04.23.2015
by John Gever
Managing Editor, MedPage Today

WASHINGTON — Multiple sclerosis patients who reported consuming hard liquor had significantly less disability according to Expanded Disability Status Score (EDSS) ratings than teetotalers, a researcher reported here.

Beer drinkers also had lower EDSS scores, but consumption of red and white wine had no association with EDSS score, reported Camilo Diaz-Cruz, MD, of Brigham and Women’s Hospital in Boston, during a poster session at the American Academy of Neurology’s annual meeting.

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In particular, he and colleagues calculated that, among patients in the cross-sectional study reporting that 80-proof liquor was their favorite alcoholic beverage, each 1-serving/week increase in alcohol consumption was associated with a 31% reduction in odds of having a 1-point EDSS increase (OR 0.69, 95% CI 0.57-0.84, P=0.0002) in a proportional odds logistic regression model, Diaz-Cruz said.

Overall alcohol consumption was also associated with lower EDSS scores, with an odds ratio of 0.93 (95% CI 0.89-0.97) for each 1-serving/week increase in intake versus each 1-point increment in EDSS.

The findings emerged from data collected in the CLIMB (Comprehensive Longitudinal Investigation of Multiple Sclerosis at Brigham and Women’s Hospital) study, including 908 patients in the current analysis. Participants completed a questionnaire asking about their drinking habits: frequency of intake in servings and their favorite beverages. Diaz-Cruz and colleagues correlated those responses with other aspects of participants’ conditions, including scores on the EDSS as well as the Multiple Sclerosis Severity Score (MSSS). The researchers adjusted for age, sex, disease duration, time since first treatment, and cumulative exposure to disease-modifying therapies.

Most participants were only mildly to moderately disabled (median EDSS 1.5, IQR 1-3). Age and gender characteristics were typical for an MS population with this level of disability.

There were 56 nondrinkers in the cohort; 98 said they preferred drinks with 80-proof liquor, 249 named beer as their favorite, 283 listed red wine, and 222 named white wine. Median alcohol intake was 1.1 servings per week (interquartile range 0.4-3.8).

Findings similar to the EDSS analysis were seen with MSSS as well, Diaz-Cruz said. Using a different statistical approach, since MSSS is a continuous variable (as opposed to the categorical EDSS system), he and colleagues calculated an adjusted score difference of -0.07 for each 1-serving/week increase in alcohol consumption (95% CI -0.12 to -0.02).

The researchers did not find associations between wine consumption (red or white) and EDSS or MSSS scores. They did find that beer drinkers (that is, those listing beer as their preferred beverage) tended to have less disability in the EDSS evaluation, though the relationship was weaker than for hard liquor (OR 0.94, 95% CI 0.88-0.99, for each serving/week versus each 1-point EDSS increment).

Diaz-Cruz and colleagues also had 1-year longitudinal data on study participants. However, they found no relationship between any aspect of alcohol consumption and changes in EDSS or MSSS score over time.

Finally, none of the analyses indicated any association between alcohol intake and brain MRI measures, including parenchymal fraction or T2 lesion volume.

In reporting the findings, Diaz-Cruz noted that some previous studies, including two large case-control analyses from Sweden, had also suggested some kind of protective effect of alcohol on risk of developing MS. But other investigations (such as the long-running Nurses Health Study I) have not confirmed those results. No previous clinical studies had addressed possible alcohol effects on established MS, he said.

But, he added, some research has suggested that alcohol can interfere with certain immune pathways, which at least in theory could inhibit disease processes in an autoimmune disorder such as MS.

Only prospective longitudinal studies can answer the question fully, he concluded.

• Reviewed by Robert Gross, MD Multiple Sclerosis Fellow, Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Icahn School of Medicine at Mount Sinai, New York, NY