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To the Editor:
We read with interest the article by Fox et al. and the accompanying editorial by Jagust and Noseworthy.1,2⇓ We are concerned that the demographics relating to the MS patients studied by Fox et al. are atypical of a randomly selected group for several reasons. 1) The patient cohort is highly unusual, with 35% primary progressive (PP), 23% secondary progressive (SP), 23% relapsing-remitting (RR), and 19% benign MS patients. 2) The sex ratio among MS patients is usually 2:1 women to men,3 whereas Fox et al. present a 1:2 ratio. 3) Mean age and duration of disease within SPMS patients suggests an unusually early onset of MS in these patients. The disease duration of RRMS and SPMS patients has no overlap. The median and range of Expanded Disability Status Scale (EDSS) values show hardly any overlap among benign, RR, and SPMS patients. 4) No mention is made of concomitant treatment modalities for these patients.
Given these atypical characteristics, one must question whether generalizability of these findings to larger cohorts of MS patients is appropriate. Let us further mention that the design apparently is that of a matched pair study, but the analysis ignores pairing completely.
We wished to determine whether we could replicate the findings of Fox et al. in our …
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