PARIS (Reuters Health) Apr 25 - Calls for aggressive early treatment of multiple sclerosis are falling on deaf ears in some European countries, notably the UK, according to speakers at the Eleventh Meeting of the European Neurological Society, under way here.
Dr. Lance D. Blumhardt, of Queen's Medical Centre in Nottingham, UK, said that data from the PRISMS-4 study showed the clear benefit from high-dose, thrice-weekly interferon ß-1a. Findings from PRISMS-4 (Prevention of Relapses and Disability by Interferon ß-1a Subcutaneously in MS — Long-term efficacy) will be published in Neurology this summer.
"This is new data and it clearly shows that frequency and dose are very important issues for interferons," Dr. Blumhardt told Reuters Health. "In order to get long-term benefit, you have to use high doses, frequently given, from the beginning — in fact, as early as possible if you are to get a good effect at 4 years."
Based on these results, the European Commission recently recommended the highest dose of Rebif, 44 mcg subcutaneously three times a week, as first-line therapy for the treatment of relapsing-remitting MS.
Dr. Blumhardt now uses this strategy for almost every new patient. However, he says, his practice is the exception rather than the rule — most UK patients with MS would be fortunate to get any disease-modifying therapy such as interferons, according to international statistics.
Data show that while one in three US patients receives a disease-modifying drug (DMD), the figure for UK patients is less than one in twenty. Out of more than 20 countries, only Turkey and Poland prescribe disease-modifying drugs to fewer patients than in the UK. Portugal, Argentina, Brazil, Mexico and the Czech Republic are all ahead of the UK in aggressive management of MS.
"In some parts of the UK, one in ten patients receives a DMD, but in other regions, no patients receive such therapy. I have 100 patients on DMDs, but of these, only seven are funded by my health authority. The others receive treatment by being part of clinical trial extensions," said Dr. Blumhardt.
According to Dr. Blumhardt, part of the blame lies with the UK Government's National Institute for Clinical Excellence (NICE), which he accused of "procrastinating and delaying" in making its final report on the cost-effectiveness of interferons and their availability as refundable health service drugs.
"NICE seem to have their minds set on turning down interferons for British patients. However, I do not see how they can ignore the PRISMS data," he said. "At the end of the day, if we treat early, and treat hard, patients will receive more benefit, will be less likely to become disabled, be more likely to be employed, more likely to be able to get about, and to be involved with their family at the end of a 4-year period."
"As soon as I saw the PRISMS data, I started prescribing high-dose treatment as early as possible — I want to get all patients on high dose as early as possible. We need to treat hard to prevent secondary progression, we need to be much more aggressive in treating patients — even milder or so called 'benign' cases of MS," said Dr. Blumhardt.
Dr. Mark S. Freedman,
of the University of Ottawa, said during a separate presentation at the
meeting, "Dose matters, and the frequency with which you administer it
matters. Repeated administration of high dose yields the best response,
with improved clinical and MRI outcomes, and should be the preferred therapy
for longer-term benefit in MS patients."
2000 Reuters Ltd.