Uppitycats?

[Sunshine]

Hey Uppitycats:

My BIL has a wound that refuses to heal on his chest where pacemaker was inserted several months ago. He has diabetes as well. He is feeling very discouraged and told him a short version of your sags. Do you any words of wisdom? Diabetes is under good control. He works with a wound care doctor.

[SalpalSally]

So sorry, hope he starts healing!

[Cat Dancer]

Diabetic wounds are a bitch to heal. I have a friend who has been dealing with a wound on her toe for a couple of years, now. She is likely going to lose the toe when she goes in to the doctor this week. :( The kind of wound you're describing is different from a pressure sore...which gets pressure on it so it won't heal. Keeping it clean and dry is all I can suggest. We tried everything from Dakin solution (which seemed to work best -- old fashioned, but it goes on under any dressing, cleans and gets rid of bacteria) to honey, to a mess of other things. He's seeing a wound doctor who would know about debriding, cutting away any dead tissue that if left there could "kill" the live tissue. Bummer all around, and very frustrating.

[Sunshine]

Thanks Cat for taking the time, I will copy it and forward to him.

[SuzE-Q]

I thought of you, Cat, when I read this study recently...

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J Neurol Neurosurg Psychiatry. 2016 Jun 13. pii: jnnp-2016-313760. doi: 10.1136/jnnp-2016-313760. [Epub ahead of print]

Discontinuing disease-modifying therapy in MS after a prolonged relapse-free period: a propensity score-matched study.

Kister I1, Spelman T2, Alroughani R3, Lechner-Scott J4, Duquette P5, Grand'Maison F6, Slee M7, Lugaresi A8, Barnett M9, Grammond P10, Iuliano G11, Hupperts R12, Pucci E13, Trojano M14, Butzkueven H2; MSBase Study Group.


BACKGROUND:
Discontinuation of injectable disease-modifying therapy (DMT) for multiple sclerosis (MS) after a long period of relapse freedom is frequently considered, but data on post-cessation disease course are lacking.

OBJECTIVES:
(1) To compare time to first relapse and disability progression among 'DMT stoppers' and propensity-score matched 'DMT stayers' in the MSBase Registry; (2) To identify predictors of time to first relapse and disability progression in DMT stoppers.

METHODS:
Inclusion criteria for DMT stoppers were: age ≥18 years; no relapses for ≥5 years at DMT discontinuation; follow-up for ≥3 years after stopping DMT; not restarting DMT for ≥3 months after discontinuation. DMT stayers were required to have no relapses for ≥5 years at baseline, and were propensity-score matched to stoppers for age, sex, disability (Expanded Disability Status Score), disease duration and time on treatment. Relapse and disability progression events in matched stoppers and stayers were compared using a marginal Cox model. Predictors of first relapse and disability progression among DMT stoppers were investigated using a Cox proportional hazards model.

RESULTS:
Time to first relapse among 485 DMT stoppers and 854 stayers was similar (adjusted HR, aHR=1.07, 95% CI 0.84 to 1.37; p=0.584), while time to confirmed disability progression was significantly shorter among DMT stoppers than stayers (aHR=1.47, 95% CI 1.18 to 1.84, p=0.001). The difference in hazards of progression was due mainly to patients who had not experienced disability progression in the prebaseline treatment period.

CONCLUSIONS:
Patients with MS who discontinued injectable DMT after a long period of relapse freedom had a similar relapse rate as propensity score-matched patients who continued on DMT, but higher hazard for disability progression.

[SalpalSally]

Interesting, thanks!

[agate]

You have to wonder if some of the people who didn't have relapses after 5 years or more might have had SPMS, and so maybe the results need some more explanation--?


Neuros have been prescribing DMTs for people with SPMS all along, and they sometimes can't say for sure whether a person has SPMS or RRMS.

People with SPMS usually have no relapses unless they have one of the rare forms that do have relapses. That statement probably makes very little sense. But I've known of people with "chronic relapsing progressive MS" and "progressive relapsing MS." Since this whole classification is so vague, I wonder if it's useful to conclude that a DMT is or isn't working based on the number of relapses.

Disability progression may be a more useful standard, and according to this study, it looks as if being on a DMT may reduce disability progression.

Weren't we being told a while back that we couldn't expect the DMTs to reduce disability progression? I often wondered about that. If the DMT was "modulating" the disease process, wouldn't it also reduce disability progression, at least in some people?

[Virginia]

As far as I am concerned, at the end of the day, it is the disability that counts - who cares as much about relapses as they do about being disabled?

[SalpalSally]

Soooooooo true!!