Moving toward earlier treatment of multiple sclerosis: Findings from a decade of clinical trials and implications for clinical practice

Mark S. Freedman, Giancarlo Comi, Nicola De Stefano, Frederik Barkhof, Chris H. Polman, Bernard M J Uitdehaag, Lorenz Lehr, Bettina Stubinski, Ludwig Kappos

Research output: Contribution to journalArticlepeer-review

Abstract

The first clinical presentation of multiple sclerosis (MS) is usually a single episode of typical symptoms and signs and is designated a "first clinical demyelinating event" (FCDE) or a "clinically isolated syndrome". Patients with an FCDE who show 'silent' magnetic resonance imaging lesions are at high risk of further clinical events and therefore of meeting the criteria for the diagnosis of clinically definite MS (CDMS). Here we review five Phase III trials, in which treatment with the following disease-modifying drugs (DMDs) was initiated at this early stage: interferon beta (ETOMS, CHAMPS, BENEFIT, and REFLEX) and glatiramer acetate (PreCISe). Differences in the design of the trials and their patient inclusion criteria limit comparisons. However, the proportion of placebo-treated patients who developed CDMS within 2 years was 38-45% across studies, and this rate was significantly reduced by DMD treatment. Conversion to McDonald MS was reported by only two of the trials: BENEFIT (2001 criteria) and REFLEX (2005 criteria). Around 85% of placebo-treated patients developed McDonald MS by 2 years in each, and again a beneficial effect of DMD treatment was seen. Overall, these studies support early use of DMDs to treat patients with an FCDE who are at high risk of conversion to CDMS.

Original languageEnglish
Pages (from-to)147-155
Number of pages9
JournalMultiple Sclerosis and Related Disorders
Volume3
Issue number2
DOIs
Publication statusPublished - Mar 2014

Keywords

  • Clinically isolated syndrome
  • Disease-modifying drug
  • First clinical demyelinating event
  • Glatiramer acetate
  • Interferon beta
  • Multiple sclerosis

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

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