More MS news articles for Nov 2001

Treatment of Optic Neuritis With Interferon Beta-1a Seems to Reduce MS Odds

WESTPORT, CT (Reuters Health) Nov 05 - The use of interferon beta-1a in the treatment of a first episode of optic neuritis in patients at high risk for multiple sclerosis (MS) reduces the likelihood of developing clinically apparent MS, according to results of the Controlled High Risk Subjects Avonex Multiple Sclerosis Prevention Study (CHAMPS).

From 50 clinical centers in the US and Canada, Dr. Roy W. Beck, of the Jaeb Center for Health Research in Tampa, Florida, and associates enrolled 192 patients with acute unilateral optic neuritis characteristic of a demyelinating disorder. The subjects also had at least two clinically silent brain MRI lesions 3 mm in size or greater, "at least one of which was periventricular in location and/or ovoid in shape."

As reported in the American Journal of Ophthalmology for October, the patients were treated initially with corticosteroids. Ninety-five subjects were assigned to treatment with interferon beta-1a 30 µg/week IM beginning within 27 days of symptom onset, and 97 subjects were assigned to placebo. Subjects who did not develop clinically definite MS were followed for at least 22 months, and for a mean of about 30 months.

Clinically definite MS developed in 27 (28%) of patients in the treatment group and in 36 (37%) of those in the placebo group, a significant difference (p = 0.05). At 18 months' followup, the change in MRI T2 lesion volume was significantly less (p = 0.02) in the treatment group, as was the number of new or enlarging lesions (p < 0.001).

"Based on the results of this study, we would predict that the probability of long-term moderate or severe neurologic disability will be lower with than without treatment," the investigators write. They caution, however, that many treated patients will still manifest clinical evidence of MS over time.

Dr. Beck told Reuters Health that the decision to start treatment right away for optic neuritis patients remains "a tough call."

"The real issue that how important it is to start treatment right away versus waiting to see what happens with the disease itself," he said. "For example, a rational argument can be made for waiting 6 months and then making a treatment decision based on whether there is further disease activity."

The problem, he added, is that once treatment starts, assuming that the patient does well, there is no endpoint to treatment. He concluded, "the physician and the patient have in essence made the decision to continue treatment with interferon beta-1a indefinitely, or at least until something better comes out."

Am J Ophthalmol 2001;132:463-471.

Copyright © 2001 Reuters Ltd