By Will Boggs, MD NEW YORK (Reuters Health) - Early and ongoing treatment with interferon beta-1a can provide lasting benefits to patients with relapsing-remitting multiple sclerosis (MS), according to a report in the second September issue of Neurology. "Long-term treatment with this agent is feasible and tolerated by most patients with some evidence of sustained benefit regarding clinical disease progression and MRI related outcomes," Dr. Ludwig Kappos from University Hospital Basel, Switzerland told Reuters Health. Dr. Kappos and colleagues report follow-up data for up to 8 years after entry of patients into the Prevention of Relapses and Disability by Interferon beta-1a Subcutaneously in Multiple Sclerosis (PRISMS) study. The annualized relapse rate was significantly lower among patients in both originally treated groups (44 mcg and 22 mcg interferon beta-1a, three times weekly) than among patients treated later, the researchers note, and patients were more likely to remain in remission if they were originally randomized to the high-dose treatment group. Patients randomized originally to 44 mcg interferon (but not to 22 mcg interferon) had a lower median percentage increase in MRI-measured burden of disease during long-term follow-up, the report indicates. Treatment with interferon was generally well tolerated, the investigators say, with no new safety concerns. "This trial represents another enormous expenditure of effort to determine whether we are helping our relapsing-remitting MS patients with existing therapies," writes Dr. John H. Noseworthy from the Mayo Clinic College of Medicine, Rochester, Minnesota in a related editorial. "I respect this effort," Dr. Noseworthy concludes, "but am cautious about the authors' conclusions that 'patients with relapsing-remitting MS can experience sustained benefit over many years from early interferon beta-1a subcutaneously three times weekly therapy.' Perhaps this is true (I hope it is), but the evidence is not yet fully convincing to me." Dr. Kappos responded: "Dr. Noseworthy is correct in that this study did only provide indicative evidence for efficacy as it did not have an untreated control group from year 3 onwards and because at the end of the day we do not know what the impact of those patients who did not complete the follow-up would have been." Nonetheless, he concluded, "Justification of early treatment with IFN-beta or glatiramer is not only based on this observation but also on data from early treatment studies and from new insights in the neuropathology of early and late phases of MS." Neurology 2006;67:944-953,930-931
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