Shifting the paradigm toward earlier treatment of multiple sclerosis with interferon beta

Research output: Contribution to journalArticle

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 languageEnglish
Pages (from-to)1142-1157
Number of pages16
JournalClinical Therapeutics
Volume31
Issue number6
DOIs
Publication statusPublished - Jun 2009

Fingerprint

Interferon-beta
Multiple Sclerosis
Therapeutics
Magnetic Resonance Imaging
Risk Reduction Behavior
Clinical Trials
MEDLINE
Disease Progression
Early Diagnosis
Central Nervous System
Randomized Controlled Trials

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 journalArticle

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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.",
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