Abstract
Background: Axonal damage occurs early in the course of multiple sclerosis (MS). Among untreated patients, 85% to 94% with a first clinically isolated syndrome (CIS) suggestive of MS and positive findings on magnetic resonance imaging (MRI) are at risk for developing MS. Objectives: This article reviews the current literature concerning early diagnosis of MS, the rationale for early immunomodulatory treatment of patients with a CIS and MRI evidence of central nervous system lesions, and the efficacy of early treatment with interferon beta (IFN-β). Methods: MEDLINE was searched from 1990 through the end of 2008 for papers published in English concerning the treatment of MS. Search terms included IFN-β, early treatment, CIS, and multiple sclerosis, and limits were set to return results related to human clinical trials in adults. Results: Three pivotal randomized controlled trials were identified, 2 involving IFN-β-1a (30 μg IM once weekly and 22 μg SC once weekly) and 1 involving IFN-β-1b (250 μg SC qod). In these trials, treatment with IFN-β effectively reduced the risk of developing MS by up to 50% in patients with a CIS. Furthermore, compared with delayed treatment, early treatment was associated with a reduced risk of disease progression: a 40% reduction in risk for confirmed disability progression at 3 years and a 41% reduction in risk of MS at 3 years. Conclusions: The evidence that axonal damage begins in the early stages of MS, before symptoms are evident, provides a rationale for early intervention with immunomodulatory agents. In 3 pivotal clinical trials, IFN-β effectively reduced the risk of developing clinically definite MS in CIS patients with a first demyelinating event and positive brain MRI.
| Original language | English |
|---|---|
| Pages (from-to) | 1142-1157 |
| Number of pages | 16 |
| Journal | Clinical Therapeutics |
| Volume | 31 |
| Issue number | 6 |
| DOIs | |
| Publication status | Published - Jun 2009 |
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Keywords
- clinically isolated syndrome
- disability progression
- disease activity
- immunomodulatory treatment
- interferon beta
- multiple sclerosis
- relapsing-remitting
ASJC Scopus subject areas
- Pharmacology (medical)
- Pharmacology
Cite this
Shifting the paradigm toward earlier treatment of multiple sclerosis with interferon beta. / Comi, Giancarlo.
In: Clinical Therapeutics, Vol. 31, No. 6, 06.2009, p. 1142-1157.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Shifting the paradigm toward earlier treatment of multiple sclerosis with interferon beta
AU - Comi, Giancarlo
PY - 2009/6
Y1 - 2009/6
N2 - Background: Axonal damage occurs early in the course of multiple sclerosis (MS). Among untreated patients, 85% to 94% with a first clinically isolated syndrome (CIS) suggestive of MS and positive findings on magnetic resonance imaging (MRI) are at risk for developing MS. Objectives: This article reviews the current literature concerning early diagnosis of MS, the rationale for early immunomodulatory treatment of patients with a CIS and MRI evidence of central nervous system lesions, and the efficacy of early treatment with interferon beta (IFN-β). Methods: MEDLINE was searched from 1990 through the end of 2008 for papers published in English concerning the treatment of MS. Search terms included IFN-β, early treatment, CIS, and multiple sclerosis, and limits were set to return results related to human clinical trials in adults. Results: Three pivotal randomized controlled trials were identified, 2 involving IFN-β-1a (30 μg IM once weekly and 22 μg SC once weekly) and 1 involving IFN-β-1b (250 μg SC qod). In these trials, treatment with IFN-β effectively reduced the risk of developing MS by up to 50% in patients with a CIS. Furthermore, compared with delayed treatment, early treatment was associated with a reduced risk of disease progression: a 40% reduction in risk for confirmed disability progression at 3 years and a 41% reduction in risk of MS at 3 years. Conclusions: The evidence that axonal damage begins in the early stages of MS, before symptoms are evident, provides a rationale for early intervention with immunomodulatory agents. In 3 pivotal clinical trials, IFN-β effectively reduced the risk of developing clinically definite MS in CIS patients with a first demyelinating event and positive brain MRI.
AB - Background: Axonal damage occurs early in the course of multiple sclerosis (MS). Among untreated patients, 85% to 94% with a first clinically isolated syndrome (CIS) suggestive of MS and positive findings on magnetic resonance imaging (MRI) are at risk for developing MS. Objectives: This article reviews the current literature concerning early diagnosis of MS, the rationale for early immunomodulatory treatment of patients with a CIS and MRI evidence of central nervous system lesions, and the efficacy of early treatment with interferon beta (IFN-β). Methods: MEDLINE was searched from 1990 through the end of 2008 for papers published in English concerning the treatment of MS. Search terms included IFN-β, early treatment, CIS, and multiple sclerosis, and limits were set to return results related to human clinical trials in adults. Results: Three pivotal randomized controlled trials were identified, 2 involving IFN-β-1a (30 μg IM once weekly and 22 μg SC once weekly) and 1 involving IFN-β-1b (250 μg SC qod). In these trials, treatment with IFN-β effectively reduced the risk of developing MS by up to 50% in patients with a CIS. Furthermore, compared with delayed treatment, early treatment was associated with a reduced risk of disease progression: a 40% reduction in risk for confirmed disability progression at 3 years and a 41% reduction in risk of MS at 3 years. Conclusions: The evidence that axonal damage begins in the early stages of MS, before symptoms are evident, provides a rationale for early intervention with immunomodulatory agents. In 3 pivotal clinical trials, IFN-β effectively reduced the risk of developing clinically definite MS in CIS patients with a first demyelinating event and positive brain MRI.
KW - clinically isolated syndrome
KW - disability progression
KW - disease activity
KW - immunomodulatory treatment
KW - interferon beta
KW - multiple sclerosis
KW - relapsing-remitting
UR - http://www.scopus.com/inward/record.url?scp=68649128836&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=68649128836&partnerID=8YFLogxK
U2 - 10.1016/j.clinthera.2009.06.007
DO - 10.1016/j.clinthera.2009.06.007
M3 - Article
C2 - 19695384
AN - SCOPUS:68649128836
VL - 31
SP - 1142
EP - 1157
JO - Clinical Therapeutics
JF - Clinical Therapeutics
SN - 0149-2918
IS - 6
ER -