More MS news articles for July 2001

Delaying Interferon-ß-1a Treatment for MS Results in Worse Outcome

WESTPORT, CT (Reuters Health) Jul 02 - Delaying treatment of relapsing MS with interferon-ß-1a results in greater progression of disability compared with immediate, continued treatment, according to results of the Prevention of Relapses and Disability by Interferon-ß-1a Subcutaneously in Multiple Sclerosis (PRISMS-4) study.

Dr. Richard Hughes, of Guy's, King's and St. Thomas' School of Medicine in London, and associates extended the original PRISMS study into years 3 and 4. Interferon-ß-1a treatment was initiated in 172 patients who during the first 2 years had received placebo (designated the crossover group), while the other 334 patients continued treatment. As in the original study, patients were randomized to 22 mcg or 44 mcg three times weekly.

Those who received interferon-ß-1a for 4 years exhibited fewer relapses, less disability progression, and fewer MRI measures of MS pathology than patients in the crossover group, the authors report in the June 26th issue of Neurology.

The relapse rate over 4 years averaged 1.02 for those in the crossover group, significantly higher than the 0.80 for those who received the 22-mcg dose for the entire 4 years and the 0.72 for those who received the 44-mcg dose for 4 years.

Patients who received the high dose for 4 years had 29% fewer one-point Expanded Disability Status Scale changes over 4 years compared with what was observed in the crossover group. Median Integrated Disability Status Scores were significantly lower for the original 44-mcg group than for the original 22-mcg group or the crossover group.

According to an editorial by Dr. Steven R. Schwid, of the University of Rochester School of Medicine and Dentistry in New York, and Dr. Christopher T. Bever, Jr., of the University of Maryland School of Medicine in Baltimore, these findings reflect what many clinicians had suspected, but for which there had been no direct confirmation.

"We weren't sure if there was a problem with delaying treatment," Dr. Bever told Reuters Health. "For a patient who presented with optic neuritis and some MRI lesions but not much else, some physicians were taking a wait-and-see attitude. The question was, did you lose anything by waiting?"

"This trial suggests that you do lose something," he said. "These people in whom treatment is delayed fall behind those who start on the drug immediately, and don't catch up."

Neurology 2001;56:1620,1628-1636.

Copyright © 2001 Reuters Ltd.