Why treat early multiple sclerosis patients?

Class 1 clinical trials demonstrated that immunomodulatory treatments (interferonβ and glatiramer acetate) reduce the disease activity and the accumulation of disability in relapsing remitting multiple sclerosis. Moreover interferonβ-1b also had similar positive effects in secondary progressive multiple sclerosis. The magnitude of these clinical effects was modest, but the reduction of inflammatory activity, as revealed by magnetic resonance imaging, was marked. Converging evidence from new pathological studies and new magnetic resonance techniques, characterized by increased pathological specificity, has shown that already in the early phases of the disease inflammatory activity determines irreversible axonal damage. Moreover, the amount of inflammatory activity at the clinical presentation of the disease has some value in predicting long-term disability. Taken together, these data indicate that patients may benefit from early treatment; the positive results of the Controlled High Risk Subjects Avonex Multiple Sclerosis Prevention Study support this conclusion. (C) 2000 Lippincott Williams and Wilkins.