let off any fireworks. In 1952 no one knew the trigger cause / trigger of MS. In 2022 (70 years later) a paper pointed the finger at ebv. Although even you admit that you don’t know how ebv is involved (another recent paper came up with 10+ possible ways ebv may trigger / drive MS). More research required! Maybe in ten years time (BTK inhibitors, anti-virals targeting ebv, remyelination therapies) the world of neurology can reassess the progress made in treating MS. Compared to the progress made in other fields eg cancer, neurology is at the back of the queue. Don’t get me started on MND ((family friend) or Huntington’s (colleague’s wife).
>My 57 year old friend (diagnosed 2005) operates her electric wheelchair with one finger and relies on multiple carers (her husband walked out ten years ago). She’s got nothing to celebrate. My GP visits a local care home where there are two women with MS who are in their mid to late 30s. No careers, no family life, no future….
All of these stories are due to the negligence and/or incompetence of contemporary neurologists. If your friend had been put on Tysabri at diagnosis she would be in much better shape. If oncologists were in charge of managing MS, bone marrow transplantation would have become the standard of care for all patients in the 90s. Neurology as a whole is full of weird and arrogant characters who are very interested in diagnosis but aren't capable of empathizing with their patients or feeling a sense of urgency about helping them. Almost every possible thing that could be mismanaged about MS research or treatment over the last 50 years, has been mismanaged. Some doctors still refuse to believe facts as basic as that MS causes pain. Neurologists with a conscience should be begging the MS community for forgiveness instead of patting themselves on the back.
I feel very lucky to have been diagnosed now vs. 70 years ago. I am empowered to manage my symptom with diet, exercise and mindfulness and am on a high efficacy DMT. There is plenty to celebrate though there may be a ways to go until MS is considered preventable or easily treatable.
I do wonder if that would have super charged the search for better drugs...
Perhaps I am one of the unlucky ones but my prognosis is not too different from if I’d been diagnosed in 1952. It is worth pointing out that even wonder treatments such as alemtuzamab have an efficacy of 70-80percent leaving 20-30 percent of us no better off. That’s what I think of the back patting.
I appreciate the attempt to highlight progress. I take issue with the part about Norway finding that MS patients lose "only 3 years" of life compared to healthy controls. When I think about how drugs are approved for cancer and the costs justified for "only 6 months" prolonged life of a cancer patient, 3 years seems like a very long time to live- or not. The adverb "only" is what caught my eye. In the past I have read that MS shortens a life span by 7-8 years. In comparison, 3 years is an improvement, but not a comfort to a MSer.
Perhaps a gentle warning of content on some of your posts would be appropriate, especially for those of us with untreated SPMS - you really didn't get my day off to a great start ........
My grandmother would have been the same age as the Queen. She was diagnosed with MS before I was born and as a small child I can remember her getting down on the floor to play with me (around the time of the silver jubilee). She died when I was 18 from sepsis related to bed sores. I've already been diagnosed 21 years (symptoms much longer) and I am still mobile with a stick. I don't nod off mid sentence, choke on food (on my own saliva though), need a SP catheter (all the things she needed for her last 5 years or so).
And talking about disease modifying therapy and MS, I don’t see things as you see them at all.
We could use cyclophosphamide pills in early SPMS and achieve better results, but we don’t do this. Why? Those pills are cheap. For early active SPMS, the cancer risk from that doesn’t even matter. Those people are only going downhill. And there are studies that testified that.
We could use i.v. cladribine in much higher dosis and more often for active SPMS, but we don’t. Why? I.v. Cladribine is cheap. And the list goes on, you know it very well. I respect you, you’re a great person and much more involved in the search of a MS cure than any other, but knowing all that pharma does in MS, I’m not happy. I’m mad.
I am not sure if you aware that cyclophosphamide has not been shown to be effective in progressive MS (see Cochrane review below). The data for cladribine in SPMS is better, but based on a small study and our open-label real-life data, which is why we commonly use the subcutaneous (generic) formulation in more advanced MS and underpins our CHARIOT-MS study. So I am not sure what point you are making?
La Mantia et al. Cyclophosphamide for multiple sclerosis. Cochrane Database Syst Rev . 2007 Jan 24;2007(1):CD002819.
Background: Multiple sclerosis is a presumed cell-mediated autoimmune disease of the central nervous system. Cyclophosphamide (CFX) is a cytotoxic and immunosuppressive agent, used in systemic autoimmune diseases. Controversial results have been reported on its efficacy in MS. We conducted a systematic review of all relevant trials, evaluating the efficacy of CFX in patients with progressive MS.
Objectives: The main objective was to determine whether CFX slows the progression of MS.
Search strategy: We searched the Cochrane MS Group Trials Register (searched June 2006), Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3 2006), MEDLINE (January 1966 to June 2006), EMBASE (January 1988 to June 2006) and reference lists of articles. We also contacted researchers in the field.
Selection criteria: Randomised controlled trials (RCTs) evaluating the clinical effect of CFX treatment in patients affected by clinically definite progressive MS.CFX had to be administered alone or in combination with adrenocorticotropic hormone (ACTH) or steroids. The comparison group had to be placebo or no treatment or the same co-intervention (ACTH or steroids)
Data collection and analysis: Two reviewers independently decided the eligibility of the study, assessed the trial quality and extracted data. We also contacted study authors for original data.
Main results: Of the 461 identified references, we initially selected 70: only four RCTs were included for the final analysis. Intensive immunosuppression with CFX (alone or associated with ACTH or prednisone) in patients with progressive MS compared to placebo or no treatment (152 participants) did not prevent the long-term (12, 18, 24 months) clinical disability progression as defined as evolution to a next step of Expanded Disability Status Scale (EDSS) score. However, the mean change in disability (final disability subtracted from the baseline) significantly favoured the treated group at 12 (effect size - 0.21, 95% confidence interval - 0.25 to -0.17) and 18 months (- 0.19, 95% confidence interval - 0.24 to - 0.14) but favoured the control group at 24 months (0.14, CI 0.07 to 0.21). We were unable to verify the efficacy of other schedules. Five patients died; sepsis and amenorrhea frequently occurred in treated patients (descriptive analysis).
Authors' conclusions: We were unable to achieve all of the objectives specified for the review. This review shows that the overall effect of CFX (administered as intensive schedule) in the treatment of progressive MS does not support its use in clinical practice.
I can't access the Cochrane study as the University of Tuebingen doesn't have the licence.
The Cy therapy protocol used (15) consisted of monthly intravenous (i.v.) administration of Cy for the first year, and then at two month interval for a second year. The dose of Cy was tailored to the leukocyte and lymphocyte counts, starting at 600 mg/m2 and then increasing by 200 mg/m2 every month to obtain leukocyte and lymphocyte counts not lower than 2000/µl and 700/µl, respectively, at nadir (i.e., 10–12 days after therapy).
Your opinion?
Subgroups of mitoxantrone- and cyclophosphamide-responding patients were identified (14/25 and 17/25, respectively) and were characterized by a significantly shorter duration of the secondary progressive phase of the disease. In these subgroups, the improvement in the EDSS score at the end of therapy was highly significant (p<0.0001 for Mito, p = 0.0004 for Cy).
https://pubmed.ncbi.nlm.nih.gov/16609811/
I think there’s no interest in it. And yeah, there are some risks. But for some if we examine them well , it’s very much worth it. Risk/benefit
And long may research continue to find ways of holding back this horrible condition.
Until MS sufferers stop being the “poor cousin “ of neurological chronic diseases, treatment will always be a grave disappointment. The demographic is still on the back foot. I’m talking about older female, post fertility, low economic importance factor which will always prevail until society radically changes. Everybody needs to get very pro feminist before changes might happen. We are just too jolly expensive and our worth comes in for judgment. For the record I think we are worth it.
Sorry for being that offtopic, but any idea of how much ATA188 would cost?
My idea is that it will be over 50.000 euros a year and will not be broadly used if it proves effective. Can you inform me if I’m wrong?
My opinion is that it requires a lot of personalized technology and will be incredibly expensive.
For the NHS to adopt a treatment it has to be cost-effective. The algorithm for to show a new treatment is cost-effective is well known. Si if ATA188 is effective it will have to priced relative too its effectiveness, which is why I don't think it will be that expensive.
Wonderful reading! Truly highlights the improvements seen in the care and treatment of patients with MS.
Thank you Prof G. Hope you're having a lovely Bank Holiday weekend. ☺
I was diagnosed in 1965 aged 16 by Dr Aldren Turner …( a silent man) I had x rays and a lumber puncture over a three week stay in hospital…hadn’t appreciated the LP was to eliminate neurosyphilis !.
He proscribed me acthar gel injections which I think were quite cutting edge.
From an episode of complete paralysis from waist down over a period of six months ..I made a total recovery …I have not had any other drugs .
However I now apparently have SPMS ..a new concept from the disseminated sclerosis I was initially diagnosed with . I am deteriorating now but have had a very full and free from symptom life until now. So had I been the Queen and diagnosed in 1952 by Aldren Turner when I think the situation was much the same as it was in the 1960s ..I might not have been dead by 1970s….!
Thanks! But please don’t stop searching for something that puts an end to this disease!
Great article and the progress in MS has been good. Especially last 15 years
Do you think with more people (bar the US) starting on higher efficacy DMT as first line treatment the overall outlook on disability and expectancy is much better especially those of us in their 30s?
I know there isn't any long-term data to show that but surely the overall outlook for us starting it now will have better outcomes?
Thx for this post. In it you write that the latest data from Nordic countries indicate that life expectancy of someone with MS is now only 3 years less vs general population. Do you mind letting us know which study this is? All the studies I see still point to 5-10 years less.
Rachel, the study below is where the modelling data was presented from. It shows that for Norwegian people diagnosed with MS during the epoch 1997-2012 they have a standardised mortality ratio of 0.7, i.e. an equivalent or better survival rate than the general population. However, as these pwMS are still in early adulthood this SMR result should be interpreted carefully. But the overall message is that for someone diagnosed with MS now in 2022 their life expectancy will be very good.
Bøe Lunde et al. Survival and cause of death in multiple sclerosis: a 60-year longitudinal population study. J Neurol Neurosurg Psychiatry. 2017 Aug;88(8):621-625.
Objective: Survival and causes of death (COD) in multiple sclerosis (MS) provide ultimate endpoints. We aimed to investigate survival and COD in a 60-year population-based MS cohort compared with the general population.
Methods: All patients with incident multiple sclerosis (MS) (N=1388) with onset during 1953-2012 in Hordaland County, Western Norway, were included. Data were obtained from patient records at Haukeland University Hospital and linked to the Norwegian COD registry. Survival adjusted for sex, age and disease course were estimated by Kaplan-Meier analyses from birth and from disease onset. Mortality and COD in MS relative to the general population were examined by standardised mortality ratio (SMR).
Results: Of 1388 patients, 291 had deceased, mainly of MS (56.4%). Median life expectancy was 74.7 years for MS and 81.8 years for the general population (p<0.001); 77.2 years for women with MS and 72.2 years for men with MS (p<0.001). Life expectancy for patients with relapsing remitting MS (RRMS) was 77.8 years and -71.4 years for primary progressive MS (PPMS) (p<0.001). Overall SMR was 2.7 (p>0.0001); 2.9 in women and 2.5 in men (p=0.0009). SMR was 2.4 in RRMS and 3.9 in PPMS (p<0.0001). SMR from disease onset during 1953-1974 was 3.1; 2.6 during 1975-1996 and 0.7 during 1997-2012 (p<0.0083). No difference in cause-specific deaths were found (p=0.0871).
Conclusion: We found a 7-year shorter life expectancy and almost threefold higher mortality in MS compared with the general population. A rise in survival in MS was observed during the entire observation period.
Yes, you are right the published figures are between 5-10 years, but these are based on historical cohorts, i.e. on people who developed MS in the pre-DMT era. However, I was at a meeting where modelling data was presented that a person born today with MS, based on the slower acquisition of disability on DMTs, would on average only be expected to have a 3 year reduction in life expectancy.
However, other commentators are right they are likely to live this life with increasing disability. All that we have done is move the EDSS curve to the right, i.e. you reach all disability end-points later including EDSS 10.
Totally agree! It’s so important for research to continue.